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Keratoprostheses: Are Osteo-Odonto-Keratoprostheses still up to date?
Hille K.,
Universitätskliniken des Saarlandes, Augenklinik und Poliklinik (Homburg/Saar)
In patients with disturbance of the environment of the ocular surface like in severe sicca syndrome (Fuchs-Steven-Johnson-Syndrome), symblepharon (ocular pemphigoid) or severe vascularisation of the cornea (ocular burns) the success of keratoplasties is limited even if modern procedures are used as there are transplantation of limbal stem cells and immune suppressive therapy. Following multiple graft rejections the risk of repeated rejections is high even with matched material and especially in patients with anatomic pathology of the anterior segment or silicon oil tamponade. For such patients the implantation of a keratoprosthesis is a therapeutic alternative. To replace the cornea with alloplastic materials the permanent fixation of the optic system on the surface of the body is the mayor problem. Therefore Keratoprostheses conventionally consist of an optical cylinder made of PMMA and a support. The latter may be fabricated from the same material as the optical cylinder, as well as from biocompatible material as there is Dacron or from biologic substance like bone or dentin. While prostheses made entirely from PMMA (Cardona type) imply a high risk of endophthalmitis and expulsion is common within few month, the survival of prosthesis with a biocompatible support is longer. Due to our own experience and according to the literature we found that the osteo-odonto-keratoprosthesis made of the root of a tooth of the patient embedded by the maxillary bone has the best long-time survival of all available keratoprostheses. Therefore, even if it is necessary to scarify a tooth of the patient, the osteo-odonto-keratoprosthesis is still the gold standard and all new methods of fixation should be compared with it.