AIM: To investigate whether hydroxyapatite (HAp) coating can improve keratoprosthesis (KPro) implant biointegration, ultimately to decrease the risk of implant-associated complications. METHODS: The modified titanium implant was designed and prepared for artificial cornea. The titanium implant was treated with sandblasting and hydroxyapatite coating by acid-base two-step method. Surface was analyzed by scanning electron microscopy (SEM), KPro implants coated with HAp and KPro implant sandblasted were implanted in rabbits. Tissue adhesion to the implant was assessed and compared to an unmodified implant by histopathology (HE), transmission electron microscopy (TEM) and SEM. RESULTS: SEM demonstrated successful deposition of HAp on titanium implant sandblasted (HA/SB-Ti). The hydroxyapatite coatings caused enhancement of keratocyte proliferation compared with unmodified implant surfaces. HAp coating significantly increased adhesion forces. HAp coating of implants reduced the inflammatory response around the KPro implants in vivo. CONCLUSION: HAp-coated surfaces for use in titanium KPro implant greatly enhanced adherence of the titanium KPro implant in the rabbit cornea.