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Corneal blindness is a major cause of blindness in the world, second only to cataract. For many patients, a corneal graft could offer a second chance of sight. However, in some cases (eg, in patients with multiple graft failures, limbal stem cell failure, severe chemical burns and autoimmune diseases such as Stevens–Johnson syndrome) the ocular environment is too hostile for a corneal graft. Keratoprostheses offer these patients the hope and prospect of visual rehabilitation. With modern advancements, many exciting developments are in store for the future of the keratoprosthesis (KPro).
The idea of an artificial cornea or a KPro was first introduced by the French ophthalmologist, Guillaume Pellier de Quengsy, in 1789. The first published surgical case was in 1853 by Nussbaum who implanted a quartz crystal into the cornea.1 The prosthesis was retained for 6 months. Further attempts at refining keratoprostheses were associated with a high rate of failure with tissue necrosis, leakage, infection and extrusion of the device.2
Interest in keratoprostheses waned when Zirm performed the first successful human-to-human corneal graft in 1906. However, there was renewed interest when it was found during World War II that polymethylmethacrylate (PMMA) splinters embedded in the corneae of pilots were well tolerated.
Many KPros …