Modified Osteo-odonto Keratoprosthesis Research Articles

Dentist ‘An Arsenal’ in the Journey of ‘Tooth in the Eye’-the Osteo-Odonto-Kerato-Prosthesis [OOKP

Background: Global blindness is mainly due to Cataract, after this Corneal disease is the major cause. For end stage corneal disease, the only successful treatment is by providing Osteo-Odonto-Kerato-Prosthesis (OOKP). The dental surgeon will play a vital role in this surgeon. After extracting a canine tooth from the patient, the dental surgeon places the acrylic lamina in the centre of the dentine (Dental Lamina) which acts like an ocular lens, later the Ophthalmic surgeon will place the same in the patient’s blind eye to get vision.
 Review Results: After electronic search was done on the role of dental surgeon and OOKP , through PubMed, Scopus, Web of Science, Wiley Online, Science Direct Ebscohost and Google Scholar for articles published from 1960 to July 2022, using the Key words, Osteo-Odonto-Kerato Prosthesis (OOKP), Modified Osteo-Odonto-Kerato Prosthesis (MOOKP), Osteo-Odonto-Alveolar Lamina, Corneal Disease Tooth-in-Eye, and Poly Methyl Meth Acrylate (PMMA) Cylinder, finally 14 articles were found to be relevant for the present research topic.
 Conclusion: Studies shows OOKP is providing vision and the success rate more than 85%. Not a single study mentioned the importance of a dental surgeon in OOKP surgery.
 Clinical Significance: Though the dental curriculum not mentioned directly about the role of a dentist in the OOKP surgery, but all the dental surgeons should have knowledge on OOOKP Surgery.

Temporo-Parietal Flap Incorporated Into a Modified Osteo-Odonto Keratoprostheses Protocol for Longevity of the Dental Lamina.

To describe a novel pedicled temporo-parietal flap to delay laminar resorption in a modified osteo-odonto keratoprosthesis (MOOKP) and measure resorption of the dental lamina by an objective method. A retrospective case series was performed on patients who received an osteo-odontokeratoprosthesis for Steven-Johnson-Syndrome. Surgeries were performed between October 2016 and November 2017 by the same surgical team (G.M. and S.W.). A modified temporo-parietal flap was incorporated into stage 1 of the MOOKP procedure. CT Scans were performed post op and on follow up. Volumetric evaluation was achieved by automated software analysis of 3D reconstructed CT images (Vitrea, Software Version 6.7.6, Cannon Medical Systems ANZ Pty Ltd). The procedure was performed in 3 eyes from 3 patients. Patients were followed up for stage 2 review at 9.6 months on average (22-55 weeks). One case was complicated by early postoperative hematoma of the buccal graft; however, this was managed conservatively. Another case required relaxing incisions at the time of flap creation due to increased vascularized collagenous tissue. On follow up, volume changes in the dental lamina were minimal. Loss of laminar volume can potentially jeopardize the success of the MOOKP, and consequently cause significant visual, graft or globe complications. The long-term success of this method needs further evaluation; however, initial results suggest a possible role for pedicle grafts in maintenance of the dental lamina. Furthermore, objective CT-based calculation of laminar volume may reduce inter-study variability and standardize comparison of techniques.

Anesthesia Considerations in Modified Osteo-odonto-keratoprosthesis.

To elucidate anesthesia-related challenges in patients who underwent modified osteo-odonto-keratoprosthesis (MOOKP). Retrospective cohort study. Medical records of consecutive patients who underwent MOOKP surgery between January 2007 and January 2015 were reviewed. Data including demographic details, systemic comorbidities, indications for MOOKP, and anesthesia techniques at various stages of MOOKP were collected and analyzed. A total of 74 patients (47 men, 27 women) were included in this study. The mean age of the patients was 29.7 ± 9.1 years. The most common indication for MOOKP was Stevens-Johnson syndrome (53%), followed by chemical burn (38%). In all stages of the MOOKP procedure, 94.6% of patients were American Society of Anesthesiologists (ASA) grade II, whereas 5.4% were ASA grade III. Mallampati score 1 was found in 79.7% of patients in stage 1A, 82.4% of patients in stage 1B + 1C, and 81.1% of patients in stage 2. Recovery grade of 10 was noted in all patients at all stages of the MOOKP procedure. Intubation in the second attempt was carried out in 8 patients and oral intubation in stage 1B + 1C was performed in 4 patients. Difficulty in intubation was noted in 3 patients in stage 1A, 4 patients in stage 1B + 1C, and 1 patient in stage 2. In patients undergoing MOOKP, a good preoperative anesthetic evaluation and intraoperative anesthesia plan before each stage could help in successful administration of anesthesia in these patients.

