Keratoprosthesis in dry eye disease

Area of Science:

• Ophthalmology
• Corneal Surgery
• Biomaterials Science

Background:

• Severe bilateral corneal blindness presents complex challenges, often rendering conventional treatments like penetrating keratoplasty ineffective.
• Conditions include dry eye disease (DED), limbal stem cell deficiency, scarring, vascularization, and cicatrizing conjunctivitis.
• Autoimmune disorders (e.g., Stevens-Johnson syndrome) and non-autoimmune pathologies (e.g., chemical burns) contribute to treatment resistance.

Purpose of the Study:

• To review keratoprosthesis (Kpro) designs specifically developed for eyes with severe dry eye disease (DED).
• To discuss the outcomes of Kpro implantation in patients with complex ocular surface disease.
• To highlight Kpro as a treatment option for corneal blindness unresponsive to other interventions.

Main Methods:

• Review of existing literature on keratoprosthesis (Kpro) designs and their application in severe DED.
• Analysis of outcomes data for Kpro implantation in eyes with complex pathologies.
• Focus on Kpro designs engineered to withstand hostile ocular surface environments.

Main Results:

• Keratoprosthesis (Kpro) is identified as the most viable option for corneal blindness in eyes with severe DED and other complex conditions.
• Kpro can restore vision and potentially avoid systemic immunosuppression, offering early visual recovery.
• A critical challenge is protecting the donor cornea surrounding the Kpro from desiccation and stromal melt in severe DED.

Conclusions:

• Keratoprosthesis (Kpro) provides a crucial treatment avenue for patients with severe corneal blindness and dry eye disease (DED).
• Specific Kpro designs are necessary to ensure survival and success in the challenging ocular environment of severe DED.
• Further research into Kpro modifications for hostile ocular surfaces is warranted to improve long-term outcomes.