A Revolutionary Technology
Dr. Claes H. Dohlman’s most notable achievement is the Boston Keratoprosthesis (KPro), a collar button design keratoprosthesis composed of a front plate with a stem, which houses the optical portion of the device, and a back plate with a slit. Available in Type I and Type II designs, the KPro Type II model 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.
A Promising Option for Many
The Boston KPro is now the treatment of choice for a growing list of corneal conditions, and the procedure of choice where corneal transplantation is expected to fail. When managed in experienced KPro centers, the prosthesis also can be a life-changing intervention in patients who have suffered severe chemical injuries and blinding autoimmune disorders.
KPro Around the Globe
Despite millions of people requiring corneal transplants, there is a widespread lack of eyebanks and suitable donor tissues, especially in developing countries. KPro team members, James Chodosh, MD, MPH and Roberto Pineda II, MD are working to make the KPro available to some of the world’s poorest areas and have taught surgical implantation techniques and follow-up care to ophthalmologists and medical staff around the globe. Dr. Pineda has helped to establish self-sustaining KPro clinics in developing countries, including India, Thailand, Sudan and Ethiopia, while Dr. Chodosh is working on developing a low-cost KPro to help bring its sight-saving benefits to these populations.
Current research efforts led by Eleftherios Paschalis, PhD, focus on improving KPro’s aesthetics by coloring the titanium back plate blue or brown. Collagen crosslinking, provided as part of a clinical trial at Mass. Eye and Ear led by Joseph Ciolino, MD, is also helping to strengthen the ocular tissue around the KPro and help maintain the prosthesis better. Furthermore, Dr. Ciolino and colleagues from Boston Children’s Hospital and Massachusetts Institute of Technology have developed a drug-eluting contact lens, which could improve surgical outcomes for patients with KPro by both protecting the ocular surface of the eye and by preventing postoperative infections. One day, these lenses may replace eye drops.
- Aldave AJ, et al. International results with the Boston Type I Keratoprosthesis. Ophthalmology. 2012 Aug;119(8):1530-8.
- Ciolino JB, et al. Retention or the Boston Keratoprosthesis Type 1. multicenter study results. Boston Keratoprosthesis Type I Study Group. Ophthalmology 2013; 120:1195-2000.
- Srikumaran D, et al. Long-term outcomes of Boston Type I Keratoprosthesis implantation: a retrospective multicenter cohort. Ophthalmology 2014;121(11):2159-64.
- Crnej A, et al. Glaucoma progression and role of glaucoma in patients with Boston keratoprosthesis. Cornea 2014;33(4):349-54.