Initial Experience With Tibial-Bone-Based Keratoprosthesis For Bilateral End-Stage Mucous Membrane Pemphigoid: A Case Series

Bilateral limbal stem cell deficiency (LSCD) due to Mucous Membrane Pemphigoid (MMP) presents a challenge in treatment. When LSCD coincides with dry surface and shallow fornices, Boston Keratoprosthesis is contraindicated. In such scenarios, Osteo-odonto-keratoprosthesis (OOKP, tooth-in-eye surgery) is a viable option. When patients also have inadequate dentition for OOKP - a final recourse may be considered: Osteo-kerato-prosthesis surgery (OKP). This procedure involves extracting a cortical bone block from the patient's shin and sculpting it to serve as a rigid biological anchor for a PMMA corneal prosthesis, subsequently implanted into the patient's eye. We present herein the initial four OKP cases conducted at our institution.    

Ophthalmology and Orthopedics departments at a tertiary hospital

The department's cornea clinic encountered four cases involving patients with bilateral mucous membrane pemphigoid (MMP) and inadequate dentition for OOKP. All patients underwent OKP surgery performed by a multidisciplinary team comprising cornea, oculoplastics, and orthopedic surgeons. This report will briefly outline this complex surgery. Assessments conducted one to three years post-surgery revealed good outcomes: one patient achieved a vision of 6/9, another attained 6/12, a third reached 6/15, while tragically, one patient succumbed to Covid-19 complications three weeks after the surgery. 

OKP likely represents the ultimate option for patients suffering from bilateral end-stage LSCD stemming from MMP, especially when they exhibit inadequate dentition, rendering them unsuitable candidates for OOKP. This surgical procedure is complex, long (averaging around 12 hours per patient), and necessitates a multidisciplinary team. Our preliminary experience with three out of four patients yielded relatively favorable outcomes.