Keratoprostheses in silicone oil-filled eyes: long-term outcomes.

To analyse the functional and anatomical outcomes of different types of keratoprostheses ineyes with retained silicone oil following vitreoretinal surgery. Retrospective chart review of patients operated with any type of permanent keratoprosthesis (Kpro) in silicone oil-filled eyes between March 2003 and June 2017 were analysed. 40 silicone oil-filled eyes underwent keratoprostheses, of which 22 were type 1 and 18 were type 2 Kpros (Lucia variant-nine, modified osteo odonto kerato prosthesis (MOOKP)-four, Boston type 2-three and osteoKpro-two) with a mean follow-up of 61.54 , 42.77, 45.25 , 25 and 37 months, respectively. Anatomic retention of the primary Kpro was noted in 33 eyes (82.5%). A best-corrected visual acuity of better than 20/200 and 20/400 was achieved in 26 (65%)+32 (80%) eyes. Retroprosthetic membrane (RPM) was the most common complication noted in 17 eyes (42.5%). Perioptic graft melt was noted in 4 of 22 eyes of the type 1 Kpro (2 (10.5%) without associated ocular surface disorder (OSD)) and in 1 eye each of Boston and Lucia type 2 Kpro. Laminar resorption occurred in one eye each of the MOOKP and OKP groups. Endophthalmitis and glaucoma did not occur in any eye. Appropriately chosen keratoprosthesis is a viable option for visual rehabilitation in eyes post vitreoretinal surgery with retained silicone oil-induced keratopathy not amenable to conventional penetrating keratoplasty. Kpro melt among type 1 Kpro did not occur in 89.5% eyes without associated OSD (19 of 22 eyes), despite the lack of aqueous humour and presence of RPM (4 eyes), two factors considered to play a significant role in the causation of sterile melts. Of interest to note was the absence of infection in any of these eyes. The possible protective role of oil from endophthalmitis is interesting, though yet to be ascertained.

LVP keratoprosthesis: anatomical and functional outcomes in bilateral end-stage corneal blindness

PurposeTo describe the anatomical and functional outcomes of the novel LVP keratoprosthesis (Kpro), developed as an alternative to the modified osteo-odonto keratoprosthesis (MOOKP), in eyes with end-stage corneal blindness where...

Piezoelectric harvest of osteo-odonto-lamina in modified osteo-odonto keratoprosthesis: A maxillofacial perspective.

Purpose:We describe the piezo-osteotomy feasibility in rehabilitation and harvesting of osteo-odonto lamina in modified osteo-odonto keratoprosthesis (MOOKP) surgery. Surgery was evaluated regarding operative technique and success of the keratoprosthesis (KPros) in terms of perception to light (+ve) to finger counting (+ve).Materials and Methods:This retrospective cohort study included 12 patients undergone MOOKP surgery procedures. Harvesting of osteo-odonto-lamina was performed using piezosurgical osteotomy during 2007–2012.Results:The mean follow up was 34 months (range 24–48 months). Of the 12 patients six patients had vision ≥6/12, four patients had vision <6/12, but >6/60 and one patients had vision ≤6/60. KPros was retained and functional in all the eyes after a minimum follow up of 24 months. There was mucosal overgrowth over the optical cylinder occurred in two cases over 4 years follow up which was corrected with trimming. Postoperative complication at donor site was seen in three cases, two cases with exposure of root of adjacent teeth and oro antral fistula in one.Conclusions:This study suggests that piezoelectric harvest of osteo-odonto-lamina is a valuable surgical option in patients undergoing MOOKP surgery, resulting in high success rate with less complication.

Bone augmentation of the osteo-odonto alveolar lamina in MOOKP--will it delay laminar resorption?

We aimed to describe a new technique and analyse the early outcomes of augmenting the canine tooth using a mandibular bone graft in an attempt to delay or retard the process of laminar resorption following the modified osteo odonto keratoprosthesis (MOOKP) procedure. This was a retrospective case series. Eyes that underwent the bone augmentation procedure between December 2012 and February 2014 were retrospectively analysed. The procedure, performed by the oromaxillofacial surgeon, involved securing a mandibular bone graft beneath the periosteum on the labial aspect of the canine tooth chosen to be harvested for the MOOKP procedure. This procedure was performed simultaneously with the Stage 1 A of the MOOKP. Three months later, the tooth was harvested and fashioned into the osteo-odonto alveolar lamina similar to the method described in the Rome-Vienna Protocol. The bone augmentation procedure was performed in 11 eyes (five SJS/ six chemical injuries). The mean follow-up after Stage 2 of MOOKP procedure in these eyes was 7.45 months (2 to 20 months). Complications noted were peripheral laminar exposure (three eyes-SJS) and bone graft exposure and necrosis in the mouth (nine-SJS). No evidence of clinical laminar resorption was noted in any of the eyes. Laminar resorption in MOOKP can lead to vision and globe threatening complications due to the consequent cylinder instability and chances of extrusion. Augmenting the bone on the labial aspect of the canine tooth might have a role to play in delaying or preventing laminar resorption.

