The Role of Keratoprosthesis in the Treatment of Corneal Blindness

  • Mona Harissi-Dagher


The Boston Keratoprosthesis is the most widely used artificial cornea or keratoprosthesis. It is a treatment option for corneal disease not amenable to standard penetrating keratoplasty. Continued advances in design and superior postoperative care have resulted in improved outcomes and an exponential increase in the use of the device in the last decade.


Keratoprosthesis Penetrating keratoplasty Artificial cornea Corneal blindness Glaucoma 


  1. 1.
    Ing JJ, Ing HH, Nelson LR, et al. Ten-year postoperative results of penetrating keratoplasty. Ophthalmology. 1998;105:1855–65.CrossRefPubMedGoogle Scholar
  2. 2.
    Williams KA, Ash JK, Pararajasegaram P, et al. Long-term outcome after corneal transplantation. Visual result and patient perception of success. Ophthalmology. 1991;98:651–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Williams KA, Muehlberg SM, Lewis RF, et al. How successful is corneal transplantation? A report from the Australian corneal graft register. Eye. 1995;9:219–27.CrossRefPubMedGoogle Scholar
  4. 4.
    Price FW Jr, Whitson WE, Collins KS, et al. Five-year corneal graft survival. A large, single-center patient cohort. Arch Ophthalmol. 1993;111:799–805.CrossRefPubMedGoogle Scholar
  5. 5.
    Bersudsky V, Blum-Hareuveni T, Rehany U, et al. The profile of repeated corneal transplantation. Ophthalmology. 2001;108:461–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Patel NP, Kim T, Rapuano CJ, et al. Indications for and outcomes of repeat penetrating keratoplasty, 1989–1995. Ophthalmology. 2000;107:719–24.CrossRefPubMedGoogle Scholar
  7. 7.
    Dandona L, Naduvilath TJ, Janarthanan M, et al. Survival analysis and visual outcome in a large series of corneal transplants in India. Br J Ophthalmol. 1997;81:726–31.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Pellier de Quengsy G. Precis ou cours d’operation sur la chirurgie des yeux. Paris: Didot; 1789.Google Scholar
  9. 9.
    Nussbaum N. Cornea Artificialis, ein Substitut fur die Transplantatio Cornea. Deutsche Klinik. 1853;34:367.Google Scholar
  10. 10.
    Heusser J. Die Einheilung einer Cornea artificialis. Oesterr Ztschr Pract Med. 1860;26:424.Google Scholar
  11. 11.
    Dimmer F. Zwei Falle von Celluoidplattern der Hornhaut. Klin Monatsbl Augenheilkd. 1891;29:104.Google Scholar
  12. 12.
    Salzer F. Uber den kunstlichen Hornhautersatz. Wiesbaden; 1898.Google Scholar
  13. 13.
    von Hippel A. Uber die operative Behandlung totaler stationarer Hornhaut-Trubungen. Albrecht v Graefes Arch Clin Ophthal. 1887;23:79.CrossRefGoogle Scholar
  14. 14.
    Verhoeff FH. Cited in Cardona H: keratoprosthesis. Am J Ophthalmol. 1962;54:284.Google Scholar
  15. 15.
    Filatov VP. Alloplastik bei vollstandig “hoffnungslosem” Leukomen. Soiv Viest Opht. 1936;9:400.Google Scholar
  16. 16.
    Wunsche G. Versuche zur totalen Keratoplastie und zur Cornea Artificialis. Arztliche Forschung. 1947;1:345.Google Scholar
  17. 17.
    Stone W Jr, Hebert E. Experimental study of plastic material and replacement of the cornea. Preliminary report. Am J Ophthalmol. 1953;36:168.CrossRefPubMedGoogle Scholar
  18. 18.
    Castroviejo R, Cardona H, AG DV. The present status of prosthokeratoplasty. Trans Am Ophthalmol Soc. 1969;67:207–34.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Strampelli B. Osteo-Odontokeratoprosthesis. Ann Ottalmol Clin Ocul. 1963;89:1039–44.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Falcinelli G, Missiroli A, Pettiti V, et al. Osteo-Odontokeratoprosthesis up to date. In: Acta XXV Concilium Ophthalmologicum. Milano: Kugler & Ghedini; 1987.Google Scholar
  21. 21.
    Marchi V, Ricci R, Pecorella I, et al. Osteo-odonto-keratoprosthesis. Description of surgical technique with results in 85 patients. Cornea. 1994;13(2):125–30.CrossRefPubMedGoogle Scholar
  22. 22.
    Temprano J. Resultados a largo plazo de Osteo-odonto-queratoprotesis y queratoprotesis tibial. An Inst Barraquer. 1998;27(Suppl):53–65.Google Scholar
  23. 23.
    Stoiber J, Csaky D, Schedle A, et al. Histopathologic findings in explanted osteo-odontokeratoprosthesis. Cornea. 2002;21(4):400–4.CrossRefPubMedGoogle Scholar
  24. 24.
    Liu C, Herold J, Sciscio A, et al. Osteo-odonto-keratoprosthesis surgery. Br J Ophthalmol. 1999;83(1):127.CrossRefPubMedGoogle Scholar
  25. 25.
    Hille K. Keratoprothesen. Klin Aspekt Ophthalmologe. 2002;99(7):523–31.CrossRefGoogle Scholar
  26. 26.
    Pintucci S, Pintucci F, Cecconi M, et al. The Dacron felt colonizable keratoprosthesis: after 15 years. Eur J Ophthalmol. 1996;6(2):125–30.CrossRefPubMedGoogle Scholar
