The Asia-Pacific Journal of Ophthalmology

Asia-Pacific Journal of Ophthalmology:

Issue 1, January/February 2019 Original Study - Clinical

Anesthesia Considerations in Modified Osteo-Odonto-Keratoprosthesis

Raman, Sonali; Singh, Sumeer; Jagdish, V.

Author Information

From the *Department of Anesthesiology, Sankara Nethralaya Eye Hospital; and †Elite School of Optometry, Chennai, Tamil Nadu, India.

Reprints: Sonali Raman, Department of Anesthesiology, 18, College Road, Sankara Nethralaya, Chennai-600 006, Tamil Nadu, India. E-mail:


Purpose: To elucidate anesthesia-related challenges in patients who underwent modified osteo-odonto-keratoprosthesis (MOOKP).

Design:  Retrospective cohort study.

Methods: Medical records of consecutive patients who underwent MOOKP surgery between January 2007 and January 2015 were reviewed. Data including demographic details, systemic comorbidities, indications for MOOKP, and anesthesia techniques at various stages of MOOKP were collected and analyzed.

Results: A total of 74 patients (47 men, 27 women) were included in this study. The mean age of the patients was 29.7 ± 9.1 years. The most common indication for MOOKP was Stevens–Johnson syndrome (53%), followed by chemical burn (38%). In all stages of the MOOKP procedure, 94.6% of patients were American Society of Anesthesiologists (ASA) grade II, whereas 5.4% were ASA grade III. Mallampati score 1 was found in 79.7% of patients in stage 1A, 82.4% of patients in stage 1B + 1C, and 81.1% of patients in stage 2. Recovery grade of 10 was noted in all patients at all stages of the MOOKP procedure. Intubation in the second attempt was carried out in 8 patients and oral intubation in stage 1B + 1C was performed in 4 patients. Difficulty in intubation was noted in 3 patients in stage 1A, 4 patients in stage 1B + 1C, and 1 patient in stage 2.

Conclusions: In patients undergoing MOOKP, a good preoperative anesthetic evaluation and intraoperative anesthesia plan before each stage could help in successful administration of anesthesia in these patients.

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