Ray Subhransu, Khan Bilal F, Dohlman Claes H, D'Amico Donald J
Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114, USA.
Arch Ophthalmol. 2002 May;120(5):559-66. doi: 10.1001/archopht.120.5.559.
To evaluate the spectrum and treatment of posterior segment complications in eyes that had undergone successful keratoprosthesis (KPro) placement and to determine whether transeyelid vitrectomy techniques could be effectively used in eyes otherwise vulnerable to surface exposure.
In the last 10 years, 110 patients received a Dohlman-Doane KPro at the Massachusetts Eye and Ear Infirmary, Boston. We evaluated 22 eyes in 18 patients that required subsequent vitreoretinal surgery to treat posterior segment complications. One surgeon using modified vitreoretinal techniques, as described below, performed all vitreoretinal procedures.
The posterior segment complications included 6 cases of retro-KPro membranes, 13 cases of retinal detachments, and 5 cases of isolated vitreous opacity. All 6 retro-KPro membranes were effectively removed by vitrectomy without significant complication and 3 of these patients enjoyed improvement of visual acuity of at least 5 Snellen lines. Of 13 cases of retinal detachment, 6 patients had some improvement in visual acuity, 5 showed no appreciable change, and 2 had some decline in the final visual acuity. In all 5 cases of isolated vitreous opacity, the media was effectively cleared with pars plana vitrectomy. Three patients enjoyed improvement of visual acuity of at least 3 Snellen lines. Four cases of transeyelid vitrectomy were attempted and anatomical success was achieved in all 4 and vision improved in 3 of these patients. No special surgical complications were encountered in any of the 22 eyes as a result of these modified surgical techniques.
Best preoperative and postoperative visual acuity and anatomical success were evaluated in relation to the preoperative posterior segment complication.
Modified vitreoretinal surgical techniques can be effectively and safely used to treat posterior segment complications in patients with KPro devices. Retro-KPro membranes and other vitreous opacities were the most amenable to treatment. Retinal complications posed a special challenge. However, all of these cases highlight that modified vitrectomy techniques can be used in eyes with permanent KPro devices. These techniques can be performed without additional risk to the eye. Additionally, we demonstrated that transeyelid vitrectomy techniques could be used effectively to manage complications in eyes with severe ocular surface disease without undue exposure of vulnerable tissues.
评估成功植入角膜移植片（KPro）的眼后段并发症的范围及治疗方法，并确定经眼睑玻璃体切除术技术是否可有效用于易发生表面暴露的眼。
在过去10年中，110例患者在波士顿的马萨诸塞州眼耳医院接受了多尔曼 - 多恩KPro植入术。我们评估了18例患者的22只眼，这些眼需要后续玻璃体视网膜手术来治疗后段并发症。由一名外科医生使用如下所述的改良玻璃体视网膜技术进行了所有玻璃体视网膜手术。
后段并发症包括6例KPro后膜、13例视网膜脱离和5例孤立性玻璃体混浊。所有6例KPro后膜均通过玻璃体切除术有效切除，无明显并发症，其中3例患者视力至少提高了5行斯内伦视力表。13例视网膜脱离患者中，6例视力有一定改善，5例无明显变化，2例最终视力有所下降。在所有5例孤立性玻璃体混浊患者中，经扁平部玻璃体切除术有效地清除了介质。3例患者视力至少提高了3行斯内伦视力表。尝试了4例经眼睑玻璃体切除术，所有4例均获得解剖学成功，其中3例患者视力改善。由于这些改良手术技术，22只眼中任何一只均未遇到特殊手术并发症。
根据术前眼后段并发症评估术前和术后最佳视力及解剖学成功情况。
改良玻璃体视网膜手术技术可有效、安全地用于治疗KPro装置患者的后段并发症。KPro后膜和其他玻璃体混浊最适合治疗。视网膜并发症带来了特殊挑战。然而，所有这些病例都表明改良玻璃体切除术技术可用于永久性KPro装置的眼。这些技术可在不增加眼额外风险的情况下进行。此外，我们证明经眼睑玻璃体切除术技术可有效用于治疗严重眼表疾病眼的并发症，而不会过度暴露脆弱组织。
