To report the results of osteoodontokeratoprosthesis ookp surgery in patients who sustained severe chemical and thermal injuries. Modified osteoodontokeratoprosthesis mookp what is it. Osteoodontokeratoprosthesis ookp also known as tooth in eye surgery is a medical procedure to restore vision in the most severe cases of corneal and ocular surface patients. Keratoprosthesis surgery for endstage corneal blindness in asian eyes. Introduction corneal blindness, the second most common human disability affecting a huge population 1. Ophthalmology united states, mar 2008, 1153 p503510. A new vision through combined osteoodontokeratoplasty. Since the introduction of kpro over 200 years ago, numerous designs and techniques have been suggested. The boston type 2 keratoprosthesis kpro is an artificial device used to replace the cornea in the setting of diseases with severe, recurrent scarring in which other types of corneal transplants are not a viable option. Oral acetazolamide after boston keratoprosthesis in. In 1996, we performed our first ookp operation that was televised as a bbc tomorrows world programme. Links to pubmed are also available for selected references. Defintion keratoprosthesis is a surgical procedure where a severely damaged or diseased cornea is replaced with an artificial cornea to restore useful vision or to make the eye comfortable in painful keratopathy 3.
Yet, the persistence of strampelli, helped by the excellent initial visual results, turned ookp in the keratoprosthesis of reference for decades. Standard corneal transplantation with donor tissue is the most common treatment for corneal opacity. Insertion of the osteoodontokeratoprosthesis device requires a complex staged procedure, in which the cornea is. Osteoodonto keratoprosthesis ookp is a multistaged procedure for the treatment of blindness. Modified osteoodontokeratoprosthesis treatment mookp. A subaqua system for fashioning the osteoodontokeratoprosthesis lamina.
Boston keratoprosthesis surgical technique clinical gate. The boston type i keratoprosthesis is currently the most commonly used keratoprosthesis device in the us. Optical cylinder designs to increase the field of vision. The osteo odonto keratoprosthesis ookp also known as tooth in eye surgery is an auto graft used for the treatment of severe corneal opacities not suitable for corneal transplantation.
Liu c1, paul b, tandon r, lee e, fong k, mavrikakis i, herold j, thorp s. More recently, a less invasive, nonpenetrating artificial cornea has been developed which can be used in more routine cases of corneal blindness. Get a printable copy pdf file of the complete article 564k, or click on a page image below to browse page by page. It is an operation that restores vision in the most severe cases of corneal scarring causing. Modified osteoodonto keratoprosthesis mookp university of. For many patients, a corneal graft could offer a second chance of sight.
However, in certain severe corneal opacities, there. This was not true as the technique of ookp was invented by the late benedetto. Corneal blindness, osteoodontokeratoprosthesis ookp, keratoprosthesis kpro, osteo dental acrylic complex oda complex 1. A keratoprosthesis is an artificial cornea that is intended to restore vision to patients with severe bilateral corneal damage or disease such as prior failed corneal transplants, corneal opacification, chemical injuries, or certain immunological conditions for whom a corneal transplant is not. Liu c, okera s, tandon r, herold j, hull c, thorp s.
Osteo odonto keratoprosthesis or tooth for an eye 23 is a complex 2 stage procedure in which the canine tooth or any single root tooth is removed from the. Keratoprosthesisartificial corneakeratoprosthesisartificial cornea keratocornea. A keratoprosthesis is an artificial cornea, used in situations where a human donor cornea is expected to fail. Ookp procedure in a case of end stage of corneal blindness due to stevensjohnson syndrome. Others combine stage 1b and 1c as a single procedure. Osteoodontokeratoprosthesis for endstage cornea blindness. Recent developments on osteoodontokeratoprosthesis ookp strampelli introduced for the first time in 1963 the socalled osteoodontokeratoprosthesis ookp. The ookp is a toothalveolar boneperiosteum complex that forms a framework to house an optical cylinder, which acts as the artificial cornea. This is a noncomparative retrospective case series of 14 patients who underwent ookp surgery between 2001 and 2016 at the sussex eye hospital, brighton, uk, because of severe chemical and thermal injuries. Full text full text is available as a scanned copy of the original print version. Osteoodontokeratoprosthesis ookp surgery is a technique used to replace damaged cornea in blind patients for whom cadaveric transplantation is not feasible. It is particularly resilient to a hostile environment such as the dry keratinized eye resulting from severe.
