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The osteo-odonto-keratoprosthesis (OOKP), although described over 40 years ago, remains the keratoprosthesis of choice for end-stage corneal blindness not amenable to penetrating keratoplasty. It is particularly resilient to a hostile environment such as the dry keratinized eye resulting from severe Stevens-Johnson syndrome, ocular cicatricial pemphigoid, trachoma, and chemical injury. Its rigid optical cylinder gives excellent image resolution and quality. The desirable properties of the theoretical ideal keratoprosthesis is described. The indications, contraindications, and patient assessment (eye, tooth, buccal mucosa, psychology) for OOKP surgery are described. The surgical and anaesthetic techniques are described. Follow-up is life-long in order to detect and treat complications, which include oral, oculoplastic, glaucoma, vitreo-retinal complications and extrusion of the device. Resorption of the osteo-odonto-lamina is responsible for extrusion, and this is more pronounced in tooth allografts. Regular imaging with spiral-CT or electron beam tomography can help detect bone and dentine loss. The optical cylinder design is discussed. Preliminary work towards the development of a synthetic OOKP analogue is described. Finally, we describe how to set up an OOKP national referral center.

Aims: To determine the indications for penetrating keratoplasty (PK) at the Corneoplastic Unit and Eye Bank, UK, a tertiary referral centre, over a 10 year period. Methods: Records of all patients who underwent PK at our institution between 1990 and 1999 were reviewed retrospectively. Of the 1096 procedures performed in this period, 784 records were available for evaluation (72%). Results: Regrafting was the most common indication, accounting for 40.9% of all cases. Keratoconus was the second most common indication (15%), followed by Fuchs' endothelial dystrophy (9.3%), pseudophakic bullous keratopathy (7.6%), and viral keratitis (5.9%), which included both herpes simplex and herpes zoster and showed a statistically significant decreasing trend using regression analysis (p,0.005). Among the regraft subgroup, viral keratitis accounted for 21.2% as the underlying primary diagnosis. The most common cause for graft failure in the regraft subgroup was endothelial failure (41.8%). Conclusion: Regrafting is the leading indication for PK; viral disease-although declining-is the leading primary diagnosis. P enetrating keratoplasty (PK) is the most common tissue transplant performed in Europe and the United States. Advances in the medical management of certain diagnoses and the adoption of a conservative approach have changed patterns in the indications of PK. Moreover, the decline of certain disorders due to changes in surgical practice, and the emergence of new surgical techniques have largely influenced the changing trend. The indications for PK have continued to change since 1940, 1-3 and investigators have studied the changing trends over the past few decades. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] To update these trends we report the indications for PK from 1990 to 1999, and compare these with indications during an earlier time period at the same institution 4 and to those of other series. PATIENTS AND METHODSA retrospective analysis of records of all cases of PK performed between January 1990 and December 1999 was undertaken. All cases were performed at the Corneoplastic Unit and Eye Bank, UK, a tertiary referral centre for corneal and anterior segment disorders. Of the 1097 PKs performed in this period, only 784 medical records were available for review. Records were not accessible or had been destroyed as patients had not been followed up-either because they lived abroad, transferred to another institution, or had died. Although the indications for PK for the remaining 313 cases could be retrieved from the booking register, we elected not to include these as there was little correlation between the data recorded in the operative note and the register. Information obtained was analysed with respect to age, sex, eye grafted, and preoperative clinical diagnosis. The indications for PK were divided into seven diagnostic categories (fig 1). Regrafts were further analysed for the aetiology of failure of the previous graft and original diagnosis.Statistical significance was determined using ...

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The ophthalmologist may be the first clinician to see a patient who presents with acute facial nerve palsy. Under such circumstances the ophthalmologist should make every effort to establish the underlying cause of the facial palsy and ensure that the patient's cornea is adequately protected. This article reviews the anatomy of the facial nerve, the varied disorders that may cause a facial palsy, a detailed evaluation of such a patient, and the various medical and surgical treatments available.