Sir, osteo-odonto keratoprosthesis (OOKP), also known as 'tooth in eye surgery', is a unique form of artificial cornea surgery to restore the vision of patients with the most severe, end-stage forms of corneal blindness that are not amenable to corneal transplantation or other forms of surgery.

OOKP was first described by Professor Benedetto Strampelli of San Camillo Hospital in Rome in 1963. It involves creating a support for an artificial cornea from the patient's own tooth and the surrounding bone.1 Later Falcinelli modified the technique in a stepwise fashion and the improved technique was reintroduced into Britain in the mid 1990s using a composite bone-tooth lamina to help anchor a polymethyl methacrylate cylinder to the cornea. This is now known as modified osteo-odonto-keratoprosthesis (MOOKP).2,3 The Falcinelli OOKP (MOOKP), where adequately performed, is now recognised internationally as giving the best, long-term visual and retention results among all keratoprostheses, especially in a dry eye. The MOOKP procedure is carried out in two stages 4–5 months apart. Each stage lasts 6–8 hours and in a few patients multiple surgeries are required.2,3

After intraoral examination and radiography, a tooth is selected (usually single rooted) for use depending on the length and width of the root and surrounding alveolar bone. The tooth to be used must have healthy dentine and buccal tissues. The procedure of extracting the tooth along with alveolar bone still remains technically difficult and requires special training.

The creativity of using a tooth as an eye implant should inspire future interprofessional approaches to ophthalmic practice to provide the best care for patients. OOKP is an example of interdisciplinary patient care in which opthalmologist, dentist, anaesthesiologists and other medical professionals work together in a multi-stage procedure.

References 1 Strampelli B . Keratoprosthesis with osteodontal tissue. Am J Ophthalmol 1963; 89: 1029–1039. 2 Falcinelli G, Barogi G, Taloni M . Osteoodontokeratoprosthesis: present experience and future prospects. Refract Corneal Surg 1993; 9: 193–194. 3 Falcinelli G, Barogi G, Caselli M, Colliardod P, Taloni M . Personal changes and innovations in Strampelli's osteo-odonto-keratoprosthesis. An Inst Barraquet (Barc) 1999; 29: 47–48. Download references

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