Of these, the boston keratoprosthesis and osteoodonto keratoprosthesis ookp are the two most commonly used. The idea of using a tooth as a haptic for his new device was initially taken with skepticism by his contemporary colleagues. Keratoprosthesis kp is an artificial cornea that is intended to replace the opacified corneal tissue and restore vision when severe bilateral corneal disease exists e. Osteoodontokeratoprosthesis definition of osteoodonto. Osteoodonto keratoprosthesis is one of the most successful forms of keratoprosthesis surgery for endstage corneal and ocular surface disease.
Keratoprosthesis kpro when the cornea becomes diseased and vision is significantly compromised, corneal transplantation may be necessary. Keratoprosthesis bluecross blueshield of tennessee. It is a specialist surgical intervention that can restore meaningful vision to patients suffering from end stage corneal blindness, and for whom conventional corneal surgery is not possible for reasons such as severe dry eyes causing heavy scarring of the cornea. Osteoodontokeratoprosthesis ookp instructional video. Editor,we wish to point out some inaccuracies portrayed by the media on osteoodontokeratoprosthesis ookp surgery offered at our hospital. The window of the soul is our eye and the window of the eye is cornea. After removal, a lamina of tissue cut from the tooth is drilled and the hole is fitted with optics. Osteo odonto keratoprosthesis ookp in 2016, dr webber became the first oral and maxillofacial surgeon in australia, and the southern hemisphere, to perform the surgical procedure known as osteo odonto keratoprosthesis ookp or tooth in eye surgery. Bluecross blueshield of tennessee medical policy manual keratoprosthesis. The osteoodontokeratoprosthesis ookp, although described over 40 years ago, remains the keratoprosthesis of choice for endstage corneal blindness not amenable to penetrating keratoplasty. Abstract the osteoodontokeratoprosthesis ookp, although described over 40 years ago, remains the keratoprosthesis of choice for endstage corneal blindness not amenable to penetrating keratoplasty.
Stevensjohnson syndrometoxic epidermal necrolysis sjsten is a rare but severe and sometimes fatal condition associated with exposure to medications. An artificial cornea used as a last resource to restore vision to people whose corneas have been rendered opaque by dryeye disease or chemical injury that precludes successful corneal grafting. Osteoodontokeratoprosthesis ookp is often the sole and last treatment option for visual rehabilitation in severe corneal blindness. Osteonodontokeratoprosthesis surgery british journal. The revolutionary osteoodontokeratoprosthesis procedure, illustrated by stephen f. It consists of a clear plastic polymethylmethacrylate pmma optic and back plate. This is drilled and a plastic lens cemented into the hole. Osteo odonto keratoprosthesis ookp in 2016, dr webber became the first oral and maxillofacial surgeon in australia, and the southern hemisphere, to perform the surgical procedure known as osteo odonto keratoprosthesisookp or tooth in eye surgery. Visual rehabilitation in endstage inflammatory ocular surface disease with the osteoodontokeratoprosthesis. In the programme, the operation was described as new. This is a complex artificial corneal surgical procedure that is performed in two stages for visual rehabilitation in cases of corneal blindness with dry ocular surface in which corneal transplantation with amniotic membrane and. Modified osteoodontokeratoprosthesis for treatment of. As the ultima ratio in surgical management of severe corneal scarring the osteoodontokeratoprothesis according to strampelli is recognised to be the best choice.
