[Long-term outcome of keratoprosthesis with biological support]

In severe Sicca syndrome and limbal stem cell deficiency, vision can be restored by an artificial optical implant into the cornea (keratoprosthesis, KPro). After multiple efforts to achieve long-lasting corneal fixation of such an optical implant, two methods have become established: KPro with biological support, such as osteo-odonto-keratoprosthesis (OOKP) made from the root of patient's own tooth or osteo-keratoprosthesis (OKP), made from cortical bone of the patient's tibia; and the Boston KPro.

We examined the long-term outcome of a total of 93 patients with biological support, 59 with OOKP and 34 with OKP, and compared the results with the latest literature on Boston KPro.

Medium follow-up was 7.5 years (max. 20.6 years) in OOKP and 4.5 years (max. 13.2 years) in OKP. The percentage of anatomic survival in Kaplan-Meier analysis was 95 and 89% after 2 years, 92 and 81% after 5 years, and 89 and 81% after 10 years, for OOKP and OKP, respectively; and 84% after 15 years and 56% after 20 years for OOKP. In the case of an autoimmunologic process underlying the corneal disease, long-term results are slightly worse than for non-autoimmunologic cases, but a literature comparison revealed that they are still better than with the Boston KPro.

OOKP has a slightly better anatomic survival rate than OKP. Comparison with the literature reveals the medium anatomic survival rate to be better for KPro with biological support than for Boston KPro. The OOKP is still the gold standard in KPro.