For the 1st time in Canada, surgeons put teeth in patients’ eyes to restore sight

When Brent Chapman’s doctor first pitched him on the idea of having one of his own teeth surgically embedded in his eye to restore his sight, he says he felt “a little apprehensive.”

But then he spoke to a woman in Australia who had undergone the same procedure to tremendous success. 

“She had been completely blind for 20 years, and is now snow skiing,” Chapman, 33, of North Vancouver, said. “I know it sounds a little crazy and science fiction-y.”

Chapman, who is blind in both eyes, is one of three Canadians undergoing osteo-odonto keratoprosthesis (OOKP) — or as it’s more commonly known, tooth-in-eye surgery — at a B.C. hospital this week.

It involves removing a patient’s tooth, usually the canine, installing a plastic optical lens inside it, and then implanting the whole thing into the eye. 

While it dates back several decades, the surgery has never been performed in Canada before now. And if all goes well, one of the doctors behind the initiative hopes to make it available in the long-term.

How does it work?

Why a tooth? Because teeth have dentine, which is the hardest substance the body produces, making it the ideal casing to bridge the plastic lens and the patient’s eye, says Dr. Greg Moloney, an ophthalmologist and surgeon at Mount Saint Joseph Hospital in Vancouver.

“There is no risk of rejection, because we’re using part of the patient’s own body,” he told As It Happens host Nil Kӧksal.

Moloney headed up the trio of Canadian surgeries this week. All of them went smoothly, he says, though the patients will be monitored closely.

He has performed seven successful tooth-in-eye surgeries in his native Australia before being recruited to do them in Canada. He says he’s used to people reacting to it with shock and horror.

“It is a rare operation that most people have not heard of, even if you are an eye surgeon,” Moloney said.

It’s not a cure-all for every vision problem, he says. It’s specifically meant for people with severe corneal blindness in the front of the eyes caused by conjunctival scarring from autoimmune diseases, chemical burns and other traumas, but who still have healthy retina and optic nerves in the back of their eyes.

And often, Moloney says, it’s the last resort when all other options fail.

That’s because it’s quite intensive, he says. It involves two surgeries, several months apart, which means Chapman and the two other Canadian patients will return to the operating room later this year.

During the first surgery, Moloney and his colleagues remove the patient’s tooth, shave it down into a rectangle, and drill a small hole in it to accommodate the lens.

They then remove scar tissue from the patient’s eye and fill it with a small flap of soft tissue from inside their cheek. 

Finally, they implant the tooth-encased lens inside the cheek so that it can grow new tissue around it.

A few months later, they go back in, remove the tooth from the cheek and sew it into the front of the eye, underneath the cheek tissue. The result is a pink-coloured eye with a small black circle, through which the patient can see. 

Because the surgery is so intensive, he says they only perform it in one eye. 

Not without risk

The procedure is not risk-free, says Maloney. 

“With any ocular surgery of any kind, there’s a chance that we could introduce infection and lose all our vision,” he said.

However, he says the surgery has been performed for several decades in 10 countries, including the U.K. and Australia, with a high success rate. 

A 2022 study out of Italy found that, on average, 27 years after surgery, 94 per cent of patients could still see.

“The risk-reward ratio for these patients, when they have no vision at all, is well worth it, we think,” Maloney said. 

Chapman, who spoke to CBC the day before his first surgery on Thursday, says it’s worth trying.

The massage therapist says he could see just fine until he was 13 years old, when he took some ibuprofen after a school basketball game, triggering a rare auto-immune reaction known as Stevens-Johnson syndrome.

He was in a coma for 27 days, and had severe burns all over his body, including his eyes. His sight never fully recovered.

Over the last 20 years, he says he’s had about 50 surgeries, including 10 corneal implants. Sometimes, he says, they work for a few months. One restored partial vision for two whole years.

But, inevitably, he always loses his sight again.

“When I get it back, you know, it would be sort of this great rush,” he said. “Then I’d lose it again and it would be heartbreaking, and I sort of sank into this depression.”

He’s hopeful these two surgeries at Mount Saint Joseph Hospital will be his last. 

“I’ve been imagining myself, you know, playing basketball again and shooting hoops,” he said. “I’d like to travel more and, you know, just see the world.”

Moloney’s goal is to keep helping patients like Chapman in Canada by opening the country’s first OOKP clinic at Mount Saint Joseph.

The St. Paul’s Foundation charity has raised $430,000 to start the clinic and fund it for three years, after which the B.C. health agency Providence Health Care will fold it into its annual budget. 

Dr. Samir Jabbour, an ophthalmologist at the Centre hospitalier de l’Université de Montréal, called the new clinic a “great opportunity for Canadian medicine.”

Jabbour, who was not involved in the B.C. surgeries, says there are very few cases in which a patient would require this kind of rare and complex surgery. But when it happens, they have to shoulder the cost of travelling outside the country. 

“The fact that we have it now in Canada definitely makes it much easier for patient care,” he said. 

Chapman says he’s incredibly grateful to Maloney and everyone else who made this possible.

“Hopefully, this’ll break some ground,” he said. “If there’s other people in Canada that maybe need this and it becomes, you know, an established thing here, I’d feel really great about that.”