Tooth-in-eye standardized longitudinal radiological CT monitoring: Clinical impact in a fourteen-year series

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PURPOSE: Report the natural history of laminar resorption quantitatively and qualitatively on serial CT after sight-restoring osteo-odonto-keratoprosthesis (OOKP) surgery, conduct OOKP survival analysis, and describe how standardized CT monitoring using a three-prong approach aids clinical evaluation and management, including decision-making for prophylactic OOKP exchange. METHOD: CT data of OOKPs consecutively recruited over a 14-year period since program inception were retrospectively evaluated for laminar resorption on (1) linear measurements, (2) volumetry, (3) cross-sectional imaging and three-dimensional rendering. Findings in relation to ophthalmic complications on clinical follow-up were described, and OOKP Kaplan-Meier survival analysis performed. RESULTS: 40 OOKPs (38 patients, mean age 39.9 years, 22 men) underwent a total of 197 serial CTs (average 3.9 scans per OOKP at 1.4-year intervals over 5.5-year follow-up). They charted a wide time range to first significant CT resorption (4.7 months-10.0 years): median time 3.6 years, and moderate/severe resorption < 5 years in 8/9 (88.9 %) OOKPs. Survival analysis showed steady laminar resorption beyond 2.3 years in Stevens-Johnson syndrome (SJS) patients, compared to less progressive resorption in non-SJS patients. Manual linear measurements were more sensitive than automated volumetry to laminar resorption, especially for the more commonly affected thinner and superior/inferior poles. Moderate/severe resorption culminated in OOKP failure and ocular loss in three patients; two showed preceding telltale peri-optic erosions despite clinical stability. Three other patients underwent prophylactic OOKP exchange to salvage vision. CONCLUSIONS: Lifelong, standardized three-prong CT monitoring for OOKP resorption value-adds to clinical evaluation, assisting decision-making for early intervention to avert irrevocable blindness.

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