Osteo-odonto-keratoprosthesis is generally seen as a last resort option for cases where patients are unsuitable for synthetic grafts or where corneal grafts/transplants haven’t survived in the eye due to extensive scarring or rejection. “While there is not a large demand for the surgery in Australia due to the low number of cases of corneal blindness, the extremely difficult and technically challenging surgery is a wonderful gift to give to Australians who have been without sight for many years, sometimes, their entire life,” said Dr Webber. Both Dr Webber and Dr Moloney modified and adapted the procedure after watching it performed in Europe – technically making their procedure a world-first. The modification involved creating a better blood supply to the tissue placed onto the front of the eye, by rotating some tissue, with its own blood supply, from the patient’s scalp into the damaged eye. The aim was to prevent the bone around the tooth dissolving and reducing the failure rate of the surgery even further. “The reason this operation usually fails is because the tooth extrudes itself from the eye due to a lack of blood supply,” he said. The success of both procedures means Dr Webber is hopeful that his adaptation will be an improvement of the already high success rate of the surgery for deserving Australians. After the recent second stage of surgery, and a week in hospital, both patients have successfully returned to their respective homes and will be followed closely for the rest of their lives. According to Dr Webber, the procedure is performed in two stages: 1a. The first stage involves preparing and “tidying up” the front surface of the eye. A mucosal tissue graft is then harvested from inside the patient’s cheek and secured to the surface of the eye by draping it over the cornea and sewing it to the muscles that move the eye. 1b. A tooth, usually the third or “canine” tooth, is then delicately removed as a block, with the surrounding bone and tissue left intact. The tooth and surrounding bone is then cut down in size, shaped and contoured before drilling a fine hole through the centre of the tooth allowing a small optical cylinder to be cemented into place. 1c. The tooth is then placed into a pocket created in the cheek under the person’s opposite eye. It stays in the cheek for approximately three months until a tissue covering grows onto the tooth and its surrounding bone. 2a. During the second stage, the mucosal tissue that was previously draped and sewn over the surface of the eye is raised up allowing the surface of the eye (cornea) to be seen. A hole is then made in the cornea and some volume along the lens is removed from the front of the eye. 2b. The tooth, with the optic cylinder glued into it, is removed from the cheek pocket and then placed into the front eye. It is sewn into place “watertight” by utilising the tissue that has grown around it. 2c. Once complete, the mucosal graft is returned to its original position by draping it over the tooth and making a small hole so that the optic penetrates the mucosa and “pokes through”, allowing light to enter the eye and thus creating vision. 30 Pindara Magazine 2017
Pindara Private Hospital Magazine - Issue Ten
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