Pradeep’s parents brought him to Sankara Nethralaya in 2005. He underwent 2 procedures – one in July and the other in October 2005. Today he enjoys 6/9 vision for distance and N6 for near in one eye, a vision that is almost normal. One year later, he is leading a normal life.
In 2003, Sankara Nethralaya created history in India, becoming the first eye hospital to perform a surgery called MOOKP (Modified Osteo Odonto Kerato Prosthesis). This procedure helps to restore the vision of people whose eyes have been extensively damaged because of injury or disease or accidents. This surgery will benefit those with a damaged cornea and also a damaged ocular surface, but with an intact and functional retina and optic nerve. The cornea, the clear portion of the eye in front through which light passes into the eye, is rightly called the ‘window to see the world’. In eyes where the cornea and ocular surface are severely damaged, even if a cornea were to be transplanted, it would lose its clarity after a few months as the surgery might fail.
MOOKP procedure requires the co-ordinated teamwork of varied specialties and was headed by Dr G Sitalakshmi, Director, Cornea Services, Sankara Nethralaya. Dr G Sitalakshmi was the first woman surgeon who performed this marathon surgery in the world.
The modified osteo-odonto keratoprosthesis (MOOKP) surgery is an excellent option for patients in whom the conventional corneal transplant from a cadaver fails because these eyes are too dry and patients with corneal blindness with severe ocular surface damage. In end stage disorders, the cornea along with the ocular surface and the limbal stem cells are damaged to an extent that prevents even stem cell transplant from being viable. This kind of a picture is usually seen following chemical injuries of the eye or Stevens Johnson Syndrome (a form of severe drug allergy) wherein the ocular surface is totally damaged with the rest of the internal structures of the eye being functional.
Synthetic keratoprosthesis are wrought with complications, especially of being extruded from the eye in severely dry eyes. In MOOKP, the patients own tooth is used to support an optic cylinder, which is then placed over the eye providing the clear window, required for vision.
The MOOKP procedure is done in two stages 4-5 months apart. Each stage lasts 6-8 hours and in a few patients multiple surgeries might be required. Surgery is scheduled after satisfactory assessment of the retina and the optic nerve in the eye, teeth and the patients’ psychological status. In the first stage the patient’s canine tooth is harvested and flattened into a lamina. A hole is drilled in the centre into which the cylinder is cemented to form the prosthesis. This prosthesis is temporarily placed in a pocket below the skin of the other eye where it develops a soft tissue covering over the next 4-5 months. Also in the first stage, a 3 cm diameter of mucous membrane is removed from the inside of the cheek and is used to cover the sclera of the eye.
In the second stage, the prosthesis is removed from under the pocket and after adequate preparation of the eye structures; it is placed behind the mucous membrane graft on the eye, such that only the cylinder protrudes out of the eye. This clear window now enables the patient to see and also reduces the chances of extrusion of the prosthesis out of the eye. This is because the patients own biological tissue is used and an environment simulating the mouth is created in the eye.As with the other keratoprostheses, the MOOKP procedure does have its risk of complications, but the main advantage is its ability to withstand a dry keratinized ocular surface. The need for a regular follow up is therefore mandatory.
The late Italian surgeon Benedetto Strampelli MD developed the original OOKP technique in the 1960s. The technique was however largely abandoned due to poor results, but was revived back with numerous refinements by another Italian surgeon, Professor GianCarlo Falcinelli MD, termed now as MOOKP, who began achieving good rates of device retention and vision improvement. He currently works for the San Camillo Hospital, Rome and has performed over 275 procedures all over the world. Over the past few years the procedure has undergone further changes and is now available in a few select places in the world where the Professor himself has trained surgeons meticulously.
At Sankara Nethralaya, the Ocular Surface Team has been trained under the personal guidance of Professor Falcinelli over the last three years and is now independently continuing the same with his continued support. Now the Surgery Centre in Sankara Nethralaya is named ‘Prof. G Falcinelli MOOKP Centre’. It is unfortunate that Dr G Sitalakshmi passed away a couple of weeks back, but her team Dr Geetha K Iyer, Dr S Vinay and Dr Bhaskar Srinivasan are continuing the good work.
Contact Details
Sankara Nethralaya
Phone +91 44 28226694, Mobile 98408 21919,
Dedicated Line for Eye Donation in Chennai 2828 1919,
E- mail: api@snmail.org
Report by A P Irungovel, Manager - Medical Sociology & HOD - Eye Bank,
Sankara Nethralaya.
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