Decision-Making in Keratoprosthesis: Navigating Device Selection in Complex Ocular Scenarios.

Area of Science:

• Ophthalmology
• Biomaterials Science
• Surgical Innovation

Background:

• End-stage bilateral corneal blindness necessitates advanced visual rehabilitation strategies.
• Conventional corneal transplantation is often not viable for these patients.
• Keratoprosthesis (KPro) implantation is a critical last resort for restoring vision.

Purpose of the Study:

• To provide a comprehensive overview of widely used KPro devices.
• To detail design characteristics, surgical considerations, and postoperative care.
• To support clinical decision-making in KPro selection for individual patient profiles.

Main Methods:

• Review of current literature and clinical experience with KPro devices.
• Analysis of design features of Boston type 1 and 2, and osteo-odonto-KPro.
• Discussion of influencing factors for KPro success.

Main Results:

• Advances in biomaterials and prosthetic design improve anatomical retention and visual outcomes.
• Boston type 1 and 2, and modified osteo-odonto-KPro are globally prevalent.
• Patient-specific factors (ocular surface, eyelid anatomy, systemic health) significantly impact outcomes.

Conclusions:

• Preoperative evaluation, patient counselling, and a multidisciplinary approach are crucial for successful KPro outcomes.
• A practical decision-making algorithm is proposed to aid ophthalmologists in selecting the optimal KPro.
• Tailoring KPro selection to individual patient profiles maximizes the potential for long-term visual rehabilitation.