Osteo-odonto-keratoprosthesis - a maxillofacial perspective

Area of Science:

• Ophthalmology
• Oral and Maxillofacial Surgery
• Regenerative Medicine

Background:

• The osteo-odonto-keratoprosthesis (OOKP) is a vital surgical option for end-stage ocular surface disease unresponsive to conventional treatments like penetrating keratoplasty.
• Conditions such as Stevens-Johnson syndrome, ocular cicatricial pemphigoid, trachoma, and chemical burns often necessitate advanced corneal replacement strategies.
• OOKP involves using a patient's own tooth and bone complex to support a polymethacrylate optical cylinder, replacing the damaged cornea.

Purpose of the Study:

• To retrospectively analyze the outcomes of OOKP surgery performed between 2007 and 2011.
• To evaluate the oral and maxillofacial aspects of the OOKP procedure.
• To document and manage complications associated with OOKP surgery.

Main Methods:

• Retrospective analysis of medical records for 26 patients who underwent OOKP surgery.
• Detailed review of surgical techniques, donor tooth selection (maxillary canines, mandibular canines, maxillary first premolars), and patient follow-up.
• Documentation of oral and maxillofacial complications, including oroantral fistulas and adjacent tooth root exposure.

Main Results:

• Stevens-Johnson syndrome (23 patients) and chemical burns (3 patients) were the primary causes of blindness.
• Nineteen out of 24 patients who completed both stages of the OOKP procedure achieved successful visual rehabilitation.
• Complications included oroantral fistula in 4 patients and adjacent tooth root exposure in 12 patients.

Conclusions:

• The osteo-odonto-keratoprosthesis (OOKP) demonstrates significant efficacy in restoring vision for patients with severe corneal disease.
• Careful management of oral and maxillofacial aspects and potential complications is crucial for successful OOKP outcomes.
• OOKP represents a valuable, albeit complex, reconstructive option for otherwise untreatable blindness.