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

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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 2007. 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 osteo-dental 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 Refraction Postop VA Complication 1 M/37 Chemical injury HM +4.00 DS 0.7 2 M/75 LP PR accurate Choroidal Effusion, VH 3 M/32 +3.50 DS 0.1 Pale disc 0.9 4 M/25 NLP Phthisis RD, pale disc 5 M/47 +3.00 DS 0.5 Lash touch cylinder 6 M/63 OCP +4.50 DS 0.4 7 F/73 Multiple Graft failure +4.25 DS 8 Chemical Injury Overgrowth of mucosa 9 M/67 0.6

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-ups to evaluate its efficacy and safety are warranted.