Glaucoma in Modified Osteo-odonto-keratoprosthesis Eyes: Role of Additional Stage 1A and Ahmed Glaucoma Drainage Device–Technique and Timing

To report the technique, timing, and outcomes of the Ahmed glaucoma drainage device in eyes with the modified osteo-odonto-keratoprosthesis (MOOKP) and the role of an additional stage 1A to the Rome-Vienna protocol. Retrospective interventional case series. Case records of 22 eyes of 20 patients with high intraocular pressure at various stages of the MOOKP procedure performed in 85 eyes of 82 patients were studied. Stage 1A, which includes total iridodialysis, intracapsular cataract extraction, and anterior vitrectomy, was done in all eyes as the primary stage. Seventeen Ahmed glaucoma drainage devices were implanted in 15 eyes of 14 patients (chemical injury in 9 [10 eyes] and Stevens-Johnson syndrome in 5 patients). Implantation was performed during and after stage 1A in 2 and 7 eyes, respectively, after stage 1B+1C in 1 eye, and after stage 2 in 6 eyes. Eleven of 15 eyes (73.3%) remained stable with adequate control of intraocular pressure over a mean follow-up period of 33.68 months (1-90 months). Complications related to the drainage device were hypotony in 1 eye and vitreous block of the tube in 1 eye. It is ideal to place the Ahmed glaucoma drainage device prior to the mucosal graft when the anatomy of the ocular surface is least altered with best outcomes. The technique of placement of the drainage device during the various stages of the MOOKP procedure has been described. The intraocular pressure stabilized in three quarters of the eyes with pre-existing glaucoma.

Laminar Resorption in Modified Osteo-odonto-keratoprosthesis Procedure: A Cause for Concern

To analyze the cases of lamina resorption following the modified osteo-odonto-keratoprosthesis (MOOKP) procedure. Retrospective case series. Case records of 18 eyes (20 laminae) of 17 patients who showed evidence of lamina resorption out of the 85 eyes (87 laminae) of 82 patients that underwent MOOKP procedure between March 2003 and March 2013 were analyzed. Of the 17 patients (20 laminae), 1 underwent MOOKP procedure following multiple graft failures, 6 (7 laminae) belonged to the chemical injury group, and 10 (12 laminae) to the Stevens-Johnson syndrome (SJS) group. Resorption was noted in 20 out of 87 laminae (22.98%). The need for removal of lamina/extrusion was noted in 3 out of the 7 laminae in the chemical injury group and 8 out of the 12 laminae in the SJS group. The mean duration to the first sign suggestive of resorption among patients of SJS was 36.7 months and among patients of chemical injury was 43 months. Vitritis was the presenting feature (7 of 20 laminae, 35%) indicative of early resorption, and the occurrence of the same in eyes with lamina resorption was noted to be statistically significant in comparison to controls (P<.001). Sixteen out of 20 laminae showed evidence of resorption superiorly. Vitritis was the most common presenting feature of lamina resorption and could be an indicator of lamina resorption. Resorption of the laminae was noted to occur along the aspect with thinner bone support in all eyes. Incidence of severe resorption with extrusion of cylinder/requiring lamina removal was noted to be higher among patients with SJS.

Structural &amp; functional rehabilitation in eyes with lamina resorption following MOOKP—can the lamina be salvaged?

