Lifelong experience of modified osteo-odonto-keratoprosthesis implantation over 50 years

The osteo-odonto-keratoprosthesis (OOKP) is a biological implant indicated for the treatment of eyes affected by corneal blindness, not amenable for keratoplasty. The purpose of the study is to report the long-term outcomes of patients undergone Falcinelli's modified OOKP (MOOKP). In this retrospective study, anatomical and functional survival rates were evaluated using Kaplan-Meier analysis, according to eye coverage (buccal mucosa vs skin). Best-corrected visual acuity (BCVA) was recorded before and after surgery along with intraoperative and postoperative complications. 310 eyes of 269 patients affected by corneal blindness underwent MOOKP and were followed up for 15.9±12.0 years (up to 45 years). Anatomical survival rates for eyes covered by buccal mucosa were 85.1% at 20 years (number at risk (n)=81) and 82.3% at 45 years (n=10). Functional survival rates were 70.7% at 20 years (n=74) and 56.5% at 45 years (n=7). Anatomical and functional survival rates for eyes covered by skin were 58.9% (n=3) and 37.0% (n=3) at 20 years, respectively. Survival rates were significantly lower for eyes covered by skin (p<0.001). Postoperative BCVA at the last follow-up visit was significantly higher compared with baseline (0.88±1.08 LogMAR vs 2.49±0.38 LogMAR; p<0.001). The most threatening complications were glaucoma (n=70, 22.6%), endophthalmitis (n=24, 7.7%), retinal detachment (n=20, 6.4%), instability/tilting/expulsion of the optical cylinder and expulsion of the prosthesis (n=24, 7.7%). MOOKP showed excellent long-term anatomical and functional survival rates. Visual acuity significantly improved as soon as 3 months postoperatively and remained unchanged in about two-thirds of patients throughout the entire follow-up.