Keratoprostheses in End-Stage Ocular Surface Diseases: Comparative Review of Current Concepts and Clinical Outcomes

Abstract

Introduction and Purpose

Keratoprostheses remain a treatment of last resort for patients with severe corneal blindness and end-stage ocular surface disease when conventional therapeutic options, including corneal transplantation and limbal epithelial stem cell transplantation are ineffective or contraindicated. This review summarizes currently available keratoprostheses models according to the tear status of the ocular surface and compares their clinical outcomes, retention rates, complications, and surgical technique.

The State of Knowledge

Boston keratoprosthesis type I remains the most commonly used device for eyes with a wet-ocular surface, demonstrating favorable retention rate and visual rehabilitation. In contrast, Boston keratoprosthesis type II and modified osteo-odonto keratoprosthesis are primarily indicated in severe dry eye disease and cicatrizing ocular surface disorders. Novel devices, including Lucia keratoprosthesis, CorNeat keratoprosthesis, Moscow eye microsurgery complex in Russia, Lux keratoprosthesis and Pintucci keratoprosthesis aim to improve affordability, biointegration, and long-term retention.

Conclusions

Despite ongoing advances in device design and surgical techniques, complications such as glaucoma, retroprosthetic membrane formation and extrusion remain significant challenges. Further long-term studies using standardized outcome measures are required to determine the optimal keratoprosthesis for specific clinical indications.