Long-term outcomes of osteo-odonto-keratoprosthesis surgery: Results for the United Kingdom national cohort

INTRODUCTION: The osteo-odonto-keratoprosthesis (OOKP) is the most durable device among all keratoprostheses (KPros) to date. The aim of this study was to present a brief overview of the long-term outcomes and key lessons learned from this cohort. METHODS: A retrospective review of OOKP patient records who completed at least one year of follow-up was conducted. Visual outcomes, complications, and laminar survival were analyzed. Kaplan-Meier survival curves with the log-rank test were used to assess for statistically significant differences between groups. RESULTS: A total of 64 patients were included in this study; 65 eyes had complete OOKP procedures. In total, 60 tooth autografts, 11 tooth allografts, and 3 tibial grafts were implanted in this cohort. Stevens-Johnson syndrome (SJS) was the most common indication for OOKP (43%, n = 27), while glaucoma was the most frequent complication (86%, n = 57). The probability of retaining a functioning OOKP lamina for autografts was 91% over 18 years ( P = 0.001) and over 15 years. After 10 years of follow-up, 59% ( n = 13/22) of eyes with surviving laminae had a visual acuity (VA) of 6/12 or better, and 82% ( n = 18/22) had vision better than 6/60. Eyes with autografts showed a 34% probability of retention of 6/12 or better VA and a 71% probability of retaining VA between 6/12 and 6/60 ( P = 0.332). CONCLUSION: SJS was the most common diagnosis. Endophthalmitis was the common cause of visual loss, and glaucoma was the common cause of lack of visual improvement after OOKP. Overall, OOKP offers excellent long-term anatomical retention of the lamina and visual restoration.