Keratoprosthesis surgery is carried out in very few centers. Elaborate
surgical techniques and high complication rates limit the application
of currently available keratoprostheses (KPros). However, the clinica
l need for an alternative to donor tissue has sparked considerable res
earch interest in the development of new KPros. This paper charts the
evolution of KPros from the earliest devices to those currently used,
describes their drawbacks and discusses the specifications of an ideal
device. Recent research focuses upon the use of porous polymers as th
e skirt component of core-and-skirt KPros in order to obtain improved
biological integration of the prosthetic material. Developments in bio
material als technology make a KPro analogous to a donor corneal butto
n an increasingly realistic goal. However, two particular problems sti
ll need to be addressed. First, it must be demonstrated that secure lo
ngterm fixation that is able to withstand trauma is achievable in a fu
ll-thickness artificial cornea. Second, an ideal artificial cornea for
a wet eye requires an epithelialized surface, and this has yet to be
achieved. (C) 1997 by Elsevier Science Inc. All rights reserved.