Transcript Modified Osteo-Odonto Keratoprosthesis for Severe Anterior

Modified Osteo-Odonto
Keratoprosthesis (MOOKP) in patients
with severe anterior segment disease:
Our Hong Kong Experience
Bone – Tooth Cornea replacement
骨齒人工角膜
Ben Lam, Srinivas Rao, Alvin Young, Lulu Cheng,Dennis Lam
Hong Kong Eye Hospital
Department of Ophthalmology and visual science /CUHK
(no financial interest)
Purpose
To evaluate the efficacy and safety of
Modified Osteo-Odonto Keratoprosthesis
(MOOKP) in Hong Kong patients with
severe anterior segment disease.
Methods
Retrospective review of all nine patients
with MOOKP performed at Hong Kong
Eye Hospital from June 2005 to Oct
2008.
All patients had poor vision bilaterally as
a result of chemical injury, ocular
cicatricial pemphigoid (OCP) or multiple
corneal graft failure.
Methods
In contrast to classic
OOKP, Our MOOKP
consists of 3 stages.
The first stage involves
the removal of iris and
lens, as well as the
preparation of the osteodental lamina complex.
Methods
The second stage
involves the
preparation of
buccal mucosal
surface
Third stage
involves
implantation of
complex.
Methods
Outcome measures included
post-operative visual acuity
complications such as glaucoma, retinal
detachment and wound-related problems
Age
Primary disorder
Pre op VA
1 M/37
Chemical injury
HM
2 M/75
Chemical injury
LP
PR accurate
3 M/32
Chemical injury
LP
PR accurate
4 M/25
Chemical injury
HM
5 M/47
Chemical injury
LP
PR accurate
6 M/63
OCP
7 F/73
Refraction
+4.00 DS
Postop VA
Complication
0.7
LP
Choroidal
Effusion, VH
0.1
Pale disc 0.9
NLP
Phthisis
RD, pale disc
+3.00 DS
0.5
Lash touch
cylinder
LP
PR accurate
+4.50 DS
0.4
Multiple Graft
failure
HM
+4.25 DS
0.7
8 M/63
Chemical Injury
HM
+4.00 DS
0.4
9 M/67
OCP
LP
PR accurate
+4.00 DS
0.6
+3.50 DS
Overgrowth of
mucosa
Results
The mean patients’ age was 53.6 years
(ranges 25 – 75 years).
Six patients suffered from chemical burn,
two from OCP and one had history of
multiple corneal graft failure.
The mean post-operative follow-up was
18.4 months (range 6- 28 months).
Results
The pre-operative best corrected visual
acuity (BCVA) ranged from hand
movement to light perception
Post-operative Snellen BCVA ranged from
0.4.to 0.7 except for three eyes.
Results
One eye developed choroidal effusion
and vitreous haemorrahge. One eye
developed retinal detachment and pale
disc .The visual acuity was light
perception and no light perception
respectively.
One eye also developed overgrowth of
the mucosa over the cylinder which
required excision.
Two eye had pale discs post operatively
compromising the visual potential
Conclusion
Despite the complex nature of the
operation and possible complications
MOOKP offers the hope of visual
improvement for patients with severe
anterior segment disease. Future studies
with longer follow-up to evaluate its
efficacy and safety are warranted.