Osteo-Odonto-Keratoprosthesis in Severe Thermal and Chemical Injuries

Cornea. 2018 Aug;37(8):993-999. doi: 10.1097/ICO.0000000000001618.

Abstract

Purpose: To report the results of osteo-odonto-keratoprosthesis (OOKP) surgery in patients who sustained severe chemical and thermal injuries.

Methods: This is a noncomparative retrospective case series of 14 patients who underwent OOKP surgery between 2001 and 2016 at the Sussex Eye Hospital, Brighton, UK, because of severe chemical and thermal injuries RESULTS:: OOKP surgery was performed in 14 eyes of 14 patients. Eight patients (57%) sustained thermal injuries and 6 patients (43%) chemical injuries. Every eye had previously undergone adnexal or ocular surgery, including 2 cases that underwent synthetic keratoprosthesis implantation. One case had choroidal hemorrhage during stage 2. Laminar retention was observed in 11 cases (85%) at the end of the study. The Kaplan-Meier curve showed a probability of 81% of laminar retention at 5 years and a decrease at 15 years to 61%. Functional visual success was observed in only 7 patients (50%) because of end-stage glaucomatous optic neuropathy in 4 cases and macular scar in 1 case. Two cases developed endophthalmitis. Two cases required removal of laminae, one because of endophthalmitis, bone resorption and aqueous leak and the other because of development of a retroprosthetic membrane. Glaucoma was the most frequent complication (79%) and required surgical intervention with tube shunts in 5 cases. Six cases (43%) required buccal mucosal repair, which included two cases that developed endophthalmitis.

Conclusions: Anatomic success was achieved in 11 of 13 cases in this series of OOKP surgery after severe chemical and thermal trauma; 8 of these cases had at least 5 years of follow-up and thus qualified as long-term.

MeSH terms

  • Adult
  • Aged
  • Alveolar Process / transplantation*
  • Bioprosthesis*
  • Burns, Chemical / pathology
  • Burns, Chemical / surgery*
  • Cornea / pathology*
  • Eye Burns / pathology
  • Eye Burns / surgery*
  • Female
  • Follow-Up Studies
  • Forecasting*
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications
  • Retrospective Studies
  • Tooth Root / transplantation*
  • Treatment Outcome
  • Visual Acuity
  • Young Adult