Mucosal complications of modified osteo-odonto keratoprosthesis in chronic Stevens-Johnson syndrome.

Abstract

PURPOSE:

To describe clinical outcomes of complications afflicting the autologous oral mucous membrane graft after modified osteo-odonto keratoprosthesis surgery in chronic Stevens-Johnson syndrome (SJS).

DESIGN:

Prospective case series.

METHODS:

This study included 30 eyes of 30 patients with SJS-induced dry keratinized ocular surfaces; the patients underwent various stages of this procedure between August 2009 and February 2012. Mucosal complications were classified as either necrosis or overgrowth. Mucosal necrosis was managed according to a predesigned algorithm based on timing (pre- and postimplantation) and location (central or peripheral) of necrosis. Cases with mucosal overgrowth underwent mucosal debulking and trimming.

RESULTS:

Mucosal necrosis developed in 15 (50%) eyes and overgrowth in 4 (13.3%) eyes. Preimplantation necrosis (n = 7) was initially managed conservatively, but 2 eyes required free labial-mucous membrane grafting for persistent corneal exposure. Free labial-mucous membrane grafting was performed in all cases of postimplantation necrosis (n = 10), but 8 eyes required additional tarsal pedicle flaps (n = 6, for peripheral necrosis) or through-the-lid revisions (n = 2, for central necrosis). Debulking and trimming effectively managed all cases of mucosal overgrowth, but 3 eyes required repeat procedures. At 24.1 ± 6.5 months postimplantation, the keratoprosthesis was retained in all eyes, and the probability of maintaining 20/60 or better vision was similar in eyes with or without mucosal necrosis (86 ± 8.8% vs 80 ± 10.3%).

CONCLUSIONS:

Mucosal complications, especially necrosis, occurred commonly following modified osteo-odonto keratoprosthesis surgery in dry keratinized post-SJS eyes. The algorithm-based management approach described in this study was successful in treating these complications, retaining the prosthesis and preserving useful vision.

• Authors: Sayan Basu, Vinay Sukumara Pillai, Virender S Sangwan
• Journal: American journal of ophthalmology (Am J Ophthalmol) Vol. 156 Issue 5 Pg. 867-873.e2 (Nov 2013) ISSN: 1879-1891 [Electronic] United States
• PMID: 23958700 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Alveolar Process (transplantation)
• Autografts
• Chronic Disease
• Corneal Diseases (physiopathology, surgery)
• Corneal Transplantation (methods)
• Cuspid (transplantation)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Mouth Mucosa (pathology, surgery)
• Necrosis
• Postoperative Complications
• Prospective Studies
• Prostheses and Implants
• Stevens-Johnson Syndrome (physiopathology, surgery)
• Treatment Outcome
• Visual Acuity (physiology)
• Young Adult