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

Am J Ophthalmol. 2013 Nov;156(5):867-873.e2. doi: 10.1016/j.ajo.2013.06.012. Epub 2013 Aug 16.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

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