Press Releases & Archive

OSTEO – ODONTO Keratoprosthesis– ‘TOOTH- IN- EYE’ Surgery

In July 2004, eye surgeons from the Singapore National Eye Centre together with a dental team from the National Dental Centre reported the first successful case of OOKP ‘Tooth-in-eye’ surgery in Singapore , the first of its kind in the region.

OOKP is a complex 2-stage operation which aims to restore vision to the most severe cases of corneal and ocular surface patients for whom all previous attempts to restore vision had failed. The procedure involves removing a canine tooth from the patient, shaping and drilling it to allow implantation of an artificial plastic corneal device (optical cylinder), and ultimately implanting it back into one eye a few months later.

Since the first successful case in a 19-year old boy from Thailand in June 2004, a total of 12 more OOKP surgery have been performed with phenomenal success. Ten of these patients have come from overseas, including Malaysia , Indonesia , Sri Lanka and Thailand , and 2 local patients. The list of local and regional patients awaiting the possibility of this surgery continues to grow.

A summary of the OOKP surgical procedure is as follows:

Stage 1 of the surgery involved 5 separate procedures:

• opening up one eye and removing the entire inner surface of his eyelids, his corneal surface, and all scar tissue from his previous eye injury
• removing the inner mucosal lining of the cheek and transplanting it onto the new surface of the eye
• removing a canine tooth and part of the adjacent bone and attached ligaments from his jaw (interestingly, the canine tooth is also known as the “eye-tooth”) (we recently have been able to modify the dental procedure to also use a premolar tooth in the even that the patient does not have suitable canine teeth)
• fashioning a bolt-shaped structure from this tooth-bone complex to receive a plastic optical cylinder which is cemented into place
• implanting the tooth-bone-cylinder complex into his cheek to grow a new blood supply

Stage 2 (about 4 months later)

This stage involves 2 separate procedures.

First, the cheek mucosal lining over the eye will be opened, and a circular opening made in his cornea to receive the implant. The inner contents of the eye will also be removed at the same time.

Secondly, the living tooth-bone-cylinder complex will be removed from the cheek, and placed within the eye, and the mucosal cheek lining will be replaced over the implant. At the end of the procedure, light can now enter through the plastic cylinder, and he will be able to see through this cylinder with good vision.

Results of the first 12 cases

We have completed Stage 2 surgery in two-third of cases (8 patients so far), while the remaining 4 will have their final Stage 2 surgery within the next 2-4 months. Of the 8 patients who have completed their surgery, amazingly, there have been virtually no complications and all 8 patients have vision restored to a level which previously had been deemed not possible. Of these 8, 3 have perfect vision of 6/6, 1 has 6/9 vision and 2 have 6/12 vision (all these 6 patients have vision good enough to drive) and the remaining 2 patients have 6/24 and 6/60 vision which are functional vision. Our longest follow-up in these patients is now over 15 months and all are doing very well.

A Team Effort

OOKP surgery has been an excellent example of multi-disciplinary collaboration involving a dedicated group of eye surgeons, dental surgeons, anaesthetists, radiologists, and visual therapists/psychologists contributing their respective skills and expertise in a complex procedure that eventually brings vision back to patients who will otherwise remain blind.

International Recognition for our OOKP Program

The international medical community has recognized our efforts and contributions to the field. At the most recent international eye surgery scientific meeting (the American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting) which was held in Washington DC , our surgical team won the First Place Film Award under the “New Techniques” Category, for the OOKP procedure, which has never been performed in the US . This is the first time Singapore surgeons have won the first place award at this prestigious meeting which is one of the largest clinical ophthalmology meetings in the world.

Our success with the OOKP program has enhanced Singapore ’s international reputation for excellent and innovative eye surgery and research. We have presented our results at several international meetings in Malaysia , the Philippines , Indonesia and Brazil , and we have been invited to present our program in Australia .

Several countries in the region are planning to initiate their own OOKP programs and have approached SNEC to assist with their training. At a most recent eye meeting in Hong Kong 2 weeks ago, delegates from Taiwan and Korea met up with our team to request Singapore to assist in training in OOKP surgery. Teams from Taiwan and Korea will be coming to Singapore later this year to observe the surgery and learn OOKP techniques. They will also be sending their most severe cases to Singapore for OOKP surgery. Several countries in the Middle East have also expressed keen interest to send patients and learn OOKP surgery.

