Management of vitreoretinal complications in eyes with permanent keratoprosthesis.

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Abstract
ATTEMPTS TO rehabilitate clinically phthisical eyes and corneas that are refractory to standard keratoplasty have been challenging. Since the first description of an artificial prosthesis in 1789,1 numerous materials and methods have been used to functionally recreate the anatomy of the cornea. These efforts are summarized in previous publications.2,3 These devices suffered from early postoperative failure because of implant extrusion and uncontrollable inflammation. However, with advancements in material design, surgical techniques, and postoperative management, new models of keratoprostheses (KPros) can provide long-term solutions for both the phthisical eye and end-stage corneal disease.4-6 This progress has shifted the focus to late-developing sequelae involving the posterior segment. Posterior segment abnormalities in association with a KPro may be present prior to KPro placement (as a consequence of injury, previous ocular disease, or complication of prior surgical intervention), may develop intraoperatively during KPro placement, or may occur postoperatively. Management of such challenging vitreoretinal issues requires modified microsurgical techniques to preserve vision in these revitalized eyes. In this article we summarize our experience with patients who underwent KPro surgery and who have required surgical intervention for posterior segment complications.

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