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

To describe the use of oral mucosa overlay in Boston Keratoprosthesis surgery as an adjunct in complex cases. Retrospective case series on eyes that underwent Type I Boston keratoprosthesis where oral mucosa was used as an adjunct procedure. 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. 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.