Prosthokeratoplasty in Ocular Surface Disease

The artificial cornea, or keratoprosthesis, is an idea that has fired the imagination and ingenuity of bioengineering ophthalmologists for over two centuries.1 Over this period of time, investigators have attempted, with varying degrees of success, to produce a truly biocompatible and functional artificial cornea. Several reviews of the history of keratoprosthesis have been published in the ophthalmic literature.2–8 Keratoprosthesis development cannot be discussed comprehensively in a text of this scope. We will provide only a brief overview of the subject in the specific context of the management of ocular surface disease. Despite the enthusiasm for the concept of the artificial cornea, most of the clinical attempts at prosthokeratoplasty in both animals and humans have enjoyed only limited success, due to complex issues of materials biocompatibility as well as technical difficulty. Indeed, in the context of severe ocular surface disease, a keratoprosthesis is reserved for the patients in whom surface therapies, reconstructive surgery, and organic transplant are not feasible. It is, in a sense, the last resort.