Tooth in Eye Surgery ( OOKP )

What Is Tooth-in-Eye Surgery OOKP?

Tooth in eye surgery OOKP involves using a patient’s tooth to anchor an artificial lens, restoring their ability to perceive light and shapes, or even to regain partial or full vision. The procedure is highly specialized and typically reserved for patients with end-stage corneal disease or total blindness caused by severe ocular surface disorders.

Tooth in Eye Surgery: A Remarkable Innovation in Vision Restoration

In the world of medical science, creativity and innovation often lead to groundbreaking solutions for seemingly insurmountable challenges. One such innovation is the tooth in eye surgery, also known as osteo-odonto-keratoprosthesis (OOKP). This extraordinary procedure uses a patient’s tooth to restore vision in cases where traditional treatments have failed. While it may sound like something out of science fiction, this surgical technique has transformed the lives of individuals with severe corneal damage or blindness. In this article, we will explore the origins, process, benefits, limitations, and future potential of tooth-in-eye surgery.

The Challenge: Severe Corneal Damage and Blindness

Vision loss due to corneal damage is a devastating condition that affects millions worldwide. The cornea, the transparent outer layer of the eye, is essential for focusing light onto the retina. When the cornea becomes severely damaged due to trauma, infection, chemical burns, or autoimmune diseases like Stevens-Johnson syndrome, vision can be irreversibly impaired.

Traditional treatments for corneal damage include:

Corneal transplants: Replacing the damaged cornea with donor tissue.
Artificial corneas: Implanting synthetic materials to mimic the cornea’s function.

However, these options are not always viable. For example:

Corneal transplants require a healthy donor match and carry risks of rejection.
Artificial corneas may fail in patients with extensive ocular surface damage or dry eye syndrome.

For individuals who cannot benefit from conventional treatments, tooth-in-eye surgery offers a ray of hope.

How Tooth In Eye Surgery Works

The surgery consists of two main phases:

Phase 1: Preparing the Tooth and Implant

- A tooth—usually a canine or premolar—is extracted from the patient’s mouth. These teeth are chosen because they provide sufficient bone and root structure.
- A small hole is drilled through the crown of the tooth to hold an optical cylinder (a clear acrylic lens).
- The tooth-lens combination is then implanted into the patient’s cheek or jawbone to allow soft tissue to grow around it.

Phase 2: Attaching the Tooth-Lens Assembly to the Eye

- Once the tooth-lens assembly is ready, surgeons create a pocket in the patient’s eye using tissue from the cheek or other areas.
- The tooth-lens unit is carefully attached to the eye, with the optical cylinder positioned to align with the pupil.
- Over time, blood vessels integrate with the implant, stabilizing it and reducing the risk of rejection.

This innovative approach leverages the body’s natural healing processes, ensuring compatibility and minimizing complications.

Benefits of Tooth in Eye Surgery

Biocompatibility: Since the tooth comes from the patient’s own body, there is virtually no risk of immune rejection, a common issue with corneal transplants or artificial implants.
Durability: The tooth provides a strong foundation for the artificial lens, making it less prone to dislodging or failing over time.
Improved Vision Outcomes: Many patients experience significant improvements in visual acuity after the procedure, ranging from perceiving light and movement to regaining functional vision.
Customization: Each procedure is tailored to the individual, taking into account their unique anatomy and needs.
Hope for “Untreatable” Cases: Tooth-in-eye surgery offers a lifeline to patients who would otherwise remain blind due to being unsuitable candidates for traditional treatments.

Limitations and Challenges

While tooth-in-eye surgery is a remarkable advancement, it is not without its drawbacks:

Complexity and Expertise Required: The procedure is highly intricate and demands exceptional skill from both the ophthalmic surgeon and dental specialist. Only a handful of centers worldwide offer this treatment.
Cost: Due to its complexity and rarity, the surgery can be expensive, limiting access for many patients.
Limited Availability: Currently, only a few countries have facilities equipped to perform OOKP, including Italy (where the technique was pioneered), the United Kingdom, and parts of Asia.
Post-Surgical Care: Patients require meticulous follow-up care to prevent infections and ensure proper integration of the implant.
Partial Restoration of Vision: While many patients achieve meaningful improvements, complete restoration of normal vision is rare. Most retain limited but life-changing sight.