  27. 27.
    Girard LJ, Hawkins RS, Nieves R, et al. Keratoprosthesis: a 12-year follow-up. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. 1977;83(2):252–67.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Legeais JM, Renard G, Parel JM, et al. Keratoprosthesis with biocolonizable microporous fluorocarbon haptic. Preliminary results in a 24-patient study. Arch Ophthalmol. 1995;113(6):757–63.CrossRefPubMedGoogle Scholar
  29. 29.
    Yakimenko S. Results of a PMMA/titanium keratoprosthesis in 502 eyes. Refract Corneal Surg. 1993;9:197–8.Google Scholar
  30. 30.
    Moroz ZI. Artificial cornea. In: Fyodorov SN, editor. Microsurgery of the eye: main aspects. Moscow: Mir; 1987.Google Scholar
  31. 31.
    Crawford GJ, Hicks CR, Lou X, et al. The Chirila keratoprosthesis: phase I human clinical trial. Ophthalmology. 2002;109(5):883–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Kim MK, Lee JL, Wee WR, et al. Seoul-type keratoprosthesis: preliminary results of the first 7 human cases. Arch Ophthalmol. 2002;120(6):761–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Dohlman CH, Schneider HA, Doane MG. Prosthokeratoplasty. Am J Ophthalmol. 1974;77(5):694–70.CrossRefGoogle Scholar
  34. 34.
    Dorzee MJ. Kratoprothèse en acrylique. Bull Soc Belge Ophtalmol. 1955;108:582–93.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Barraquer J. Keratoplasty and keratoprosthesis. Pocklington memorial lecture (delivered at the Royal College of Surgeons of England on 5th May, 1966). Ann R Coll Surg Engl. 1967;40(2):71–81.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Doane MG, Dohlman CH, Bearse G. Fabrication of a keratoprosthesis. Cornea. 1996;15(2):179–84.CrossRefGoogle Scholar
  37. 37.
    Harissi-Dagher M, Khan BF, Schaumberg DA, Dohlman CH. Importance of nutrition to corneal grafts when used as a carrier of the Boston keratoprosthesis. Cornea. 2007;26(5):564–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Kammerdiener LL, Speiser JL, Aquavella JV, Harissi-Dagher M, Dohlman CH, Chodosh J, Ciolino JB. Protective effect of soft contact lenses after Boston keratoprosthesis. Br J Ophthalmol. 2016;100(4):549–52.CrossRefPubMedGoogle Scholar
  39. 39.
    Yaghouti F, Nouri M, Abad JC, et al. Keratoprosthesis: preoperative prognostic categories. Cornea. 2001;20:19–23.CrossRefGoogle Scholar
  40. 40.
    Dohlman CH, Terada H. Keratoprosthesis in pemphigoid and Stevens – Johnson syndrome. In: Sullivan D, editor. Lacrimal gland, tear film and dry eye syndromes II. Basic science and clinical relevance. Adv Exp Med Biol. Vol. 438. New York: Plenium Publishing; 1998. p. 1021–5.Google Scholar
  41. 41.
    Nouri M, Terada H, Alfonso EC, et al. Endophthalmitis after keratoprosthesis: incidence, bacterial causes, and risk factors. Arch Ophthalmol. 2001;119(4):484–9.CrossRefGoogle Scholar
  42. 42.
    Talajic JC, Agoumi Y, Gagné S, Moussally K, Harissi-Dagher M. Prevalence, progression, and impact of glaucoma on vision after Boston type 1 keratoprosthesis surgery. Am J Ophthalmol. 2012;153(2):267–74.CrossRefPubMedGoogle Scholar
  43. 43.
    Behlau I1, Martin KV, Martin JN et al. Infectious endophthalmitis in Boston keratoprosthesis: incidence and prevention. Acta Ophthalmol. 2014;92(7).CrossRefPubMedGoogle Scholar
  44. 44.
    Dohlman CH, Doane MG. Some factors influencing outcome after keratoprosthesis surgery. Cornea. 1994;13(3):214–8.CrossRefPubMedGoogle Scholar
  45. 45.
    Dohlman CH. Postoperative regimen and repair of complications after keratoprosthesis surgery. Refract Corneal Surg. 1993;9:198.Google Scholar
  46. 46.
    Dohlman CH, Dudenhoefer EJ, Khan BF, et al. Protection of the ocular surface after keratoprosthesis surgery: the role of soft contact lenses. CLAO J. 2002;28(2):72–4.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Bath PE, McCord RC, Cox KC. Nd:YAG laser discission of retroprosthetic membrane: a preliminary report. Cornea. 1983;2:225–8.Google Scholar
  48. 48.
    Ray S, Khan BF, Dohlman CH, et al. Management of vitreoretinal complications in eyes with permanent keratoprosthesis. Arch Ophthalmol. 2002;120(5):559–66.CrossRefPubMedGoogle Scholar
  49. 49.
    Nouri M, Durand ML, Dohlman CH. Sudden reversible vitritis after keratoprosthesis: an immune phenomenon? Cornea. 2005;24(8):915–9.CrossRefPubMedGoogle Scholar
  50. 50.
    Ma JJ, Graney JM, Dohlman CH. Repeat penetrating keratoplasty versus the Boston keratoprosthesis in graft failure. Int Ophthalmol Clin. 2005;45(4):49–59.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Mona Harissi-Dagher
    • 1
  1. 1.Centre Hospitalier de l’université de Montréal, Department of OphthalmologyMontrealCanada

Personalised recommendations