Keratoprosthesis in dry eye disease

Abstract

Bilateral corneal blindness with severe dry eye disease (DED), total limbal stem cell deficiency with underlying corneal stromal scarring and vascularization, combined with adnexal complications secondary to chronic cicatrizing conjunctivitis is a highly complex situation to treat. In such eyes, procedures such as penetrating keratoplasty alone or combined with limbal stem cell transplantation are doomed to fail. In these eyes, keratoprosthesis (Kpro) or an artificial cornea is the most viable option, eliminating corneal blindness even in eyes with autoimmune disorders such as Stevens–Johnson syndrome, ocular mucous membrane pemphigoid, Sjogren’s syndrome, and nonautoimmune disorders such as chemical/thermal ocular burns, all of which are complex pathologies. Performing a Kpro in these eyes also eliminates the need for systemic immunosuppression and may provide relatively early visual recovery. In such eyes, the donor cornea around the central cylinder of the Kpro needs to be covered with a second layer of protection to avoid desiccation and progressive stromal melt of the underlying cornea, which is a common complication in eyes with severe DED. In this review, we will focus on Kpro designs that have been developed to survive in eyes with the hostile environment of severe DED. Their outcomes in such eyes will be discussed.

Comment on “Keratoprosthesis in dry eye disease”

“…[ 3 ]) in the outcomes section (page 1161) of their article. [ 1 ] Of note, our retrospective study, which included 82 eyes with up to 30 years of follow-up, demonstrated that the original OOKP technique by Strampelli resulted in better anatomical and functional outcomes when compared to other types of prostheses, including the MOOKP.…”

“…With reference to the recent article “Keratoprosthesis in Dry Eye Disease” by Sharma et al ,[ 1 ] published in your journal, we wish to extend our congratulations to the authors for their comprehensive review article and thank them for the inclusion of our publication, “Osteo-odonto-keratoprosthesis According to Strampelli Original Technique: A Retrospective Study With Up to 30 Years of Follow-up” in the American Journal of Ophthalmology in May 2022. [ 2 ] However, we have identified a few inaccuracies that we would like to clarify to enhance the quality of the work.…”

“…In contrast, Sharma et al . [ 1 ] erroneously referred to the MOOKP (OOKP modified by Falcinelli et al . [ 3 ]) in the outcomes section (page 1161) of their article.…”

“…Additionally, we would like to point out that in Table 9, Sharma et al . [ 1 ] reported that the most common etiology we identified in eyes undergoing OOKP surgery was Stevens–Johnson syndrome (SJS, 58 eyes, 70.7%). However, our study reported that the most frequent etiology was chemical injuries (58 eyes, 70.7%), with SJS identified as the cause in only seven eyes (8.5%).…”

Response to the comments on: Keratoprosthesis in dry eye disease

“…We thank the authors of the letter to the editor for their interest and comments regarding our review article titled ‘Keratoprosthesis in Dry eye disease’. [ 1 2 ] Thank you for the clarifications. In our manuscript, in Table 3, we have mentioned the most common etiology for Osteo-Odonto-Keratoprosthesis (OOKP) in the paper by Iannetti et al .…”