Osteo-odonto-keratoprosthesis according to Strampelli original technique: a retrospective study with up to 30 years of follow-up

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 original Strampelli technique. Design: retrospective clinical cohort study. Methods: 82 eyes of 59 patients who underwent OOKP surgery between 1969 and 2011 were included. Patients’ clinical characteristics before surgery as well as complications and further surgeries until the end of follow-up were recorded. 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 (2.4-52). The most frequent cause of blindness was chemical injuries (71%). OOKP integrity was maintained in 77 out of 82 eyes until the end of follow-up (94%). Excluding the 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 a 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, while glaucoma showed not to significantly affect visual acuity. Conclusions: the original OOKP still represents a valid surgical choice, durable over time, for restoring vision in end-stage corneal blindness patients not eligible for a corneal transplant.