What is Tooth-in-Eye Surgery?

Imagine a surgery that uses your own tooth to restore your eyesight. Sounds like the stuff of science fiction novels, right? Well, there is an ophthalmic procedure that does just that. Osteo-Odonto-Keratoprosthesis (OOKP), also known as “tooth-in-eye” surgery, was first developed in Rome in the early 1960s by an ophthalmic surgeon named Professor Benedetto Strampelli. This procedure is reserved for cases where traditional solutions are not possible due to the amount of damage in the eye, or other complications such as trauma, disease, autoimmune disorders, or multiple failed corneal transplants.

Why use a Tooth?

The tooth provides stability as well as blood supply to the eye and as such, a healthy tooth must be used for the procedure. In most cases, a single root tooth such as the canine is used as this tends to provide the best fit. Advancements in medicine have significantly improved the success rate of this treatment, but it still remains a highly specialised and technical procedure that is reserved for cases where all other options have been exhausted.

The steps of Tooth-in-Eye surgery

Tooth-in-eye surgery takes place over two stages.

In the first step of the surgery, there are five different procedures that are done:

1. The eye is opened up and the inner lining of the eyelid, the front surface of the cornea (the clear part at the front of the eye), and scar tissue is taken out.
2. A special lining from the inside of the cheek is put on the new surface of the eye.
3. A tooth, most often a canine or premolar, along with some of the bone and ligaments around it, is taken out.
4. The tooth and bone are shaped like a bolt, and a clear plastic tube is put on it.
5. This tooth-bone-plastic tube structure is put into the patient's cheek, where it starts to get a new blood supply to keep it alive while the eye recovers for the next step.

After a recovery period of about 4 months, the second step of the surgery is done in two parts:

1. The lining on the cheek over the eye is opened, and the inside part of the eye is taken out.
2. The tooth-bone-plastic tube structure is taken out from the cheek and put into the eye. Then, the lining from the cheek is put back over this structure.

After this whole process, light is now able to go through the plastic tube, allowing the patient to see through their eye again with good vision.

Benefits:

• Restoration of Vision: Tooth-in-eye surgery is primarily performed as a last resort for patients who have severe corneal damage or have exhausted other treatment options. The significant benefit is the potential restoration of vision, which can significantly improve a patient's quality of life.
• High Success Rate: Advances in medical technology and surgical techniques have improved the success rate of OOKP over the years. When performed by a skilled surgeon, the procedure can be highly effective in restoring functional vision. As of February 2023, the anatomic success rate for this procedure stands at 93.9%.
• Long-Term Solution: Unlike some other eye surgeries, OOKP can provide a long-term solution for patients with severe corneal issues. It can be especially beneficial for individuals who cannot undergo traditional corneal transplantation.
• Bespoke Treatment: Tooth-in-eye surgery is tailored to the specific needs of each patient. The choice of tooth and the procedure's customization ensure that it is a personalised approach to vision restoration.

Limitations:

• Complexity: Tooth-in-eye surgery is an intricate and complex procedure that requires a highly specialised surgeon with extensive training and experience. Not all ophthalmologists are qualified to perform it, which can limit accessibility.
• Surgical Risks: As with any surgical procedure, tooth-in-eye surgery carries inherent risks. There is a risk of infection, complications related to the implanted tooth, or issues with the plastic tube.
• Poor Aesthetics: The eye will not look the same as a natural eye after the surgery, and its appearance will be different from what the patient and others are accustomed to. Some individuals may find this aspect challenging.
• Long Recovery Period: As the surgery is performed in two stages, with several months between each stage, this prolonged recovery period can be physically and emotionally demanding for patients.
• Specialised Aftercare: Patients who undergo tooth-in-eye surgery will require ongoing specialised care and monitoring to ensure the success and health of the implanted tooth and tube structure.
• It’s a Last Resort: Tooth-in-eye surgery is reserved for cases where traditional corneal transplantation is not possible due to the extent of damage or other complications. It is not a first-line treatment and is typically considered when all other options have been exhausted.

Tooth-in-eye surgery offers hope and the potential for restored vision in cases where other treatments are ineffective or impossible. However, it is an incredibly technical and difficult procedure that requires a skilled ophthalmologist with specialised training to perform successfully.

While the results may not aesthetically resemble a regular human eye, tooth-in-eye surgery provides an invaluable last resort to restore sight to patients that have run out of alternative options. We don’t perform tooth-in-eye surgery at Optimax, but it is essential for patients and their healthcare providers to carefully weigh the potential benefits against the drawbacks of this procedure before pursuing this option. If you are interested in learning more about tooth-in-eye surgery, we advise you to speak to a qualified ophthalmologist.