Osteo-odonto-keratoprosthesis. A summary of 6 years surgical experience

Abstract

In patients with severe corneal scarring and vascularisation, corneal grafts have a high risk of failure. In those patients an osteo-odonto-keratoprosthesis (OOKP) can be performed. We performed OOKP in eight patients in all with ocular pemphigoid, severe alkali burns, or repulsion of a corneal graft. Each of the patients had finger-counting visual acuity or less. The OOKP consisted of a PMMA cylinder 8 mm long, with a diameter of 3-4 mm, and from a root of the patient's tooth. This was implanted in the cornea and covered with buccal mucosa. The medium follow-up was 3 years. The implants are now well incorporated. The best visual acuity was between 0.6 and 0.9 in four patients with intact retinas. In the remaining patients, visual acuity was dependent on the posterior segment findings. The visual field was centred. Five of the eight patients had vitreous bleeding after the operation that was spontaneously absorbed. Revision of the mucous coverage was necessary in four patients, and one of them had a severe inflammation with partial absorption of the bone and tooth implant. One patient developed a secondary angle-closure glaucoma and was treated successfully by implantation of an Ahmed valve. Two patients developed membranes behind the cylinder that were successfully removed. There was no loss of any prosthesis during follow-up. In impasse in severe corneal scars, the osteo-odonto-keratoprosthesis is still indicated and shows good results in visual rehabilitation of patients.