In severe corneal disease, a corneal allograft has been the mainstay of therapy for the last century. However, when a standard penetrating keratoplasty has failed or is unlikely to succeed, an artificial cornea is an alternative given that it is not susceptible to an immune rejection. Currently, the Boston Keratoprosthesis (B-KPro) is the most frequently used such device, often resulting in substantial visual restoration.
1–8 However, long-term safety has been an issue. Both tissue melt around the device, resulting in leak or extrusion, or devastating endophthalmitis, were common problems in the past but their incidence has decreased substantially in more recent years.
9–11 The development of retroprosthetic membranes, a more benign complication, has also been reduced to approximately 20% through some recent design modifications such as the titanium back plate.
12 Today, postoperative glaucoma has emerged as the greatest threat to good long-term visual acuity outcomes,
12–15 particularly after chemical burns, but also in most other patient categories. In addition, other optic neuropathies without glaucomatous cupping can occur. The mechanisms remain obscure, but may be related to chronic postoperative inflammation, difficult to detect clinically in these often very diseased eyes. Postoperative complications, such as epiretinal membrane, macular edema, and retinal detachment,
16–18 may likewise be caused by chronic inflammation. However, systematic studies of the pathophysiologic mechanisms that lead to these complications have been hampered owing to the difficulties encountered in clinical studies, where numerous confounding factors and comorbidities make it difficult to study mechanisms. The development of a standard and validated animal model would address these shortcomings.
To date, most animal B-KPro research regarding design and retention has for convenience been performed on eyes of rabbits
19–21 because of similar size and dimensions compared to human eyes. However, the modern study of immunoinflammatory responses is best done in the mouse where access to inbred mice with well-defined immune and genetic variability, as well as extensive access to immunologic reagents, makes it an optimal species for immunologic research. The purpose of the present study was to develop a novel murine model of the B-KPro.