The osteo-odonto-keratoprosthesis (OOKP).
The osteo-odonto-keratoprosthesis (OOKP), although described over 40 years ago, remains the keratoprosthesis of choice for end-stage corneal blindness not amenable to penetrating keratoplasty. It is particularly resilient to a hostile environment such as the dry keratinized eye resulting from severe Stevens-Johnson syndrome, ocular cicatricial pemphigoid, trachoma, and chemical injury. Its rigid optical cylinder gives excellent image resolution and quality. The desirable properties of the theoretical ideal keratoprosthesis is described. The indications, contraindications, and patient assessment (eye, tooth, buccal mucosa, psychology) for OOKP surgery are described. The surgical and anaesthetic techniques are described. Follow-up is life-long in order to detect and treat complications, which include oral, oculoplastic, glaucoma, vitreo-retinal complications and extrusion of the device. Resorption of the osteo-odonto-lamina is responsible for extrusion, and this is more pronounced in tooth allografts. Regular imaging with spiral-CT or electron beam tomography can help detect bone and dentine loss. The optical cylinder design is discussed. Preliminary work towards the development of a synthetic OOKP analogue is described. Finally, we describe how to set up an OOKP national referral center.
Liu
Christopher
C
Sussex Eye Hospital, Brighton, England, Aston University, Birmingham, England, and Kinki University, Osaka, Japan. CSCLiu@aol.com
Paul
Bobby
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Tandon
Radhika
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Lee
Edward
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Fong
Ken
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Mavrikakis
Ioannis
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Herold
Jim
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Thorp
Simon
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Brittain
Paul
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Francis
Ian
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Ferrett
Colin
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Hull
Chris
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Lloyd
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Green
David
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Franklin
Valerie
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Tighe
Brian
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Fukuda
Masahiko
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Hamada
Suguru
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D000539:Alveolar Process / Q000637:transplantation*; D003315:Cornea / Q000601:surgery*; D003316:Corneal Diseases / Q000601:surgery*; D006801:Humans; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D014092:Tooth Root / Q000637:transplantation*