Osteo-odonto-keratoprosthesis (OOKP), also known as "tooth in eye" surgery, is a medical procedure to restore vision in the most severe cases of corneal and ocular surface patients. It includes removal of a tooth from the patient or a donor. After removal, a longitudinal

lamina Lamina may refer to: Science and technology * Planar lamina, a two-dimensional planar closed surface with mass and density, in mathematics * Laminar flow, (or streamline flow) occurs when a fluid flows in parallel layers, with no disruption betwee ...

is cut from the tooth and a hole is drilled perpendicular to the lamina. The hole is then fitted with a cylindrical lens. The lamina is grown in the patients' cheek for a period of months and then is implanted upon the eye. The procedure was pioneered by the Italian ophthalmic surgeon Professor Benedetto Strampelli in the early 1960s. Strampelli was a founder-member of the International Intra-Ocular Implant Club (IIIC) in 1966.National Dental Centre - 25 May 2005 TOOTH-IN-EYE (OOKP) SURGERY HELP 8 REGAIN SIGHT

Medical uses

An operation to graft the OOKP is undertaken in severe

pemphigoid Pemphigoid is a group of rare autoimmune blistering diseases of the skin, and mucous membranes. As its name indicates, pemphigoid is similar in general appearance to pemphigus, but, unlike pemphigus, pemphigoid does not feature acantholysis, a l ...

chemical burn A chemical burn occurs when living tissue is exposed to a corrosive substance (such as a strong acid, base or oxidizer) or a cytotoxic agent (such as mustard gas, lewisite or arsine). Chemical burns follow standard burn classification and may ca ...

Stevens–Johnson syndrome Stevens–Johnson syndrome (SJS) is a type of severe skin reaction. Together with toxic epidermal necrolysis (TEN) and Stevens–Johnson/toxic epidermal necrolysis (SJS/TEN), it forms a spectrum of disease, with SJS being less severe. Erythema ...

trachoma Trachoma is an infectious disease caused by bacterium ''Chlamydia trachomatis''. The infection causes a roughening of the inner surface of the eyelids. This roughening can lead to pain in the eyes, breakdown of the outer surface or cornea of ...

Lyell syndrome Toxic epidermal necrolysis (TEN) is a type of severe skin reaction. Together with Stevens–Johnson syndrome (SJS) it forms a spectrum of disease, with TEN being more severe. Early symptoms include fever and flu-like symptoms. A few days later th ...

and multiple

corneal graft Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by Corneal button, donated corneal tissue (the graft). When the entire cornea is replaced it is known as penetrating ...

failure. There is a significant risk of anatomical failure of lamina in the long term, estimated at 19% in a small study, with the main risks being laminar

resorption Resorption is the absorption of cells or tissue into the circulatory system, usually by osteoclasts. Types of resorption include: * Bone resorption * Herniated Disc Resorption * Tooth resorption * Fetal resorption * Blood resorption See also ...

, particularly in

allograft Allotransplant (''allo-'' meaning "other" in Greek) is the transplantation of cells, tissues, or organs to a recipient from a genetically non-identical donor of the same species. The transplant is called an allograft, allogeneic transplant, o ...

s, and

glaucoma Glaucoma is a group of eye diseases that result in damage to the optic nerve (or retina) and cause vision loss. The most common type is open-angle (wide angle, chronic simple) glaucoma, in which the drainage angle for fluid within the eye rem ...

. Another, bigger study comparing OOKP with the lesser known osteo-keratoprosthesis (OKP) in 145 and 82 patients and follow-up terms up to 10 years yielded the following statistics: * 10-year anatomical survival: 66% for OOKP and 47% for OKP * 2-year functional survival (visual acuity better than 1.30 logMAR or 20/400 Snellen): 63% for OOKP and 49% for OKP * 10-year functional survival (visual acuity better than 1.30 logMAR or 20/400 Snellen): 38% for OOKP and 17% for OKP Another long-term study of 181 patients puts the chances of retaining an intact OOKP after 18 years at 85%. In 2022, a retrospective study conducted on 82 eyes with OOKP using original Strampelli technique, showed an anatomical survival of 94% up to 30 years of follow-up. The same study also reported a visual acuity better than 1.00 logMAR (or 20/200 Snellen) at 10 years in 81% of the eyes, and a visual acuity of 1.21 logMAR (or 20/324 Snellen) at 30 years.

Procedure

OOKP is a two-stage operation: Stage 1 of the surgery involves five separate procedures: # The eye is opened up and the entire inner surface of the eyelids, corneal surface and all scar tissue is removed # Inner mucosal lining of the cheek is transplanted onto the new surface of the eye # A canine or

premolar The premolars, also called premolar teeth, or bicuspids, are transitional teeth located between the canine and molar teeth. In humans, there are two premolars per quadrant in the permanent set of teeth, making eight premolars total in the mouth ...

tooth and part of the adjacent bone and ligaments are removed # A bolt-shaped structure is fashioned from the tooth-bone complex which is fitted with a plastic optical cylinder # The tooth-bone-cylinder complex is implanted into the patient's cheek to grow a new blood supply Stage 2 (about 4 months later) involves two separate procedures: # The cheek mucosal lining over the eye is opened and the inner contents of the eye are removed # The tooth-bone-cylinder complex is removed from the cheek and inserted into the eye, the mucosal cheek lining is replaced over the implant. At the end of the procedure, light can now enter through the plastic cylinder, and the patient is able to see through this cylinder with good vision.

History

The procedure was pioneered by the Italian ophthalmic surgeon Professor Benedetto Strampelli in Rome in the early 1960s. The son of the geneticist and agronomist

Nazareno Strampelli Nazareno Strampelli (May 29, 1866, in Castelraimondo, Italy – January 23, 1942) was an Italian agronomist and Plant breeding, plant breeder. He was the forerunner of what became known as the Green Revolution of the late 1960s. Strampelli's work a ...

, Benedetto Strampelli held the chair of ophthalmic surgery at Rome's Ospedale di San Giovanni in Laterano where he was one of the first surgeons in Italy to transplant cornea. In 1953 he was the first Italian to implant

intraocular lens Intraocular lens (IOL) is a lens implanted in the eye as part of a treatment for cataracts or myopia. If the natural lens is left in the eye, the IOL is known as phakic, otherwise it is a pseudophakic, or false lens. Such a lens is typically i ...

which were manufactured to his own design by Rayners in UK. Strampelli was a founder-member with Harold Ridley and Peter Choyce of the International Intra-Ocular Implant Club (IIIC) in 1966.

References

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External links

Blind man has sight restored by having tooth implanted in his eye
– Article about a man receiving this procedure

– story about blind man receiving this procedure Dentistry procedures Eye surgery Ophthalmology Surgical procedures and techniques