Oral Mucosa in Boston Keratoprosthesis Surgery: Innovative Approaches for Complex Cases

Abstract

Objectives: To describe the use of oral mucosa overlay in Boston Keratoprosthesis surgery as an adjunct in complex cases.

Methodology: Retrospective case series on eyes that underwent Type I Boston keratoprosthesis where oral mucosa was used as an adjunct procedure.

Results: 30 eyes were identified. The oral mucosa may be used as a salvaging technique for an extruded Type I Boston Keratoprosthesis. In cases of severe dry eye where osteo-odontokeratoprosthesis cannot be performed for reasons like edentulia, or patient refusal due to cosmetic reasons, the Boston Keratoprosthesis with mucosa overlay may be performed as a simpler technique. It may also be used as a primary procedure in cases where there is high risk of melt or extrusion for a Type I Boston Keratoprosthesis such as autoimmune corneal opacity, severe chemical burn, congenital aniridia. Surgery can be performed either as a single stage or in two stages, three months apart, to ensure the development of a well-vascularized pedicle flap. Lastly, the mucosa may be used as an alternative covering to a Type II Boston Keratoprosthesis allowing for better cosmesis and easier access for possible future retina or glaucoma surgery.

Conclusion: The use of oral mucosa is widely accessible to corneal surgeons due to the ease of harvesting oral mucosa, and the availability of the Type I Boston KPro. The learning curve is less steeper than the modified osteo-odontokeratoprosthesis and the cosmesis is more acceptable.

Keywords: Autoimmune disease; Boston keratoprosthesis; chemical burn; oral mucosa; oral mucosa overlay.