Boston Keratoprosthesis Type I: Surgical Techniques

Abstract

The treatment of corneal blindness in the setting of high-risk graft failure poses a prominent clinical challenge. The Boston type I keratoprosthesis has revolutionized the approach to treating such conditions. The most common indication for a keratoprosthesis is repeated graft failure. The perpetual evolution of the design of the device, coupled with the overall improvements in patient management, has continued to expand the application of the keratoprosthesis. The Boston type I keratoprosthesis is now a primary surgical option for certain patients. The keratoprosthesis has a front plate, which provides a clear optical zone for long-term visual rehabilitation and preservation. The assembly of the keratoprosthesis couples the synthetic components of the device with corneal donor tissue. The surgical implantation of the final composition is not unlike a standard penetrating keratoplasty. Careful patient selection and pre-, peri-, and postoperative care are essential to lasting stability of an eye after keratoprosthesis surgery. Diligent patient compliance and indefinite postoperative care is an absolute requirement. Intimate knowledge of prominent risk factors prior to and following surgery is crucial to providing appropriate patient care. In the proper patient, the keratoprosthesis is a safe long-term treatment of corneal blindness.