7 Shocking Facts About 'Tooth-In-Eye' Surgery (OOKP) That Restores Vision

The concept of implanting a tooth into an eye sounds like science fiction or a medical horror story, but it is a genuine, life-changing surgical procedure. Medically known as Osteo-Odonto-Keratoprosthesis (OOKP), or simply "tooth-in-eye" surgery, this complex, multi-stage operation is a last-resort treatment for patients suffering from the most severe forms of corneal blindness. As of today, December 10, 2025, OOKP remains the most successful long-term option for vision restoration in specific, devastating ocular conditions where traditional corneal transplants have repeatedly failed or are impossible to perform. It is a testament to the innovation that can occur when dental and ophthalmic surgery converge.

This extraordinary technique leverages the body’s natural rejection-fighting mechanisms by using the patient’s own biological material—a tooth and its surrounding bone—to anchor an artificial lens. This method provides a stable, blood-supplied environment that prevents the body from rejecting the prosthetic, offering a durable solution for people who have been blind for years or even decades. The success stories of patients regaining functional vision after this procedure are a powerful reminder of its pioneering role in modern ophthalmology.

What is Osteo-Odonto-Keratoprosthesis (OOKP)? The Revolutionary Procedure Explained

The Osteo-Odonto-Keratoprosthesis (OOKP) is a highly specialized surgical technique developed to treat severe corneal blindness, particularly in eyes with extensive damage to the surface and severe dry eye disease.

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OOKP is often referred to as the Strampelli Technique, named after the Italian ophthalmologist Benedetto Strampelli, who first conceived of the procedure over 30 years ago. The procedure has since been refined into the Modified Osteo-Odonto-Keratoprosthesis (MOOKP), which is the version commonly performed by a select group of specialized surgeons worldwide.

The core principle is ingenious: the patient's own tooth is used to house and anchor an artificial plastic lens—known as an optical cylinder—into the eye. A patient’s biological tissue is used because it is far less likely to be rejected by the body than fully synthetic materials in eyes that are already severely compromised.

Who is Eligible for This Extreme Surgery?

OOKP is not a first-line treatment for corneal issues. It is reserved for eyes that are considered "high-risk" for failure with standard corneal transplants (allografts). The primary goal is to restore *functional vision*—the ability to see light, shapes, and movement, and often to read—in patients who have otherwise exhausted all other options.

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The main indications for OOKP include:

• Stevens-Johnson Syndrome (SJS): A severe, rare disorder of the skin and mucous membranes, often leading to severe dry eye and corneal damage.
• Ocular Cicatricial Pemphigoid (OCP): A chronic, progressive autoimmune disease that causes scarring of the conjunctiva and cornea.
• Extensive Chemical or Thermal Burns: Severe injuries to the eye that cause massive and irreversible corneal damage.
• Multiple Failed Keratoplasties: Eyes that have undergone several unsuccessful corneal transplants.
• Severe Dry Eye Disease: Conditions where the eye surface is too dry to support a standard corneal graft.

The Two-Stage Surgical Process: From Canine to Cornea

The OOKP procedure is a complex, multidisciplinary effort that requires close coordination between an ophthalmologist and a dental surgeon. It is typically performed in two major stages, separated by a period of several months.

Stage 1: The Prosthesis Creation and Vascularization

The initial stage is dedicated to creating and preparing the bio-integrated prosthetic device.

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• Tooth Extraction: A healthy, single-rooted canine tooth (cuspid) is usually extracted, along with the surrounding bone and periodontal ligament. This entire unit is called the lamina.
• Shaping and Lensing: The tooth is carefully shaped and drilled to fit the optical cylinder (a small, clear plastic lens). The lens is then cemented into the tooth’s root canal, creating the OOKP device.
• Vascularization: The OOKP device is then implanted under the skin of the patient (often in the cheek or shoulder) for a period of two to four months. This crucial step allows the tooth and bone tissue to grow new blood vessels (vascularization), which is essential for the body to accept the device when it is finally placed in the eye.
• Eye Preparation: During this time, the eye itself is prepared. The damaged cornea is removed, and the eye surface is covered with a graft, often a piece of buccal mucosa (tissue harvested from the inside of the patient’s cheek) to create a new, stable outer layer.

Stage 2: The Final Implantation and Vision Restoration

After the OOKP device has successfully vascularized, the final surgery can take place.

• Retrieval and Insertion: The vascularized OOKP device is retrieved from its temporary location under the skin. A hole is created in the prepared eye (through the buccal mucosa graft) where the prosthetic will be inserted.
• Anchoring: The tooth-and-lens complex is securely anchored into the eye's surface, with the tooth's root facing inward, providing a strong, biologically compatible base.
• Light Exposure: Finally, a small window is cut in the buccal mucosa graft covering the eye, directly over the optical cylinder. This allows light to pass through the artificial lens and onto the retina, restoring vision.

Astonishing Success Rates and Modern Advancements

Despite its seemingly radical nature, the OOKP procedure boasts remarkable long-term success rates, which is why it remains the gold standard for this specific, severely compromised patient cohort.

1. High Long-Term Retention

The success of OOKP is often measured by the anatomical retention of the prosthesis. Studies have shown excellent long-term retention, with survival rates exceeding 80% at 10 years and, in some specialized centers, retention rates reaching up to 94% at 30 years. This durability is the OOKP’s greatest advantage over other synthetic keratoprosthesis devices in eyes with severe ocular surface disease.

2. Significant Visual Acuity Improvement

The functional success of the surgery is equally impressive. Many patients achieve a visual acuity of 20/40 or better, allowing them to read, recognize faces, and perform daily activities independently. For individuals who have been functionally blind for decades due to conditions like Stevens-Johnson Syndrome, this restoration of sight is genuinely life-changing.

3. Continuous Technological Refinements

Modern advancements continue to improve the procedure. The optical cylinder itself has seen improvements, with newer designs aimed at better vision quality and reduced glare. Furthermore, research is ongoing into synthetic OOKP analogues, which would mimic the biological structure of the tooth-bone complex but potentially eliminate the need to extract a natural tooth, though these are not yet widely adopted.

4. A Global Network of Expertise

While only performed a few hundred times worldwide, the OOKP procedure is not limited to a single country. Specialized OOKP centers exist in the UK, Canada, India, and other nations, establishing a global network of expertise for this rare and complex surgery.

The tooth-in-eye surgery is a powerful example of how medical ingenuity can overcome what were once considered insurmountable forms of blindness. By harnessing the body's own durable materials, OOKP offers a beacon of hope for those with the most challenging corneal conditions.