Osteo-odonto-keratoprosthesis (OOKP), commonly referred to as “tooth-in-eye” surgery, is a remarkable and complex surgical procedure designed to restore vision in patients who are blind due to severe corneal damage, particularly when all other treatments have failed. Developed over 60 years ago by Italian ophthalmic surgeon Benedetto Strampelli, OOKP is now performed in select centers worldwide, including recent adoption in Canada.
OOKP is a two-stage operation that utilizes a patient’s own tooth and surrounding bone to create a biologically compatible support for an artificial corneal lens. The process begins with the selection and extraction of a canine tooth, chosen for its robust root structure. The tooth, along with a segment of the surrounding jawbone, is shaped into a rectangular lamina, and a hole is drilled into it to fit a plastic optical cylinder, which will serve as the new “window” for vision.
This tooth-lens composite is then implanted into the patient’s cheek for approximately three months. During this time, the structure becomes enveloped by living tissue, which is crucial for its long-term integration and survival once transplanted into the eye.
Simultaneously, a patch of mucous membrane is harvested from inside the patient’s cheek and grafted onto the surface of the damaged eye, replacing the scarred or diseased corneal tissue. This graft provides a healthy, vascularized surface to support the eventual implant.
After the initial healing period, the second stage of surgery commences. The cheek-implanted tooth-lens structure is retrieved, and the eye is prepared by removing the damaged iris and lens. The composite is then inserted into the eye, and the mucosal graft is repositioned over it, with an aperture cut to allow light to reach the optical cylinder.
OOKP is reserved for patients with bilateral corneal blindness where the retina and optic nerve remain functional, but the cornea is irreparably damaged. Ideal candidates often include those with severe dry eye from autoimmune diseases, chemical or thermal burns, Stevens-Johnson syndrome, or other conditions that have led to total corneal scarring and blindness.
The procedure is not suitable for all types of blindness; it specifically targets cases where the ocular surface is destroyed but the internal eye structures are intact. Patients typically begin to regain vision about a month after the final surgery, and studies have shown that the restored vision can be maintained for decades, significantly improving independence and quality of life.
While OOKP offers a life-changing solution for some, it is a highly specialized, labor-intensive, and invasive procedure that requires collaboration between ophthalmologists and dental surgeons. It is available in only a handful of countries, including Australia, the UK, Japan, Germany, India, and now Canada.
The surgery places significant demands on both patients and medical teams, involving multiple operations, lengthy recovery periods, and rigorous follow-up care. Despite these challenges, the rewards are substantial, with many recipients regaining enough sight to navigate independently, read large print, and perform daily activities without assistance.
OOKP stands out as one of the most advanced examples of using one part of the body to restore function in another, akin to skin or tissue grafts for burns or reconstructive surgery. Its success demonstrates the potential of interdisciplinary approaches in medicine, inspiring further innovation in the treatment of complex conditions.
OOKP or “tooth-in-eye” surgery is a pioneering, last-resort option for restoring vision in select patients with end-stage corneal blindness. It combines dental and ophthalmic expertise and, though demanding, offers the possibility of sight to those who would otherwise remain blind.
More information is available here.
Image: Dr. Greg Moloney. A canine tooth (aka eyetooth) is fitted with a plastic optical lens before being embedded in a patient’s cheek to grow a layer of tissue.
You must be logged in to post a comment.