title: Mucosal complications of modified osteo-odonto keratoprosthesis in chronic Stevens-Johnson syndrome.
abstract: OBJECTIVE
  To describe clinical outcomes of complications afflicting the autologous oral mucous membrane graft after modified osteo-odonto keratoprosthesis surgery in chronic Stevens-Johnson syndrome (SJS).
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  This study included 30 eyes of 30 patients with SJS-induced dry keratinized ocular surfaces; the patients underwent various stages of this procedure between August 2009 and February 2012. Mucosal complications were classified as either necrosis or overgrowth. Mucosal necrosis was managed according to a predesigned algorithm based on timing (pre- and postimplantation) and location (central or peripheral) of necrosis. Cases with mucosal overgrowth underwent mucosal debulking and trimming.
  
  
  RESULTS
  Mucosal necrosis developed in 15 (50%) eyes and overgrowth in 4 (13.3%) eyes. Preimplantation necrosis (n = 7) was initially managed conservatively, but 2 eyes required free labial-mucous membrane grafting for persistent corneal exposure. Free labial-mucous membrane grafting was performed in all cases of postimplantation necrosis (n = 10), but 8 eyes required additional tarsal pedicle flaps (n = 6, for peripheral necrosis) or through-the-lid revisions (n = 2, for central necrosis). Debulking and trimming effectively managed all cases of mucosal overgrowth, but 3 eyes required repeat procedures. At 24.1 ± 6.5 months postimplantation, the keratoprosthesis was retained in all eyes, and the probability of maintaining 20/60 or better vision was similar in eyes with or without mucosal necrosis (86 ± 8.8% vs 80 ± 10.3%).
  
  
  CONCLUSIONS
  Mucosal complications, especially necrosis, occurred commonly following modified osteo-odonto keratoprosthesis surgery in dry keratinized post-SJS eyes. The algorithm-based management approach described in this study was successful in treating these complications, retaining the prosthesis and preserving useful vision.
authors: Cornea and Anterior Segment Services, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Banjara Hills Road No. 2, Hyderabad 500034, Andhra Pradesh, India. Electronic address: sayanbasu@lvpei.org.
authors: Sayan
authors: S
authors: Basu
authors: Vinay Sukumara
authors: VS
authors: Pillai
authors: Virender S
authors: VS
authors: Sangwan
mesh_terms: D000293:Adolescent; D000328:Adult; D000539:Alveolar Process / Q000637:transplantation*; D064592:Autografts; D002908:Chronic Disease; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D003481:Cuspid / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000473:pathology* / Q000601:surgery; D009336:Necrosis; D011183:Postoperative Complications; D011446:Prospective Studies; D019736:Prostheses and Implants; D013262:Stevens-Johnson Syndrome / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult