Low-Cost and Readily Available Tissue Carriers for the Boston Keratoprosthesis: A Review of Possibilities

Abstract

The Boston keratoprosthesis (B-KPro), currently the most commonly used artificial cornea worldwide, can provide rapid visual rehabilitation for eyes with severe corneal opacities not suitable for standard corneal transplantation. However, the B-KPro presently needs a corneal graft as a tissue carrier. Although corneal allograft tissue is readily available in the United States and other developed countries with established eye banks, the worldwide need vastly exceeds supply. Therefore, a simple, safe, and inexpensive alternative to corneal allografts is desirable for the developing world. We are currently exploring reasonable alternative options such as corneal autografts, xenografts, noncorneal autologous tissues, and laboratory-made tissue constructs, as well as modifications to corneal allografts, such as deep-freezing, glycerol-dehydration, gamma irradiation, and cross-linking. These alternative tissue carriers for the B-KPro are discussed with special regard to safety, practicality, and cost for the developing world.

The Boston keratoprosthesis 2014: a step in the evolution of artificial corneas

“…Clinically such corneas have been employed as carriers with success [47,69]. For the developing world, however, less expensive alternatives must be sought when autografts are not possible; experiments with γ-radiated porcine xenografts, supplemented with a total conjunctival flap, and other possibilities are presently ongoing [26]. predominant, fungal keratitis is common.…”

UV Cross-linking of Donor Corneas Confers Resistance to Keratolysis

“…It is composed of synthetic materials ([PMMA] and titanium) and requires a donor cornea to function as a carrier for the device. 10 Modifications to the B-KPro design and postoperative management have improved the retention rate, but keratolysis remains the most common cause of B-KPro failure. In the most recent report from the Boston Keratoprosthesis Type 1 Study Group, 43% of the B-KPro loss could be attributed to sterile keratolysis.…”

Evaluation of a low-cost design keratoprosthesis in end-stage corneal disease: a preliminary study

“…However, corneal blindness is seen more often in Africa, Indian subcontinent and China, where the number of keratoprostheses implanted are still low 5 10. The predominant cause for this is lack of patient’s access to surgery and postoperative care, the prohibitive cost of the implant, limited technical expertise as well as difficulty and time lag in overseas procurement of customised Boston Kpro 11. These reasons have prevented its widespread usage in the low-income/middle-income parts of the world, and in areas where the insurance coverage is poor 12 13.…”