[Results of 30 keratoprostheses with retrocorneal fixation]

Keratoprosthesis is the last solution for corneally blind patients who cannot benefit from corneal grafts. The indications are limited to blind patients with monophthalmia and bilateral problems that are otherwise untreatable. After implanting the Choyce and Strampelli's devices for more than 10 years, we abandoned these anterior fixation techniques and now use a keratoprosthesis in which the sole mechanical fixation consists of a posterior support which is subsequently sealed by the fibrosis produced by the endothelial-Descement tissues. This new prosthesis is made of two pieces, an optic and an haptic fashioned out of CQ-PMMA. To minimize expulsion, the haptic outer diameter is greater than the central corneal orifice through which the optic is inserted and screwed into the haptic. The keratoprosthesis refractive power can be easily adjusted after lensectomy by changing the 40 D for a 63 D optic. The prosthesis is implanted in a single step surgical procedure, and can be implanted in phakic eyes while respecting the physiology and anatomy of these fragile eyes. This single step procedure reduces the usual repeated operations required when using, other techniques. We operated 12 cases of pseudopemphigus, 9 cases of burns, 7 cases of trachoma, and 2 cases of pseudophakic oedema with good cosmetic and visual results with a follow-up ranging from several months to more than 3 years. The results obtained with this new keratoprosthesis are encouraging. The results have been analysed and classified into: anatomic and functional success 20 cases, anatomic success and functional failures 4 cases, anatomic failures 6 cases.