Osteo-odonto-keratoprosthesis According to Strampelli Original Technique: A Retrospective Study With Up to 30 Years of Follow-up

Abstract

Purpose: To describe clinical, anatomical, and visual outcomes obtained from a long-term follow-up of 59 patients who underwent osteo-odonto-keratoprosthesis (OOKP) using the Strampelli original technique.

Design: Retrospective clinical cohort study.

Methods: The study included 82 eyes of 59 patients who underwent OOKP surgery between 1969 and 2011. Patients' clinical characteristics before surgery as well as complications and further surgeries until the end of follow-up were recorded. Best-corrected visual acuity (BCVA) was revised before surgery and at 1 month, 1 year, and every 5 years until the 30th year of follow-up.

Results: Mean follow-up post-OOKP was 27.4 ± 11.2 years (range, 2.4-52). The most frequent cause of blindness was chemical injuries (71%). OOKP integrity was maintained in 77 of 82 eyes (94%) until the end of follow-up. Excluding cataract, acquired glaucoma was the most frequent complication, with a prevalence at 10 years of 36%. Mean BCVA improved from 2.60 ± 0.32 at presentation to 0.40 ± 0.65 at 1 year and 1.21 ± 1.19 logMAR at 30 years. Overall, 51% of the included eyes attained a BCVA better than 0.05 logMAR, and stabilization of BCVA was observed for the first 10 years of follow-up post-OOKP. Better BCVA outcomes were observed in the Stevens-Johnson syndrome or toxic epidermal necrolysis (SJS/TEN) group, whereas glaucoma was found not to significantly affect visual acuity.

Conclusions: The original OOKP still represents a valid surgical choice, which is durable over time, for restoring vision in end-stage corneal blindness patients who are not eligible for a corneal transplant.