A Brief History of Tooth in Eye Surgery

Tooth-in-eye surgery was first developed in the 1960s by Dr. Benedetto Strampelli, an Italian ophthalmologist. Strampelli sought a solution for patients with severe corneal damage who could not undergo traditional transplants. He discovered that using a tooth as a base for an artificial lens provided stability and biocompatibility unmatched by other materials.

Over the decades, refinements to the technique have improved outcomes and expanded its applications. Today, OOKP remains one of the most advanced forms of keratoprosthesis available.

Real-Life Success Stories

Numerous patients have benefited from tooth-in-eye surgery, regaining independence and quality of life. For instance:

A British woman named Claire Stanbridge, who lost her vision due to Stevens-Johnson syndrome, underwent OOKP and was able to see her newborn child for the first time.
Another patient, Martin Jones from the UK, regained enough vision to recognize faces and navigate his surroundings after years of blindness.

These stories highlight the profound impact of this procedure on individuals and their families.

The Future of Tooth-in-Eye Surgery

As technology advances, researchers continue to refine and expand the possibilities of OOKP. Potential developments include:

Improved Materials: Enhanced lenses and scaffolds could further increase durability and clarity.
Broader Accessibility: Efforts to train more specialists and establish new treatment centers may make the procedure more widely available.
Combination Therapies: Integrating stem cell therapies or gene editing with OOKP could address additional causes of blindness.

Additionally, ongoing studies aim to simplify the procedure and reduce recovery times, making it more accessible to a larger population.

Abstract

Tooth in Eye Surgery
Ludovico Iannetti¹, Marco Liberali², Marta Armentano³, Ludovico Alisi³, Giacomo Visioli³, Davide Mastromarino³, Edoardo Brauner⁴, Giorgio Iannetti⁴

PMID: 35618023
DOI: 10.1016/j.ajo.2022.05.015

tooth in eye surgery جراحة السن في العين

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 Strampelli original technique.

Design

Retrospective clinical cohort study.

Methods

The study included 82 eyes of 59 patients who underwent OOKP surgery between 1969 and 2011. Patients’ clinical characteristics before surgery, as well as complications and further surgeries until the end of follow-up, were recorded. Best-corrected visual acuity (BCVA) was revised before surgery and at 1 month, 1 year, and every 5 years until the 30th year of follow-up.

Results

The mean follow-up post-OOKP was 27.4 ± 11.2 years (range, 2.4-52). The most frequent cause of blindness was chemical injuries (71%). OOKP integrity was maintained in 77 of 82 eyes (94%) until the end of follow-up. Excluding cataracts, 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 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, whereas glaucoma was found not to significantly affect visual acuity.

Conclusions

The original OOKP still represents a valid surgical choice, which is durable over time, for restoring vision in end-stage corneal blindness patients who are not eligible for a corneal transplant.

The Tooth in Eye Surgery: How a Tooth Restores Vision

Imagine being told that your tooth could save your eyesight. It sounds like a plot twist from a sci-fi movie, but this is real life, and it’s called Osteo-Odonto-Keratoprosthesis (OOKP), or the “tooth in eye” surgery. Buckle up as we dive into one of medicine’s most fascinating procedures, where dentistry and ophthalmology collide to create miracles.

Introducing the Tooth in Eye Surgery To The Ophthalmologists

Let’s cut to the chase: OOKP or Tooth in Eye Surgery is a groundbreaking surgery that uses a patient’s tooth to restore vision in people with severe corneal blindness. Yes, you read that right—a tooth becomes part of the eye! This procedure is reserved for cases where traditional cornea transplants fail, often due to burns, injuries, or diseases like Stevens-Johnson syndrome.

The star of the show? A canine or premolar tooth (don’t worry, you have extras!). This tooth is sculpted into a tiny biological “frame” that holds an artificial cornea, acting like a window to let light back into the eye.

The Wild History of Tooth In Eye Surgery OOKP: From Italy to the World

The “tooth in eye” concept began in 1960s Italy, but it was Professor Giancarlo Falcinelli, an Italian ophthalmologist, who revolutionized the technique in the 1990s. His refinements turned OOKP from a last-ditch effort into a life-changing solution with a high success rate.

But here’s the twist: While Falcinelli pioneered the method in Rome, Singapore became a global hub for OOKP. Surgeons at the Singapore National Eye Centre (SNEC) adopted his technique, offering hope to patients across Asia. Talk about teamwork!

How Does the Tooth in Eye Surgery Work?

