Long-term functional and anatomical results of osteo- and osteoodonto-keratoprosthesis

  • Ralph Michael
  • Victor Charoenrook
  • Maria Fideliz de la Paz
  • Wolfgang Hitzl
  • Jose Temprano
  • Rafael I. Barraquer



To analyse the functional and anatomical results of keratoprosthesis using tooth and tibial autograft.


We reviewed 227 charts of patients that underwent osteo-keratoprosthesis (OKP) (n = 82) or osteo-odonto-keratoprosthesis (OOKP) (n = 145) at the Centro de Oftalmología Barraquer. Mean follow-up time was 8.4 years for OOKP and 3.5 years for OKP. Kaplan-Meier survival curves with 95% confidence interval (CI) were calculated for functional success, defined as BCVA >0.05. Anatomical success was defined as retention of the keratoprosthesis lamina. Visual Acuity by Time (VAT) Index with 95% CI was calculated for up to 2 years post-OKP and up to 6 years post-OOKP. Maximum visual acuity ever reached after the last step of the implantation of the keratoprosthesis was used as an indicator for the potential of the retina.


Based on Kaplan-Meier analyses, 10-year anatomical survival was 66% (CI 57–76) for OOKP and 47% (CI 27–67) for OKP. Two-year functional survival was 63% (CI 55–71) for OOKP and 49% (CI 37–60) for OKP, and 10-year functional survival was 38% (CI 29–48) for OOKP and 17% (CI 5–28) for OKP. Multivariate analysis showed that neither surgical technique (OOKP or OKP), primary diagnosis nor age had a significant influence on the functional survival. However, a high maximum visual acuity ever reached post-op decreased the risk for functional failure. According to the VAT Index calculations, mean BCVA 2 years after OOKP was 0.33 (CI 0.28–0.41) and after OKP was 0.28 (CI 0.20–0.36).


Although we found a tendency that OOKP had better anatomical results than OKP, this difference was not statistically significant up to 10 years post-op. Functional results for both techniques were not significantly different at the 2-year follow-up, but at 10 years they were. However, this difference was influenced by the retinal potential and not by the technique itself.


Keratoprosthesis Long-term results Tooth Tibial bone Visual acuity 


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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Ralph Michael
    • 1
  • Victor Charoenrook
    • 2
  • Maria Fideliz de la Paz
    • 2
  • Wolfgang Hitzl
    • 3
  • Jose Temprano
    • 2
  • Rafael I. Barraquer
    • 1
    • 2
  1. 1.Institut Universitari BarraquerBarcelonaSpain
  2. 2.Centro de Oftalmología BarraquerBarcelonaSpain
  3. 3.Eye Clinic and Research officeParacelsus Medical University SalzburgSalzburgAustria

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