To describe a new technique and analyze the outcome of procedures performed for anatomic and functional rehabilitation in eyes with lamina resorption following the modified osteo-odonto keratoprosthesis (MOOKP) procedure. Retrospective case series. Eighteen eyes were noted to have lamina resorption of the 85 eyes that underwent the MOOKP surgery over the last 10 years. Further intervention to salvage the globe, and therefore the visual potential, was possible in only 11 eyes, of which two are yet to undergo further intervention. Two patients who had undergone the procedure elsewhere also presented to our centre with evidence of resorption. In all, 11 eyes (nine operated at our centre, two operated elsewhere) were included in this study. Bone morphogenetic protein (BMP) was used alone or along with mandibular cancellous bone within the fibrovascular capsule of the osteo-odonto alveolar lamina, in an effort to prevent further resorption and promote bone generation in areas of resorption in ten eyes. In three of these eyes, there was a continued progression of resorption requiring lamina removal. In these three eyes and another eye with extrusion of the cylinder from the eye, the Lucia Type 2 keratoprosthesis was performed for visual rehabilitation (four eyes). The BMP procedure was performed in ten eyes. Continued resorption with need for further rehabilitative surgery in the form of Lucia Type 2 Kpro was required in three of these eyes. Of the four patients who had the Lucia Type 2 Kpro, visual acuity improved to better than 20/200 in three eyes over a mean follow-up period of 3 months. Of the remaining seven eyes that had the BMP procedure performed, all have remained stable with respect to anatomic integrity of the lamina and globe, with maintenance of or improvement in pre BMP visual acuity over a mean follow-up of 9.2 months. No other complications of the procedure were noted. Resorption of the lamina in MOOKP can be addressed by reinforcing the same with BMP in eyes where the cylinder mobility is not significant, as a means to prolong the longevity of the existing lamina. The Lucia Type 2 Kpro might also have a role to play in the functional rehabilitation of eyes with severe lamina resorption or cylinder extrusion if preparation of a new lamina cannot be performed for various reasons.

Biointegration of the Osteo-odonto Lamina in the Modified Osteo-odonto Keratoprosthesis: Engineering of Tissue to Restore Lost Vision

The modified osteo-odonto keratoprosthesis (MOOKP) is a biologic keratoprosthesis that is used to treat a severely scarred cornea. The procedure involves multiple stages, including the transplantation of buccal mucosa to the damaged ocular surface and the implantation of an osteo-odonto lamina with a mounted polymethylmethacrylate lens. Among the keratoprostheses currently available, the MOOKP has proven to be the most effective based on the number of patients who have undergone the procedure and the duration of documented follow-up. Upon successful biointegration of the osteo-odonto lamina, the keratoprosthesis is able to resist resorption, provide stability, and prevent bacterial invasion and epithelial ingrowth. The effectiveness of the MOOKP is dependent on the anatomic and physiologic characteristics of the dental tissues and periodontal ligament.

Visual rehabilitation with keratoprosthesis after tenonplasty as the primary globe-saving procedure for severe ocular chemical injuries

To analyze the outcome (functional and anatomic) of eyes that underwent tenonplasty as the primary globe-saving procedure in severe ocular chemical injuries (grade V-VI Dua's classification). The records of patients who underwent tenonplasty for associated scleral ischemia in severe chemical burns in our institute between October 2005 and June 2011 were analyzed retrospectively. Out of 31 eyes that underwent tenonplasty, 21 belonged to grade V and VI of Dua's classification with diffuse scleral ischemia for which a four-quadrant tenonplasty was performed and only these 21 eyes were included for further analysis. The time to presentation following chemical injury, the need for revision surgeries, the time to complete epithelization, the procedures performed for ocular surface reconstruction and for visual rehabilitation and their outcome, both functional and anatomic, were analyzed. Of the 21 eyes of 13 patients, four were unilateral and nine were bilateral cases of chemical injury. The mean time to presentation following chemical injury was 14.61days. Tenonplasty with amniotic membrane transplantation (AMT) was performed as the primary surgery. Revision tenonplasty was required in six eyes (seven procedures), the mean time to complete epithelization of the ocular surface was 5.4±4.03months. Of the 21 eyes, three lost perception of light following phthisis, evisceration for corneal infection, and uncontrolled glaucoma. Eighteen of 21 eyes were salvaged anatomically, of which ten eyes of 13 patients underwent surgery for visual rehabilitation. Among the unilateral cases, two eyes underwent ex vivo limbal stem cell transplant (LSCT) with or without keratoplasty for further visual rehabilitation. Among the patients with bilateral burns, visual rehabilitative procedure was performed in only one eye. Modified osteo-odonto-keratoprosthesis (MOOKP) was performed in five eyes, Boston type 1 keratoprosthesis in two eyes, and penetrating keratoplasty with keratolimbal allograft with systemic immunosuppression in one eye. One patient with bilateral injury is awaiting Boston keratoprosthesis type 1 for one eye. Of these eight eyes (bilateral injuries), all achieved a BCVA of 20/200 or better over a mean follow-up period of 27.37±14.5months following visual rehabilitative procedure. Tenonplasty has a globe-saving role in eyes with severe chemical injuries with associated scleral ischemia, by accelerating the healing process. Further on, these eyes can undergo visual rehabilitative procedures and our results highlight the feasibility of achieving a good functional outcome following anatomical stability. The role of tenonplasty to salvage the eye in the initial management of chemical injury, the need for multiple surgeries, close follow-up, and monitoring of intraocular pressure prior to and after procedures for visual rehabilitation cannot be underemphasized.