It includes removal of a tooth from the patient or a donor. Osteoodontokeratoprosthesis ookp is a technique used to replace damaged corneae in blind patients for whom cadaveric corneal transplantation is not an. Corneal blindness mosman, nsw corneal specialist gordon. Boston type 2 keratoprosthesis kpro university of iowa. Modified osteo odonto keratoprosthesis mookp tooth. Keratoprosthesis implantation is a procedure that involves fullthickness removal of the cornea and replacement by an artificial cornea. The preservation of the osteoodontolamina is the vital feature in maintaining the stability of the ookp.
Steps in worstsingh keratoprosthesis implantation1 a peritomy is done. Osteoodontokeratoprosthesis ookp is a technique used to replace damaged corneae in blind patients for whom cadaveric corneal transplantation is not an option. We sought to address the safety of acetazolamide, a chemically related compound, in patients with prior sjsten and glaucoma. Claes dohlman began development of the boston keratoprosthesis in 1965. Endoscopic cyclophotocoagulation for refractory glaucoma. As configured for implantation, the most anterior component is the optic, which is lathed from a. Keratoprosthesis can be divide into two broad categories. Ookp surgery is a complex procedure requiring lifetime followup. Of the original cohort, 181 patients 98 men and 83 women. Keratoprosthesis definition of keratoprosthesis by. It is an operation that restores vision in the most severe cases of corneal scarring. It was developed some 40 years ago in italy and uses the patients own tooth root and alveolar bone to support an optical cylinder. Referrers wishing to send patients for consideration of boston keratoprosthesis or osetoodonto keratoprosthesis are invited to do so via mosman eye centre contact information at the top of page or via fax.
Osteoodontokeratoprosthesis surgery involves 2 proceduresin stage 1, an autologous canine tooth is removed, modified to receive an optical polymethyl methacrylate cylinder, and implanted into. Comparison of candidate materials for a synthetic osteoodonto. Osteoodontokeratoprosthesis ookp is a medical procedure to restore vision in the most severe cases of corneal and ocular surface patients. Keratoprosthesis is a surgical procedure where a diseased cornea is replaced with an artificial cornea. The keratoprosthesis with the best success rate till date is the osteoodontokeratoprosthesis ookp. Objective to evaluate longterm anatomical and functional outcomes of a modified osteoodontokeratoprosthesis ookp technique for treatment of corneal blindness from various etiologies methods twohundred three patients 224 eyes underwent modified ookp surgery between 1973 and 1999. Until now we performed the osteoodontokeratoprothesis in four patients. Keratoprosthesis kpro has revolutionized the treatment of patients with severe corneal diseases who do not benefit from allogeneic corneal transplantation. Osteo odonto keratoprosthesis ookp gold coast oral. Osteoodontokeratoprosthesis ookp is a surgical procedure for replacing severe damaged corneas when corneal transplant is impossible and giving sight back.
For such cases, osteoodonto keratoprosthesis ookp which was first described by strampelli and later on modified by falcinelli et al and hull et al is a useful method for visual rehabilitation because of its higher retention rate and better longterm visual outcome. The cornea is replaced by a polymethyl methacrylate pmma optical cylinder glued to a biological support haptic made by human living tissue. Osteo odonto keratoprosthesis or tooth for an eye 23 is a complex 2 stage procedure in. However, in some cases eg, in patients with multiple graft failures, limbal stem.
Since the first performance of osteoodonto keratoprosthesis ookp surgery,1, 2 the technique has been modified and used in many centers around the world. Traditionally, keratoprosthesis is recommended after a person has had a failure of one or more donor corneal transplants. Osteoodonto keratoprosthesis in stevensjohnson syndrome. The osteokeratoprosthesis okp and osteoodontokeratoprosthesis ookp procedures replace the opaque cornea with a polymethylmethacrylate cylinder supported by a biological skirt the patients tibia or tooth root with its surrounding alveolar bone, respectively temprano 1993. Final appearance of an osteoodonto keratoprosthesis.
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