The implantation of a keratoprosthesis (KPro) is performed as a lastclinical attempt to restore vision in patients not amenable to conventionalcorneal transplantation or ocular surface reconstruction procedures. Varioustypes and materials of KPro’s with different methods of insertion havebeen tested and implanted in patients during the last decades, with varyingbut growing success.1- 11 Despiteimproved retention rates, postoperative complications, such as glaucoma, endophthalmitis,retroprosthetic membranes, expulsion of the implant, or sometimes total visionloss, remain problems with those penetrating devices.12 Recently,new soft and flexible materials for an artificial cornea were evaluated, tested,and further developed to avoid stress at the points of attachment that couldlead to stromal melting.13- 18 However,a certain risk for complications still persists because of the penetratingnature of these devices. A lamellar supraDescemetic synthetic cornea (sDSC)implant would theoretically minimize such risks because there is no need toenter the anterior chamber, leaving the Descemet membrane (DM) and the endotheliumintact.19 Thus, potentially disastrous complications,such as epithelial downgrowth leading to aqueous humor leaks and intraocularinfection, could be prevented. The results of a pilot animal study with anintrastromal, pre-Descemetic implant developed by our institute were encouraging.20,21 However, opacification of the remainingstroma underneath the synthetic cornea developed with time, compromising apotentially good visual outcome. Consequently, the implantation techniquewas changed, inserting the sDSC at maximal depth on a completely exposed DM.To our knowledge, the reaction of the DM to the direct contact of the polymerhas not been evaluated. Bioincompatibility of the KPro material leading toexcessive scarring and opacification in the DM-polymer interface would reducethe potential visual benefit, especially with this type of KPro. In this midtermstudy, we tested the response of rabbit corneal tissue to implantation ofsuch a synthetic cornea.