Treatment of Retinal Detachment in Osteo-odonto Keratoprosthesis (OOKP)

Cesare Forlini, Adriana Bratu, Matteo Forlini, Paolo Rossini, (Ravenna, Italy)

The patient of this video was a 21 years old male with an uncertain clinical history of bilateral congenital cataract extraction and multiple surgeries for retinal detachment. One eye was enucleated for bulbar phtisis. His only eye underwent an OOKP implant according to Falcinelli for a corneal decompensation and was not amenable for an ulterior PK. The patient came to our observation with a visual acuity of uncertain light perception due to a thick cyclitic membrane, which didn’t allow fundus visualization. The OOKP consists in a single rooted tooth with its surrounding alveolar bone used as a carrier for a PMMA optical cylinder therefore not even an ecografy could give us further information on the retina. As a first approach we decided to remove the membrane with a mini-invasive 25 gauge vitrectomy system but we soon realized that this method was ineffective, so we enlarged a sclerotomy and checked the eye from the inside with an endoscopic probe. At this point we found out that there was a total rhegmatogenous-tractional retinal detachment with PVR, so we changed strategy and preceded removing the OOKP and performing a 20 gauge vitrectomy. We opened the anterior scleral surface using a 7.25 mm Franceschetti trephine and, after checking the infusion with the endoscopic probe, the thick cyclitic membrane is totally removed with scissors and PFCL is injected “open-sky” in the vitreous chamber. After positioning a Landers temporary keratoprosthesis, a 20 gauge vitrectomy is performed using a wide-angle viewing system (BIOM). Epiretinal membranes are removed bimanually, using an endoillumination probe with pic. IGCassisted ILM peeling is also performed. After a 360*DG* endolaser photocoagulation, 1000 cs silicone oil is used to tamponade the retina and the OOKP is finally repositioned and centered on the visual axis. Patient visual outcome was 1/10 at 1 year follow-up.