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83 EW CORNEA August 2017 "That is a very interesting ap- proach and a vibrant technology," Dr. Aquavella said. "It's working in simple keratoprosthesis they are seeing well the next day. Keratopros- thesis is the mainstay in helping people who are otherwise blind or debilitated because of corneal disease unsuitable for traditional transplantation." Keratoprostheses are improving, "but we still have a long way to go, and [we need to] get to where they are better fused and take care of the causes of secondary infection and inflammation that require long-term steroids and antibiotics to prevent the infections," Dr. Aquavella said. "That's a big drawback to the kerato- prostheses." One advancement that may help corneal patients in developing countries is an effort to manufacture an alternative to the Boston KPro, which costs about $5,000. "It's obviously not as good, but they are getting closer," Dr. Aquavella said. "That's where the need is in places like India and Africa, countries where they don't have access to corneal medications or standard keratoprostheses." International options Other keratoprosthesis approaches used internationally include os- teo-odonto-keratoprosthesis (OOKP), which is also known as "tooth in eye" surgery. The procedure includes removal of a tooth from the patient or a donor, a lamina of tissue is removed from the tooth, fitted with optics, implanted under the skin to reestablish blood flow, and implant- ed in the eye. "It's a two-stage surgery, and it is cumbersome," Dr. Akpek said. "Because of reimbursement issues as well as a high incidence of glaucoma and permanent vision damage it's not very popular in the U.S., but in Asia many surgeons do it." Other less-popular options have included two devices made out of polytetrafluoroethylene (PTFE), which is a synthetic fluoropolymer. Published research on that technol- ogy has reported that extrusion and corneal melting are common, Dr. Akpek said. Research continues Dr. Akpek is developing a corneal device composed of extended PTFE material. "I don't have that much data yet. I have the design patented, but we're working on rabbits right now and haven't done human studies," Dr. Akpek said. Another approach under devel- opment uses silk material to create a prototype, although no human studies have been conducted. continued on page 84