Dermal Fat Graft for Preventing Extrusion in Tibial Bone Osteo-Keratoprosthesis Exposure

Tibial bone keratoprostheses are used in situations where conventional corneal transplantation is not viable. However, the prognosis is often guarded in cases of ocular surface diseases, such as autoimmune conditions or chemical burns, because of the risk of tissue necrosis and subsequent prosthesis extrusion. In this study, we describe an innovative approach using a dermal fat graft to manage keratoprosthesis (KPro) exposure and avoid extrusion.

We report the case of a man with a history of bilateral chemical burns caused by caustic soda, who underwent tibial bone keratoprosthesis implantation in the left eye. The procedure was later complicated by buccal mucosa necrosis, leading to prosthesis exposure. This was successfully managed with a dermal fat graft. Clinical history, examination findings, imaging, and a literature review are presented.

At 5 years of follow-up, the KPro remained well positioned, with the dermal fat graft fully epithelialized and no evidence of extrusion or other complications. The patient maintained a stable uncorrected visual acuity of 0.3.

This case provides the first evidence of a favorable outcome following dermal fat graft implantation as a treatment for KPro exposure to prevent extrusion. Since KPro extrusion is one of the most frequent postoperative complications, its prevention is of utmost importance. The use of a dermal fat graft in such high-risk cases may offer a more stable and biocompatible solution for long-term prosthesis retention.