Let’s break down this medical marvel step by step:

Tooth Extraction: A dentist removes a tooth (usually a canine) along with part of its root and jawbone.
Tooth Sculpting: The tooth is trimmed into a tiny “button” and drilled to fit a plastic optical cylinder (the artificial cornea).
Cheek Muscle Graft: A piece of cheek tissue is placed in the eye to boost blood supply.
Tooth Meets Eye: Weeks later, the tooth-cylinder combo is implanted into the eye, secured by the patient’s tissue.

The result? Light enters through the artificial cornea, bypassing the damaged natural one, and “voilà!”, vision is restored.

Meet the Italian Visionary: Professor Giancarlo Falcinelli

Professor Falcinelli isn’t just an ophthalmologist; he’s a pioneer who refused to accept “untreatable” as a final diagnosis. His work on OOKP turned a radical idea into a globally recognized procedure. By using the patient’s tissue, he minimized rejection risks and maximized success rates.

His collaboration with surgeons in Singapore helped spread OOKP’s reach, making it a go-to solution for complex cases. As Falcinelli once said, “The eye and tooth are unlikely partners, but together, they create magic.”

OOKP in Singapore: A Beacon of Hope

Singapore’s SNEC is now a leader in OOKP surgeries, thanks to Falcinelli’s legacy. Patients from around the world travel here for the procedure, which boasts a success rate of over 70% for maintaining vision long-term. The SNEC team even trains surgeons globally, ensuring this life-changing surgery keeps spreading.

Real-Life Success Stories

John, 45: After a chemical burn left him blind, John’s left canine tooth gave him 20/60 vision. He now reads emails and watches sunsets again.
Aisha, 32: A Stevens-Johnson syndrome survivor, Aisha called OOKP “a second birth.”

These stories highlight why OOKP isn’t just science, it’s a testament to human ingenuity.

Risks and Considerations

OOKP isn’t a walk in the park. It involves multiple surgeries, a long recovery, and risks like infection or device loosening. But for those out of options, it’s a gamble worth taking. As one patient put it: “A tooth for vision? I’d do it twice!”

The Future of “Tooth in Eye” Surgery

Researchers are exploring synthetic materials to replace the tooth (good news for the tooth-averse!). However, the biological bond of a patient’s own tissue remains the gold standard. With advances in 3D printing and stem cells, the future of vision restoration looks brighter than ever.

References & Further Reading

Singapore National Eye Centre (SNEC): Case studies on OOKP outcomes.
British Journal of Ophthalmology: “Long-term Results of Osteo-Odonto-Keratoprosthesis” (Falcinelli et al., 2005).
Professor Giancarlo Falcinelli: Lectures and publications on OOKP advancements.
Journal of Clinical Medicine: “Innovations in Corneal Restoration” (2023).

Link to the original study

Conclusion

Tooth in eye surgery represents a triumph of human ingenuity and collaboration between medicine and dentistry. By harnessing the strength and compatibility of a patient’s own tooth, this procedure restores not just vision but hope and dignity to those facing irreversible blindness. While it remains a niche treatment, its success underscores the importance of continued research and innovation in addressing complex medical challenges.

For patients who once thought all was lost, tooth-in-eye surgery proves that even the smallest steps forward can bring immense rewards. As science continues to push boundaries, we can look forward to a future where blindness becomes increasingly treatable—and perhaps, someday, entirely curable.

FAQs

Certainly! Here are concise, expert answers to your OOKP and related FAQs:

Does tooth in the eye surgery work?
Yes, osteo-odonto-keratoprosthesis (OOKP), or “tooth-in-eye” surgery, can restore vision in patients with severe corneal blindness when other treatments fail. Success rates vary but can be high in carefully selected cases, with vision restoration possible for many years.

How to fix an eye tooth?
If “eye tooth” refers to the canine tooth, treatment depends on the issue—orthodontic alignment, extraction, or restoration may be needed. If you meant OOKP, only specialized surgeons can manage or revise complications from the procedure.

When was tooth in eye surgery invented?
OOKP was developed in the 1960s by Italian ophthalmologist Professor Benedetto Strampelli. It was later refined by others, including Dr. Falcinelli, and remains one of the most complex vision-restoring surgeries today.

Is SMILE eye surgery safe?
Yes, SMILE (Small Incision Lenticule Extraction) is a minimally invasive laser procedure for vision correction. It is generally safe, with fewer dry eye issues and a faster recovery than LASIK, but may not suit everyone.

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