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.

Mitomycin-C for mucous membrane overgrowth in OOKP eyes.

PURPOSE: The aim of this study was to report the use of mitomycin-C (MMC) in the treatment of mucous membrane overgrowth in eyes with osteo-odonto-keratoprosthesis (OOKP). METHODS: Records of 4 cases with mucous membrane overgrowth after stage 2 OOKP surgery were reviewed. RESULTS: All the patients had undergone a mucous membrane trimming procedure followed by MMC application. None of the patients had any episode of recurrence of the mucous membrane overgrowth after a single application of MMC in the follow-up period that ranged from 1 to 11 years. CONCLUSIONS: MMC can successfully arrest mucous membrane overgrowth in OOKP-implanted eyes including refractory cases.