First clinical experience with an Osteo-Odonto-Keratoprothesis

Introduction: In patients with corneal opacity due to thermal and chemical burns , or other inflammatory disorders of the ocular surface, the risk of rejection of a corneal transplant is high due to strong vascularization and scarring of the cornea in such cases the use of an osteo- odonto - keratoprosthesis (OOKP) is a possible therapeutic alternative. Materials and Methods: We describe a case of a patient who underwent OOKP-surgery, a method first published in 1963 by Strampelli. Our patient had a past history of Stevens-Johnson-Syndrome with subsequent corneal opacity. Multiple unsuccessful corneal transplants resulted in a corneal ulcerceration. The preoperative visual acuity was only hand movement. In January 2013, tooth number 13 along with its root and surrounding alveolar bone and periosteum was removed and cut along the canal of the dental pulp resulting in two halves.Afterwards a disc was prepared from this specimen.A PMMA cylinder was inserted into a transverse bore hole through the dentin and the adjacent alveolar bone. The graft consisting of the synthetic cylinder and its stable biological matrix was subcutaneously implantet into the lower lid for 3 months. In the meantime, the cornea was covered with buccal mucosa. Three months later, the OOKP was implanted into the center of the cornea with the protruding optical cylinder as a light bridge between the environment and the vitreous body. The biological graft was located between the cornea and the overlying oral mucosa. Results: Sofar the follow-up was eight months. No operative complication did occured. The postoperative visual acuity is currently 0.4 which allows newspaper reading and participation in public life. A narrow angle glaucoma, which is a typical complication in about 50% of these cases may occur. Conclusion: The OOKP is a validated, promising and demanding tool for the treatment of very severe corneal conditions .Due to the complex nature of the procedure,its use is restricted to few interdisciplinary centers. Keywords: corneal blindness, Steven-johnson-Syndrome, Osteo-Odonto-Keratoprothesis