Keratoprosthesis

Abstract

The concept of a clear device imbedded in the cornea to restore vision was first expressed in the eighteenth century. The modern era began in the 1950s with the work of WM Stone conducted in Boston’s Howe Laboratory. The team of Devoe, Castroviejo, and Cardona labored in the mid-twentieth century demonstrating the potential utility of the technique in severely damaged eyes. The current success is attributed to the design changes instituted by Claes Dohlman working at Harvard. The concepts of a fenestrated back plate, the protection of the surface with a bandage contact lens and the use of prophylactic antibiotics, were instrumental. Others contributed multiple changes in operative technique.

For a half-century, keratoprosthesis was perceived by cornea surgeons as an infrequently performed procedure associated with high rate of complication and only indicated in bilateral cases of irreversible cornea blindness. Success was considered as the ability to provide sufficient vision to enable self-care for a year or two. Developments were slow to come by in view of the small number of cases perceived to be candidates for the procedure. The close relationship between a biocompatible material, the specific design of the device, and the surgical technique necessary for successful implantation continues to this day. In the early days of the twenty-first century, the developments in device design, surgical technique, and postoperative management combined to transform the procedure in a very significant positive manner. While the acceptance of the technique has been slow, over the past decade, thousands of procedures utilizing the Boston type 1 device have been performed worldwide.