Chondro‐keratoprosthesis: an alternative to OOKP?

Purpose To evaluate the use of cartilage as a potential graft material in order to explore a new approach toward osteo‐odontal tissue replacement in keratoprosthesis surgery Methods We describe a modification of the osteo‐odonto‐keratoprosthesis that involves the use of autogenous auricular conchal cartilage graft (ACCG) in 2 patients. In stage 1, ACCG was harvested via a posterior approach. Then, an optical polymethyl‐methacrylate cylinder was embedded into a double‐layered fragment of the conchal cartilage and secured by cyanoacrylate glue. The optical cylinder and cartilage complex were then implanted into the cheek. The stage 2, performed 2–4 months later, involved retrieval of the complex and implantation into the cornea, after reflection of the buccal mucosal flap, corneal trephination, iris and lens removal, and anterior vitrectomy. Cartilage specimens were then processed for histological evaluation after retrieval. Results We report 2 cases of chondro‐keratoprosthesis (CKPRO) who underwent surgery with a 9 months follow‐up following a bilateral limbal stem cell deficiency associated with severe corneal changes. On patient 1, vision was improved to 20/100 J6 during the follow‐up. On patient 2, postoperative visual acuity stay limited to LP related to preoperative retinal lesions. During the follow‐up, any postoperative complication as extrusion, epithelial downgrowth, retrocorneal membrane or endophtalmia was observed. Conclusions ACCG could be a good alternative to replace osteo‐odontal graft in keratoprosthesis surgery especially in young patients with healthy teeth. ACCG has already been widely used for reconstructive surgery and provides safe and stable support to the optical cylinder. However, further comprehensive studies with larger sample size and longer follow‐up are required.