1.1 Current evidence on the efficacy of implantation of a corneal graft–keratoprosthesis for severe corneal opacity in wet blinking eyes is adequate in the short to medium term. Although the evidence on safety shows a high incidence of significant adverse effects, there are few options for patients with severe corneal opacity if standard corneal grafts have failed or are not appropriate. Therefore this procedure may be used with normal arrangements for clinical governance, consent and audit.
1.2 During the consent process, clinicians should ensure that patients clearly understand the balance of risks and benefits of this procedure, including: the need for long‑term follow‑up, which some patients find burdensome; the possibility that sight may not improve and may deteriorate; and the risk of serious complications. Patients should be provided with clear information in an appropriate format. In addition, the use of NICE's information for the public is recommended.
1.3 Implantation of a corneal graft–keratoprosthesis for severe corneal opacity in wet blinking eyes should only be done on carefully selected patients with corneal blindness, when standard treatments such as keratoplasty have failed or are not appropriate.
1.4 Implantation of a corneal graft–keratoprosthesis for severe corneal opacity in wet blinking eyes should only be done in specialist centres by surgeons experienced in the technique; long‑term follow‑up should be carried out by an experienced multidisciplinary team.