This surgery has now become a viable option for many blind patients who have lost their sight due to severe damage to their corneas and front part of the eye and eyelids. Patients selected for surgery will include those cases of complete blindness in which conventional corneal transplants will not work. We currently have many more patients in the region who intend to come to Singapore for sight restoration with OOKP surgery.

Through collaboration with SingaporeMedicine in a number of roadshows and media publicity in the region, many foreign patients now have come to know of the new OOKP surgery and its excellent results and have made arrangements to Singapore for sight restoration with OOKP surgery.

The Surgical Team

1. OOKP Surgeons:
   
   
   Assoc Prof Donald Tan
   Deputy Director , Singapore National Eye Centre (SNEC)
   Head and Senior Consultant, Corneal & External Eye Disease Service, SNEC
   Director, Singapore Eye Research Institute
   Head, Dept of Ophthalmology, National University of Singapore
   
   
   Dr Andrew Tay
   Consultant, Dept of Oral and Maxillofacial Surgery,
   National Dental Centre (NDC)
   
   
   Dr Julian Theng
   Consultant, Corneal & External Eye Disease Service, SNEC
   
   
   Dr Lye Kok Weng
   Registrar, Dept of Oral and Maxillofacial Surgery, NDC
   
   
   Dr Raymond Wong
   Registrar, Dept of Oral and Maxillofacial Surgery, NDC
   
   
   
2. OOKP Anaesthetist
   
   
   Dr V Sivagnanaratnam
   Visiting Consultant Anaesthetist, SNEC
   Emeritus Consultant Anaesthetist, Changi General Hospital
   
   
   
3. SNEC Corneal Fellows, Corneal Nurses and OT Nurses
   
   
   
4. NDC LAOT Team
   
   
   
5. OOKP Surgical Advisor: Dr Christopher Liu

For further information, please contact

Ravi Chandran
Corporate Communications Executive
Singapore National Eye Centre
Tel 65 6 322 8394
E-mail: ravi@snec.com.sg
Website: www.snec.com.sg

Singapore National Eye Centre

The Singapore National Eye centre is the designated national eye centre within the public healthcare network that provides specialist eye care to 70 percent of patients in the public sector. It now attends to 250,000 outpatient visits and performs 14,000 major eye surgeries and 13,000 laser procedures annually. The high quality and volume of SNEC’s services place the institution as a leading eye centre in the Asia-Pacific region and beyond. Please see enclosed VISION booklet for further information on the SNEC.

National Dental Centre

The National Dental Centre (NDC) is the nation's referral centre for specialist oral healthcare services. In addition to providing services in the areas of Oral & Maxillofacial Surgery, Orthodontics and Restorative Dentistry, NDC's specialists also collaborate with other medical specialists to manage patients with complex oral needs. Some of these complex higher-end procedures include oral rehabilitation for patients needing customised implants or undergoing radiotherapy treatment for head & neck cancers, corrective surgeries for patients with dentofacial deformities, and nerve injury repair procedures. The OOKP procedure is another demonstration of the Centre's capabilities, targeted at providing excellent clinical expertise for patients both in Singapore and the region. For more information on NDC, please refer to the enclosed Fact Sheet or visit website www.ndc.com.sg .

Singapore National Eye Centre, National Dental Centre and Singapore General Hospital are members of Singapore Health Services (SingHealth).

INFORMATION by SINGAPOREMEDICINE

The island state has lured more than 200,000 international patients to its shores each year for medical procedures. Specialized treatments such as eye, heart, and brain surgeries along with the most complex cases of cancer can be found here in the Republic. Its latest state-of-the-art diagnostic equipment, modern technology procedures and the care and experience of its highly trained medical staff and doctors, provide the very best for patients world-wide.

Whether it is OOKP, reproductive services or a wide selection of health screening and rehabilitative services, Singapore continues to provide, not only its citizens, but regional and international patients the very best in care and facilities. Singapore continues to be a pioneer in medical advancements so needed in today’s world. For more information on SingaporeMedicine, please see Website: www.singaporemedicine.com