Clinical results with a ceramic keratoprosthesis placed through the eyelid

The authors placed a ceramic keratoprosthesis through the eyelids of 11 consecutive patients: six with alkali injury, four with cicatricial pemphigoid, and one with Stevens-Johnson syndrome. The surgery was technically successful in ten patients. One patient experienced an intraoperative, expulsive choroidal hemorrhage, and the keratoprosthesis was not implanted. Six patients were followed for 21 to 56 months; three, who had no postoperative potential for visual improvement were followed for 2 to 6 months; and one patient died 14 months after surgery. Six patients achieved 20/20 to 20/100 corrected visual acuity at some point after surgery. At last examination, only three eyes (27%) saw 20/200 or better. Complications included eyelid cellulitis, extrusions, aqueous leaks, retroprosthetic membranes, endophthalmitis, and progressive glaucoma. The authors think mechanical torque by movement of eyelid and globe destabilizes the keratoprosthesis, producing many of the complications.