1. Keratoprosthesis – A Long term
review
Br J Ophthalmol, 1983 July ; 67 (7) 468 -474
JJ Barnham and MJ Roper Hall

2. AIM of the study

The aim of this study was to review the 35
patients with 55 KP insertions with regard to
visual outcome, length of time vision
maintained,retention time and complications

3. Patients and methods



Thirty five patients were reviewed with a total of
55 KP insertions of which 39 were 1 st timers, 8
were 2 nd, 4 were 3 rd, 3 were 4 th 1 was 5 th in a
single eye.
Follow up time ranged from 1 month to 15 yrs with
only 4 patients been followed up for less than 6
months.
A preoperative diagnosis of Bullous keratopathy
was made in 20 patients of which 16 followed
cataract extraction, 1 followed lens dislocation,3
had fuch’s dystrophy - surgery unrelated.

4. 

Of remaining 15 pts ,3 had corneal damage
following perforating injury , 2 followed
explosion, 1 followed lime burn, 1 had thermal
burn sustained in road accident . 4 had
herpetic keratitis , 1 interstitial keratitis, 2 had
band keratopathy following iridocyclitis , 1 had
SJ syndrome.
49 underwent penetrating KP and 6 underwent
Intralamellar KP.

10. References
1.DeVoe AG . A current evaluation of Corneal
prosthetic devices. Arch Ophthalmol
1967;78:269-71
2. Giles CL. Henderson JW . Keratoprosthesis :
current status.Am J Med Sci 1967 ; 253:239-42
3.Girard IJ . Hawkin RS. Nieves R, et al.
Keratoprosthesis : a 12 – year follow up.Trans
Am Acad Ophthalmol Otolaryngol 1977;83:25267

11. 
Keratoprosthesis is a surgical procedure
where a severely damaged or diseased
cornea is replaced with an artificial cornea to
restore useful vision or to make the eye
comfortable in painful keratopathy

12. 


It is a double plated PMMA device with a
central rigid optic that perforates Cornea .
Type 1 is a collar button shaped device with
front plate ,central optic stem, back plate .
Type 2 is a through – the – lid design with a 2
mm anterior nub designed to penetrate
through a tarsorrhaphy

13. When use a Boston type 1
Keratoprosthesis ?

When corneal transplant carries a particular
poor prognosis
1. Multiple corneal transplant rejection & failures
2. Tear deficiency syndromes
3.Eyelid contour irregularities
4.Aniridia
5.Chemical /thermal injury

14. When use a Boston type 2
Keratoprosthesis ?

Severe Cicatrical ocular surface diseases
1.Steven Johnson syndrome/ Toxic epidermal
necrolysis
2.Severe Alkali burn
3. Mucous membrane pemphigoid
4. Severe Aqueous tear deficiency

15. 
Indications of Type 2 Boston Keratoprothesis:
When not likely to successful type 1
keratoprosthesis
- Symblepharon and loss of conjunctival fornices
- Severe keratinizing dry eye

18. Threaded design
Snap in design

19. MOOKP – Eye tooth


Originally described by Strampelli later it was
Giancario Falcinelli who modified the
technique.
This technique uses a composite bone-tooth
lamina to help anchor a polymethyl
methacrylate cylinder to the cornea.

20. Proble
ms



Need for atleast two lengthy surgeries
Need for oral surgery
[minimum tooth size & good dental health]
Cosmetic result unacceptable
[tooth loss, protuding eye, prosthetic shell help]