Strampelli's osteo-odonto-keratoprosthesis

Purpose: This presentation is meant for the keratoprosthesis session organized by Christopher Liu. The early technique for "osteo-odonto-keratoprosthesis" described first by Strampelli in 1963 is demonstrated converting the inclusion of an acrylic prosthesis into an "heterotopic autoplastic transplantation" for the management of chemical and thermal burns, autoimmune disease (Stevens-Johnsons, Lyell), trachoma or pemphigoid scarring, etc. Methods: The surgery comprises three phases. Phase 1: Superficial keratectomy, cleaning and repair of the ocular surface and the fornices and transplantation of buccal mucosa from the internal lip onto the ocular surface. Phase 2: Removal of a superior canine surrounded by dentine and bone. After shaping an adequate lamina of tooth and bone a central trephination is performed to receive the optical PMMA cylinder which is glued into place with dental glue. Then the entire block is placed into the inferior orbital space for biointegration. Phase 3 consists in removal of the osteo-odonto-keratoprosthesis from the orbital socket, dissection of the buccal mucosa, central trephination of the host cornea and fixation of the osteo-odonto.keratoprosthesis into the corneo-scleral bed. Results: Some results and variations of the early technique are illustrated and discussed. Conclusions: Although the technique was primitive and complicated, Strampelli's idea to use autoplastic tissue to incorporate the artificial prothesis into the ocular surface has to be coinsidered of great importance for the evolution of modern techniques of keratoprosthesis implantation.