Innovations in keratoprosthesis: proved and unproved.

Progress in the notoriously slow and difficult field of KPro has gained speed during the last decade, and interest among corneal surgeons has been increasing slowly. Recent advances aimed at preventing complications and treating early complications after KPro surgery have improved the prognosis. In retrospect, several factors have proved critical to this progress. Organic chemistry has given us PMMA--an invaluable material--watery clear and inert. This material may be surpassed in the future, but it has served us well during the last half-century. KPro designs are undoubtedly important, although their role probably has been overstated. Temporary postoperative tissue coverage has proved its value. Antiinflammatory substances are absolutely vital, and enzyme inhibitors show promise. Glaucoma shunts are definitely effective in preventing glaucoma in some (but not all) patients. Finally, frequent follow-ups--more than after most other ocular surgeries--and early repairs of complications are mandatory. With recent resurgence in interest and further developments, the future of KPro surgery should be bright.