The evolution of the modified osteo-odonto-keratoprosthesis, its reliability, and long-term visual rehabilitation prognosis: An analytical review

Gustavo Ortiz-Morales, Denise Loya-Garcia, Maria F. Colorado-Zavala, Daniela E. Gomez-Elizondo, Matias Soifer, Bhaskar Srinivasan, Shweta Agarwal, Alejandro Rodríguez-Garcia, Victor L. Perez, Guillermo Amescua, Geetha Iyer

Research output: Contribution to journalReview articlepeer-review

Abstract

An exhaustive search of the world's literature was performed to analyze all case reports and series on the modified osteo-odonto-keratoprosthesis (MOOKP) published up to January 2022. The demographic profile, the primary indication for surgery, surgical technique variations, postoperative medical management, long-term functional and anatomical outcomes, and intra- and postoperative complications were analyzed and compared. Additionally, some of the authors' (GI, VP, and GA) unpublished MOOKP cases were studied. An extensive literature search yielded 37 case series and case reports. Overall, 958 patients were analyzed. The most common indication for surgery was autoimmune disease (39.1%), closely followed by chemical injury (38.8%). The most common intraoperative complications (21.67%) included maxillofacial, vitreous hemorrhage/vitritis, and mucosal. The most common postoperative complications (78.4%) were lamina and oral mucosa-associated, secondary glaucoma, and choroid/retinal detachment. Follow-up periods ranged from one to 364 months (median: 36.7 months). Altogether, 78% of patients achieved a visual acuity of 20/400 or better at the end of the follow-up period, and 91.2% improved at least temporarily after MOOKP surgery. Mean anatomic success at the end-of-follow-up for all patients was 88.25% (range, 50–100%). The long-term anatomic and functional success of the MOOKP makes it a reliable option for visual rehabilitation in patients with bilateral corneal blindness and end-stage ocular surface disease. This review aims to describe the evolution of the MOOKP procedure, analyzing all published case series for its long-term reliability, visual and anatomical outcomes, complications, and future directions.

Original languageEnglish (US)
Pages (from-to)129-144
Number of pages16
JournalOcular Surface
Volume24
DOIs
StatePublished - Apr 2022
Externally publishedYes

Keywords

  • KPro
  • Keratoprosthesis
  • Maxillofacial surgery
  • Modified osteo-odonto-keratoprosthesis
  • Ocular mucous membrane pemphigoid
  • Severe bilateral chemical injury
  • Stevens-Johnson syndrome

ASJC Scopus subject areas

  • Ophthalmology

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