Low-Cost and Readily Available Tissue Carriers for the Boston Keratoprosthesis: A Review of Possibilities

Table 1

Possible tissue carriers for the Boston keratoprosthesis and predicted qualities.

Donor tissue	Potential availability	Potential cost	Preparation of tissue	Ease of shipment, storage	Complexity of surgery	Risk of infection	Expected antigenicity	Likelihood of necrosis
Autograft	Uneven	None	No issue	No issue	Standard	Low	None	Low
Autograft plus conjunctival flap	Better	None	No issue	No issue	Complex	Very low	None	Very low
Skin autograft	Good	None	Skin excision	No issue	Complex	Low	None	?
Allograft, fresh	Uneven	High	Standard	Complex	Standard	Low	Low	Low
Allograft, frozen	Uneven	High	Deep-freeze	Complex	Standard	Low	Very low	Low
Allograft, dehydrated	Good	High	Dehydration (in glycerol or freeze-dried)	Good	Time to rehydrate	Low	Very low	Low
Allograft,; X-linked	Good	High	X-linking	Complex	Standard	Low	Low	Low
Allograft,; γ-radiated	Good	High?	𝛾-radiation	Good	Standard	Low	Very low	Low
Xenograft,; γ-radiated; (tested for viruses)	Good	High	𝛾-radiation	Good	Standard	Low	?	?
Xenograft,; γ-radiated; (untested for viruses)	Good	Low	𝛾-radiation	Good	standard	?	?	?
Xenograft; γ-radiated; (untested); (plus conjunctival flap)	Good	Low	𝛾-radiation	Good	Complex	?	?	Low
Collagen constructs	Good	Low	Manufacturing	Good	Complex?	Low	Very low	?