Keratoprosthesis Indications, Outcomes, and Future Directions

Purpose: To provide a comprehensive review of keratoprosthesis (KPro), emphasizing the Boston KPro's development, design, surgical techniques, complications, and outcomes, while highlighting unresolved challenges and future research directions. Methods: A narrative literature review was conducted to examine the evolution of KPro, assess commonly used artificial corneas, and analyze current technologies. Specific emphasis was placed on the Boston Keratoprosthesis. Results: The review identified key areas for improvement in Boston KPro, including enhancement of titanium backplates to reduce retroprosthetic membrane formation, better adhesion between the corneal graft and backplate, and refinement of donor graft preparation to prevent corneal melting. Challenges in glaucoma monitoring because of unreliable intraocular pressure measurements were noted. Adjunctive strategies such as optimized vancomycin use, antifungal prophylaxis, drug-releasing contact lenses, and biologic therapies were explored. Cost-containment and accessibility issues were also addressed, along with emerging innovations in KPro design. Conclusions: Keratoprosthesis represents a viable alternative for patients unsuitable for traditional corneal transplantation. Ongoing research into surgical techniques, material science, prophylaxis, and design improvements will be critical to enhancing patient outcomes, minimizing complications, and expanding global access to KPro.