Modified osteo-odonto-keratoprosthesis surgery in end-stage corneal blindness

Abstract

The modified osteo-odonto-keratoprosthesis (MOOKP) represents a highly specialized surgical option for visual rehabilitation in patients with end-stage corneal blindness, particularly in those for whom conventional corneal transplants have failed or are contraindicated. This technique involves the use of an autologous osteodental lamina and a polymethylmethacrylate (PMMA) optical cylinder, integrated through multiple surgical stages, and is indicated in conditions such as Stevens-Johnson syndrome, cicatricial ocular pemphigoid, or severe chemical burns. The objective of this study was to analyze the current status, clinical applicability, and future perspectives of MOOKP surgery. A systematic literature review was conducted using the PRISMA 2020 methodology, with an electronic search of the PubMed and Scopus databases, covering studies published between 2019 and 2024. A total of 20 scientific articles meeting quality, topical relevance, and recency criteria were included. The results indicate that MOOKP offers high rates of anatomical retention and functional visual recovery in complex clinical scenarios, although it presents significant challenges such as the need for a viable tooth, surgical complexity, and the risk of postoperative complications. Nonetheless, advancements in synthetic materials and more accessible devices are emerging, which could broaden its applicability and mitigate current limitations. In conclusion, MOOKP remains an effective and biocompatible therapeutic alternative for visual restoration in selected cases, although its future use will depend on technological developments and progress in the prevention and treatment of corneal diseases.