Keratoprosthesis: technique and instrumentation

New instruments are described for use in handling keratoprostheses. They aid manipulation of a keratoprosthesis, stabilization of the lid, and corneal trephination. The procedure should be utilized only when vision is poor in both eyes and there is little or no chance of success with keratoplasty. Preoperative workup to evaluate retinal function and intraocular pressure should be done routinely. Newer surgical techniques have decreased the extrusion rate, but other serious complications occur and include, in part, retroprosthetic membrane, endophthalmitis, retinal detachment, and glaucoma. Keratoprosthesis surgery remains a last resort in our surgical armamentarium.