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Boston keratoprosthesis
Boston keratoprosthesis (Boston KPro) is a collar button design keratoprosthesis or artificial cornea.〔Klufas MA , Starr CE. The Boston Keratoprosthesis: An update on recent advances. Cataract and Refractive Surgery Today. September 2009: 9(9).〕 It is composed of a front plate with a stem, which houses the optical portion of the device, a back plate and a titanium locking c-ring.〔Dohlman C, Harissi-Dagher M. The Boston Keratoprosthesis: A New Threadless Design. Digital Journal of Ophthalmology. 2007;13(3)〕 It is available in type I and type II formats. The type I design is used much more frequently than the type II which is reserved for severe end stage dry eye conditions and is similar to the type I except it has a 2 mm anterior nub designed to penetrate through a tarsorrhaphy. The type I format will be discussed here as it is more commonly used.
The type I Kpro is available in single standard pseudophakic power or customized aphakic optic with an 8.5 mm diameter adult size or 7.0 mm diameter pediatric size back plate. The device is currently machined from medical grade polymethylmethacrylate (PMMA) in Woburn, Massachusetts in the United States.〔Khan B, Dudenhoefer EJ, Dohlman CH. Keratoprosthesis: an update. Curr Opin Ophthalmol. Aug 2001;12(4):282-287〕 During implantation of the device, the device is assembled with a donor corneal graft positioned between the front and back plate which is then sutured into place in a similar fashion to penetrating keratoplasty (corneal transplantation).〔Todani A, Gupta P, Colby K. Type I Boston keratoprosthesis with cataract extraction and intraocular lens placement for visual rehabilitation of herpes zoster ophthalmicus: the "KPro Triple". Br J Ophthalmol. Jan 2009;93(1):119 - http://bjo.bmj.com/cgi/content/full/93/1/119/DC1〕
==Indications==
The Boston KPro is a treatment option for corneal disorders not amenable to standard penetrating keratoplasty (corneal transplantation) or corneal transplant. The Boston KPro is a proven primary treatment option for repeat graft failure,〔Ma JJ, Graney JM, Dohlman CH. Repeat penetrating keratoplasty versus the Boston keratoprosthesis in graft failure. Int Ophthalmol Clin. Fall 2005;45(4):49-59〕 herpetic keratitis,〔Khan BF, Harissi-Dagher M, Pavan-Langston D, Aquavella JV, Dohlman CH. The Boston keratoprosthesis in herpetic keratitis. Arch Ophthalmol. Jun 2007;125(6):745-749〕 aniridia 〔Akpek EK, Harissi-Dagher M, Petrarca R, et al. Outcomes of Boston keratoprosthesis in aniridia: a retrospective multicenter study. Am J Ophthalmol. Aug 2007;144(2):227-231〕 and many pediatric congenital corneal opacities including Peter's anomaly.〔Aquavella JV, Gearinger MD, Akpek EK, McCormick GJ. Pediatric keratoprosthesis. Ophthalmology. May 2007;114(5):989-994〕 The device is also used to treat cicatrizing conditions including Stevens–Johnson syndrome 〔Sayegh RR, Ang LP, Foster CS, Dohlman CH. The Boston keratoprosthesis in Stevens–Johnson syndrome. Am J Ophthalmol. Mar 2008;145(3):438-444〕 and ocular cicatricial pemphigoid, and also ocular burns.〔Tuft SJ, Shortt AJ. Surgical rehabilitation following severe ocular burns. Eye. Jan 23 2009〕〔Harissi-Dagher M, Dohlman CH. The Boston Keratoprosthesis in severe ocular trauma. Can J Ophthalmol. Apr 2008;43(2):165-169〕
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