This article originally appeared in The Daily Scan.
A decade ago, Gail Lane suffered a seizure so bad she needed to be hospitalized. But during that stay, things took a devastating turn for the Victoria resident, now 74. The anti-seizure medications she took triggered a reaction that led to a rare auto-immune disorder, Stevens Johnson Syndrome.
At age 64, she became completely blind.
“It was hard adjusting to blindness later in life,” she acknowledges, having to relearn everything sighted persons take for granted – walking, dressing so things matched, eating, using a cell phone.
But this week, Lane, two other blind patients from BC, and a team of surgeons and health-care providers will make Canadian medical history at Mount Saint Joseph Hospital in Vancouver: they’ll undergo a surgery that uses one of their own teeth, outfitted with a plastic lens, then sewn over their eyeball, to restore their sight. They will be the first patients in Canada to receive the surgery.
Surgery is for patients with severe corneal blindness
Lane is first. Her surgery takes place February 25.
Colloquially known as “tooth-in-eye” surgery, the medical name is Osteo-Odonto Keratoprostheseis (OOKP). This highly specialized and rare surgery was not, until this week, available in North America.
The procedure is suited to certain patients whose severe corneal blindness is caused by scarring, conditions like autoimmune diseases (as in Lane’s case) or chemical burns and other traumas. In these situations, traditional corneal transplants don’t work. However, for patients whose retina and optic nerves are still healthy, OOKP surgery can restore full sight by implanting an optical lens or “telescope” within a tooth to replace the scarred eye surface. (The cornea is the clear tissue part covering the eyeball.)
Another of the other three patients to receive the surgery this week is Brent Chapman, a 33-year-old Vancouver-area resident. At just age 13, he took ibuprofen during a basketball game and had a horrific reaction that blinded him fully. He and his family have spent countless hours and dollars over the years trying everything to get him to see again. He has had nine surgeries in the US, has undergone surgery using stem-cell tissue from his parents’ eyes, and had 12 corneal transplants.
Nothing has worked.
Tooth-in-eye surgery a last resort
“That’s why this tooth-in-eye surgery is the last resort,” he says.
There are two stages to it.
The first surgery, about six hours long, begins with the extraction of a tooth from the patient (typically the canine, or “eye” tooth). It is then shaped and the lens, or telescope, is glued inside.
The tooth is sewn into the patient’s cheek for up to three months, allowing tissue to grow around it before it is used as the carrier for the new lens. Surgeons also remove a flap of skin from inside the cheek and sew it over the patient’s eye until the second surgery.
During the second surgery, about three months later (and also lasting some six hours), the tooth is removed from the cheek. Mount Saint Joseph Hospital ophthalmologist and surgeon Dr. Greg Moloney will pull back the flap of skin covering the eye and take out the patient’s damaged iris and lens. He will then sew the tooth holding the plastic lens onto the eyeball. The tissue that formed around the tooth while implanted in the cheek allows the tooth to be sewn onto the eye.
The flap, which helps the tooth stay in place on the eye, is then resewn over the eye ball. Dr. Moloney will create a small hole in the flap of skin so the patient can see.
Why use a tooth? “A tooth contains dentin, which is the ideal tissue to house a plastic lens without the body rejecting it,” explains Dr. Moloney, who was recruited from his native Australia in 2021 to perform these surgeries. He and a medical team have done about seven in his home country. He adds, “The skin flap from the mouth recognizes the tooth that has been inside the cheek.”
He will be joined at Mount Saint Joseph this week by fellow Aussie Dr. Shannon Webber (the two went to medical school together) who flew in from Australia specifically for the trio of Vancouver surgeries. Dr. Webber is an oral-maxillofacial surgeon – a specialist in surgeries involving the face, jaw and mouth. For the three surgeries, he will be training local oral-maxillofacial surgeon Dr. Ben Kang, from Vancouver General Hospital, so that this expertise becomes local to Vancouver and other Canadian patients can be accommodated. Dr. Webber will remove Lane’s, Chapman’s and the other patient’s tooth in the separate surgeries, and insert it inside their cheek.
OOKP surgery has documented positive results dating back to 1973. However, it is an intricate procedure requiring multiple surgeons, which has discouraged many centres from offering the procedure.
To date, about 500 to 1000 patients have received the surgery in clinics in about 10 countries including the United Kingdom, Singapore, India, Australia – and now, Canada.
Dr. Moloney wants Mount Saint Joseph to be the Canadian OOKP clinic.
Prior to the Mount Saint Joseph clinic, patients like Brent Chapman shouldered a heavy financial burden in their quest to see again.
St. Paul’s Foundation and the Department of Ophthalmology at Providence Health Care partnered to establish an OOKP clinic. The Foundation raised $430,000 to fund it for three years to support start-up costs, including training for the OR team and equipment, and yearly operating expenses. After that, Providence Health Care will build the costs into its budget planning.
To Dr. Moloney and Dr. Webber, these are more than just surgeries. “We get emotional about them,” says Dr. Moloney. “It is so rewarding when a patient regains their sight.”