title: Impact of clinical factors on the long-term functional and anatomic outcomes of osteo-odonto-keratoprosthesis and tibial bone keratoprosthesis.
abstract: OBJECTIVE
  To report the long-term functional and anatomic outcomes of osteo-odonto-keratoprosthesis and tibial bone keratoprosthesis; to analyze the influence of clinical factors, such as surgical technique, primary diagnosis, age, and postoperative complications, on the final outcome.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  setting: Centro de Oftalmología Barraquer, between 1974 and 2005.
  
  
  METHODS
  Two hundred twenty-seven patients. intervention: Biological keratoprosthesis using osteo-odonto-keratoprosthesis or tibial bone keratoprosthesis. main outcome measures: Functional survival with success defined as best-corrected visual acuity ≥0.05; anatomic survival with success defined as retention of the keratoprosthesis lamina.
  
  
  RESULTS
  Osteo-odonto-keratoprosthesis and tibial bone keratoprosthesis have comparable anatomic survival at 5 and 10 years of follow-up, but osteo-odonto-keratoprosthesis has a significantly better functional success than tibial bone keratoprosthesis at the same time periods. Among the primary diagnoses, Stevens-Johnson syndrome, chemical burn, and trachoma have generally good functional and anatomic outcomes and the least favorable prognosis is for ocular cicatricial pemphigoid. Younger patients fared better than those in older age groups. The most frequent complications were extrusion (28%), retinal detachment (16%), and uncontrolled glaucoma (11%). The glaucoma group had the best anatomic success but the worst functional results, only exceeded by the retinal detachment group in terms of functional outcome.
  
  
  CONCLUSIONS
  Clinical factors, such as surgical technique, primary diagnosis, age, and postoperative complications, can affect the long-term anatomic and functional successes of biological keratoprosthesis. Knowledge about the impact of each of these factors on survival can help surgeons determine the best approach in every particular case.
authors.affiliation: Centro de Oftalmología Barraquer, Barcelona, Spain; Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: María Fideliz
authors.initials: MF
authors.lastname: De La Paz
authors.forename: Juan Álvarez
authors.initials: JÁ
authors.lastname: De Toledo
authors.forename: Victor
authors.initials: V
authors.lastname: Charoenrook
authors.forename: Saadettin
authors.initials: S
authors.lastname: Sel
authors.forename: José
authors.initials: J
authors.lastname: Temprano
authors.forename: Rafael I
authors.initials: RI
authors.lastname: Barraquer
authors.forename: Ralph
authors.initials: R
authors.lastname: Michael
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D002648:Child; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D003481:Cuspid / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D011183:Postoperative Complications; D012189:Retrospective Studies; D013977:Tibia / Q000637:transplantation*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology