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This standard technique of modified OOKP surgery, where adequately performed, is capable of providing excellent anatomic and functional results even in the long term. In patients with corneal blindness untreatable by other approaches, we strongly recommend this technique for visual rehabilitation. Students of OOKP surgery should become familiar with the protocol described in this paper before subjecting the technique to further modifications.

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.

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We evaluated the microscopical changes that occurred when bone and dental tissue were exposed to such a foreign environment as the ocular surface and anterior chamber in 17 osteo-odonto-keratoprostheses removed from the recipient's eye after 1 to 20 years. Histochemical methods were performed to demonstrate elastic and precursor fibers, while immunohistochemical procedures were used to study the distribution of collagen types I to VI. Islands of heterotopic, newly formed bone were observed in the dentin and the periodontal space, leading to focal dentoalveolar ankylosis. Remodelling and disappearance of the periodontal ligament was never diffuse.

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The production of local regulatory factors is a possible explanation for the survival of oral mucosa over the osteodental acrylic lamina, whereas their absence in distant areas may have induced the oral mucosa to transdifferentiate into a conjunctival-type lining. Alternatively, conjunctival regrowth from forniceal stem cells should be taken into consideration.

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