Cornea · Penetrating keratoplasty (PK)

Clinical photograph showing Boston Keratoprosthesis

A keratoprosthesis (KPro) is an artificial cornea implanted in patients with severe corneal blindness when a standard penetrating keratoplasty (PK) is unlikely to succeed. Indications Multiple failed corneal grafts (most common) Severe chemical or thermal burns Stevens-Johnson syndrome (SJS) Ocular cicatricial pemphigoid (OCP) (selected cases) Limbal stem cell deficiency Severe corneal vascularization or scarring with poor prognosis for PK Types Boston Keratoprosthesis (Boston KPro) – Most commonly used Type I: For eyes with adequate tear film and blinking. Type II: For severe dry eye and cicatrizing ocular surface disease (device protrudes through a surgically closed eyelid). Osteo-odonto-keratoprosthesis (OOKP) Uses the patient's own tooth and alveolar bone to support the optical cylinder. Used in end-stage dry ocular surface disease (e.g., severe SJS, chemical burns). Components of Boston Type I KPro Front plate with optical stem Donor corneal graft (carrier) Back plate (PMMA or titanium) Locking ring (older designs) Postoperative Care Lifelong topical antibiotics Bandage contact lens worn long-term Frequent follow-up Glaucoma surveillance (IOP measurement is difficult) Complications Glaucoma (most common cause of long-term visual loss) Retroprosthetic membrane (most common postoperative complication) Endophthalmitis Corneal melt Sterile vitritis Retinal detachment Prosthesis extrusion Viva Pearls

Contributed byDr. Chitransha GaurResident, Sankara Eye Hospital Kanpur

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