Keyhole Anterior Lamellar Keratoplasty for Boston Keratoprosthesis Corneal Melt

Corneal melt remains a challenging complication of Boston keratoprosthesis (KPro) and may lead to disastrous consequences such as endophthalmitis, KPro extrusion, and permanent loss of vision. Several procedures have been suggested to repair established melts; however, KPro removal or exchange is often required due to high recurrence. We herein describe a novel surgical technique to repair corneal melt: a lamellar corneal graft is centrally trephined, and a radial cut is extended from the central opening to create a keyhole graft. The graft is draped around the KPro and tightly secured around the central stem. The radial cut is closed with sutures, and the graft is secured into the underlying tissue with fibrin glue and sutures. The graft remains stable with the KPro in place, while the patients maintain a 20/200 vision or better at two years. This technique is a useful alternative for securing KPro and preventing corneal melt recurrence.