Modified Osteo-Odonto Keratoprosthesis (MOOKP) in patients with severe anterior segment disease: Our Hong Kong Experience Bone

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Modified Osteo-Odonto Keratoprosthesis (MOOKP) in
patients with severe anterior segment disease
Our Hong Kong Experience Bone Tooth Cornea
replacement??????

• Ben Lam, Srinivas Rao, Alvin Young, Lulu
  Cheng,Dennis Lam
• Hong Kong Eye Hospital
• Department of Ophthalmology and visual
  science /CUHK
• 
  (no financial interest)

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Purpose

• To evaluate the efficacy and safety of Modified
  Osteo-Odonto Keratoprosthesis (MOOKP) in Hong
  Kong patients with severe anterior segment
  disease.

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Methods

• Retrospective review of all nine patients with
  MOOKP performed at Hong Kong Eye Hospital from
  June 2005 to Oct 2007.
• All patients had poor vision bilaterally as a
  result of chemical injury, ocular cicatricial
  pemphigoid (OCP) or multiple corneal graft
  failure.

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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
  osteo-dental lamina complex.

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Methods

• The second stage involves the preparation of
  buccal mucosal surface
• Third stage involves implantation of complex.

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Methods

• Outcome measures included
• post-operative visual acuity
• complications such as glaucoma, retinal
  detachment and wound-related problems

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Age Primary disorder Pre op VA Refraction Postop VA Complication
1 M/37 Chemical injury HM 4.00 DS 0.7
2 M/75 Chemical injury LP PR accurate LP Choroidal Effusion, VH
3 M/32 Chemical injury LP PR accurate 3.50 DS 0.1 Pale disc 0.9
4 M/25 Chemical injury HM NLP Phthisis RD, pale disc
5 M/47 Chemical injury LP PR accurate 3.00 DS 0.5 Lash touch cylinder
6 M/63 OCP LP PR accurate 4.50 DS 0.4
7 F/73 Multiple Graft failure HM 4.25 DS 0.7
8 M/63 Chemical Injury HM 4.00 DS 0.4 Overgrowth of mucosa
9 M/67 OCP LP PR accurate 4.00 DS 0.6
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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).

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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.

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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

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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-ups to evaluate its efficacy and
  safety are warranted.

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