Modified Osteo-Odonto Keratoprosthesis-The Indian Experience-Results of the First 50 Cases

To study the results of the modified osteo-odonto keratoprosthesis (MOOKP) surgery in bilateral end-stage ocular surface disorders. The MOOKP surgery is performed as a routine in 3 stages. Stage 1A involves removal of the iris and anterior vitrectomy with a corneal transplant if indicated. Stage 1B + 1C usually performed simultaneously involves harvesting the buccal mucosa and transplanting it onto the ocular surface along with fashioning of the osteo-odonto alveolar lamina. Stage 2 involves transplanting the osteo-odonto alveolar lamina to the eye 3 months later. The MOOKP surgery was completed in 50 eyes of 47 patients with a mean follow-up of 15.38 months (range: 1-54 months). Anatomic success was achieved in 96% of the eyes. Functional success of visual acuity > or = 20/60 was noted in 66% of eyes. Complications included oroantral fistula (6%), trophic mucosal alterations (8%), lamina exposure (central 6% and peripheral 8%), mucous membrane overgrowth (2%), hypotony (2%), expulsion of optic cylinder (4%), endophthalmitis (2%), glaucoma (20%), sterile vitritis (6%), and retinal detachment (2%). MOOKP is the keratoprosthesis of choice in bilateral end-stage ocular surface disorders in the Indian subcontinent. Complications do occur and have to be recognized and treated early.

Design, surgical technique and complications MOOKP

Abstract Purpose To describe design, surgical technique of the modified osteo‐odonto‐keratoprosthesis (MOOKP),originated from Strampelli's OOKP, with the modifications and the innovations made by Falcinelli, between these thoseones of the last years to the first stage of the procedure, never published. Methods First stage:abstraction of the mono‐rooted tooth with surrounding root and bone. Preparation of the lamina to which, in the dentine central part,the PMMA optic cylinder is glued.Burying of the lamina for 3 months (subcutaneoos pocket). New modification:opening of the A.C., complete removal of the iris, lens cryo‐extraction,anterior vitrectomy.Intermediate stage: after 1 month covering of the eye surface by buccal mucosa. Final stage: after3 months implant of the lamina on the eye with insertion in A.C. of the cylinder after corneal trephining,covering with buccal mucosa previously detached. Results MOOKP COMPLICATIONS‐ 1‐ Intraoperative, easy to be cured. 2‐ After the 1st stage and intermediate stage: all easily treatable. 3‐ After the prosthesis implant, more severe: a) Prosthesis complications which affect mainly the mucosa, easy to be cured, or the lamina and the cylinder, more rare, difficult to be cured. b) Eye complications: retinal detachment, not frequent and easily cured. Retroprosthetic membranes, very rare. Endophthalmites, very difficult to treat, fortunately rare. Conclusion Biological properties Strampelli's osteo‐odonto lamina (OOL)with Falcinelli's surgical modifications make of MOOKP a KPro with best results, teorically without duration limits in the less and in the very severe cases of corneal and anterior oculare surfice alterations like the last stage of dray eye.

Retinal detachment in Falcinelli's modified osteoodontokeratoprosthesis

Abstract Purpose Aim is to evaluate the incidence, surgical treatment and outcomes of retinal detachment in eyes that had undergone Falcinelli's modified osteoodontokeratoprosthesis (MOOKP). Methods Technological and surgical advancements allow to treat successfully a severe pathology as retinal detachment, even in eyes with keratoprosthesis (KPro). The autors accurately describe the surgical technique which usually uses an Eckardt or Landers temporary KPro, a pars plana vitrectomy and a gas or silicone oil tamponade, even if in selected cases it is possible to perform just a scleral buckling. Results By the means of the described techniques good anatomical success and improvement in visual acuity have been obtained. Nine retinal detachments were successfully operated, one retinal detachment was unsuccessfully operated, four retinal detachments were judged to be inoperable for severe proliferative vitreoretinopathy because of late turning‐up to clinical examination and lack of technology in the 70's. Conclusion The autors point out that an accurate MOOKP procedure it is necessary for preventing the retinal detachment. An early diagnosis by echography performed at every clinical examination during the follow‐up in patients with MOOKP and an appropriate surgical planning for each case are fundamental for a better anatomo‐functional outcome.