Modified Osteo-Odonto Keratoprosthesis-The Indian Experience-Results of the First 50 Cases

Abstract

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.

Bone augmentation of the osteo-odonto alveolar lamina in MOOKP—will it delay laminar resorption?

“…The procedure by itself is a demanding and time consuming one, and takes up to 4-6 months towards completion of all stages. The results of the procedure are encouraging, especially given the good long-term retention of the prosthesis in these eyes [1,[7][8][9][10].…”

Osteo-odonto-keratoprosthesis – A maxillofacial perspective

“…Iyer et al (2010) have reported an anatomic success of 96% but functional success of visual acuity >/¼20/60 in 66% in 50 eyes of 47 patients who underwent modified OOKP procedure in bilateral end stage ocular surface disease. The complications they encountered were oroantral fistula (6%), trophic mucosal alterations (8%), lamina exposure (central 6% and peripheral 8%), mucous membrane overgrowth (2%), hypotony (2%), expulsion of optic cylinder (4%), endophthalmitis (2%), glaucoma (20%), sterile vitritis (6%), and retinal detachment (2%).…”

Vitreoretinal aspects of permanent keratoprosthesis

“…66 Historical series have reported incidence rates ranging from 0e10%, with many studies below 5%. 2,3,10,15,47,49,51,63,65,76,79 A more recent series found a higher rate of 14.3% in a cohort of 83 eyes. 36 No associations with initial diagnosis, comorbidities, or other risk factors have been identified.…”

“…46 There is often near complete restoration of visual acuity with appropriate treatment. 49,65 Recovery may take 2e10 weeks. 65,92 Prophylactic topical prednisolone acetate does not prevent sterile vitritis.…”

“…36,46,47 Because endophthalmitis may occasionally present with minimal pain, sterile vitritis often becomes a diagnosis of exclusion after negative cultures. 33,49 Sterile vitritis has historically been managed with peribulbar injection of triamcinolone 46 or dexamethasone, 92 followed by intensive topical steroid therapy. 77,92 Because infectious endophthalmitis is often initially in the differential, many patients are also treated preemptively with antibiotics and a vitreous tap for gram stain and culture.…”