The osteo-odonto-keratoprosthesis (OOKP)

Area of Science:

• Ophthalmology
• Biomaterials Science
• Surgical Innovation

Background:

• The osteo-odonto-keratoprosthesis (OOKP) is a long-standing solution for severe corneal blindness unresponsive to traditional corneal transplants.
• It excels in challenging ocular environments, including those caused by Stevens-Johnson syndrome, ocular cicatricial pemphigoid, trachoma, and chemical injuries.
• The device's rigid optical cylinder provides superior image resolution and quality.

Purpose of the Study:

• To review the established role and desirable properties of the OOKP.
• To detail the indications, contraindications, and comprehensive patient assessment for OOKP surgery.
• To discuss surgical techniques, anesthetic considerations, and lifelong follow-up protocols for complication management.

Main Methods:

• Review of existing literature and clinical experience with OOKP.
• Description of patient selection criteria, including ocular, dental, and psychological evaluations.
• Outline of surgical procedures, anesthesia, and post-operative management strategies.
• Discussion of imaging techniques (spiral-CT, electron beam tomography) for monitoring device integrity.

Main Results:

• OOKP remains the preferred choice for end-stage corneal blindness due to its resilience and optical performance.
• Key complications include oral, oculoplastic, glaucoma, and vitreo-retinal issues, with device extrusion a significant concern.
• Bone and dentine resorption, particularly with allografts, can lead to extrusion, necessitating regular imaging for early detection.

Conclusions:

• The OOKP is a highly effective, albeit complex, solution for otherwise untreatable corneal blindness.
• Lifelong monitoring is essential for timely detection and management of OOKP-related complications.
• Ongoing research into synthetic analogues and national referral center establishment aims to refine and broaden OOKP accessibility.