Update on tibial bone keratoprosthesis

Abstract

AbstractOsteo‐odontokeratoprosthesis (OOKP) is the gold standard for end stage cicatricial disease of the ocular surface to restore sight in patients with corneal blindness. The use of tibial bone is an option in cases of edentulia or when patient refuses to sacrifice a tooth. The surgery consists in retrieving a disc of the tibial bone and inserting an optical cylinder in the center, much like in OOKP surgery using a canine tooth.A review of 113 patients who underwent tibial bone keratoprosthesis (Tibia KPro) at a single center performed by a single surgeon showed prosthesis retention rate of 69% at 5 years and 54% at 10 years. BCVA better than or equal to decimal 0.05 at 5 years was 33% and 19% at 10 years. Patients with chemical burn had better prosthesis retention as well as visual acuity results compared to autoimmune cases. Complications found postoperatively were keratoprosthesis extrusion, glaucoma, retinal detachment, buccal mucosa necrosis, retroprosthetic membrane, etc.The anatomical results in the long‐term are comparable to OOKP (67% prosthesis retention at 10 years). However, the visual acuity results with OOKP at 10 years was better at 49% (for BCVA better than or equal to decimal 0.05) than patients with Tibia KPro. Moreover, there were more complications in Tibia KPro than in OOKP such as mucous membrane necrosis and retroprosthetic membrane formation.At present, in vitro studies are being undertaken to produce substitutes for OOKP skirts using biomimetic bone‐like composites.