U.C. Davis Health System Eye Center, University of California at Davis, Sacramento, California, USA.
Ophthalmology. 2011 Aug;118(8):1543-50. doi: 10.1016/j.ophtha.2010.12.032. Epub 2011 Mar 12.
To evaluate retention of visual acuity and development of complications after Boston type 1 keratoprosthesis implantation over a longer follow-up period than previously reported.
Cohort study.
Forty eyes of 35 patients who underwent Boston type 1 keratoprosthesis surgery at the University of California, Davis, between 2004 and 2010.
Preoperative, intraoperative, and postoperative parameters were collected and analyzed.
Best-corrected visual acuity (BCVA) and postoperative complications.
Preoperative visual acuity ranged from 20/150 to light perception and was ≤20/400 in 38 eyes (95%). Preoperative diagnoses included failed corneal transplants (19 eyes, 47.5%), chemical injury (10 eyes, 25%), and aniridia (5 eyes, 12.5%). Mean follow-up duration was 33.6 months (range, 5-72 months). Of 36 eyes followed for ≥1 year, 32 eyes (89%) achieved postoperative BCVA ≥20/200. Of eyes that achieved BCVA ≥20/200, at last follow-up, 19 of 32 eyes (59%) followed for ≥1 year retained BCVA ≥20/200; 16 of 27 eyes (59%) followed for ≥2 years retained BCVA ≥20/200; 7 of 14 eyes (50%) followed for ≥3 years retained BCVA ≥20/200; and 2 of 7 eyes (29%) followed for ≥4 years retained BCVA ≥20/200. End-stage glaucoma most commonly caused vision loss (7 of 13 eyes, 54%) when BCVA ≥20/200 was not retained (follow-up ≥1 year). Glaucoma was newly diagnosed in 11 eyes (27.5%); progression was noted in 9 eyes (22.5%). Glaucoma drainage device erosion occurred in 9 eyes (22.5%). Retroprosthetic membrane formed in 22 eyes (55%), 5 eyes (12.5%) developed endophthalmitis, 6 eyes (15%) developed corneal melt, 7 eyes (17.5%) underwent keratoprosthesis replacement, and 23 eyes (57.5%) required major surgery to treat postoperative complications. The initial keratoprosthesis was retained in 32 eyes (80%).
Keratoprosthesis implantation remains a viable option for salvaging vision. A significant number of patients lost vision over the postoperative course. Glaucoma and complications related to glaucoma surgery are significant challenges to maintaining good vision after keratoprosthesis surgery. Our study highlights the need for long-term follow-up and a team approach to management, and points to a more guarded long-term visual prognosis after surgery.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
评估波士顿 1 型角膜移植术后视力保留和并发症的发展情况，随访时间长于以往报道。
队列研究。
2004 年至 2010 年期间，在加利福尼亚大学戴维斯分校接受波士顿 1 型角膜移植术的 35 名患者的 40 只眼。
收集并分析术前、术中及术后参数。
最佳矫正视力（BCVA）和术后并发症。
术前视力范围为 20/150 至光感，38 只眼（95%）视力≤20/400。术前诊断包括角膜移植失败（19 只眼，47.5%）、化学伤（10 只眼，25%）和无虹膜（5 只眼，12.5%）。平均随访时间为 33.6 个月（5-72 个月）。在 36 只随访≥1 年的眼中，32 只眼（89%）术后 BCVA≥20/200。在获得 BCVA≥20/200 的眼中，末次随访时，32 只眼中有 19 只（59%）随访≥1 年时仍保持 BCVA≥20/200；27 只眼中有 16 只（59%）随访≥2 年时仍保持 BCVA≥20/200；14 只眼中有 7 只（50%）随访≥3 年时仍保持 BCVA≥20/200；7 只眼中有 2 只（29%）随访≥4 年时仍保持 BCVA≥20/200。当 BCVA≥20/200 无法保留（随访≥1 年）时，晚期青光眼最常导致视力丧失（7/13 只眼，54%）。新诊断出青光眼 11 只眼（27.5%）；9 只眼（22.5%）出现进展。9 只眼（22.5%）发生青光眼引流装置侵蚀。22 只眼（55%）形成了后发性膜，5 只眼（12.5%）发生眼内炎，6 只眼（15%）发生角膜溶解，7 只眼（17.5%）需要更换角膜移植，23 只眼（57.5%）需要进行主要手术以治疗术后并发症。初始角膜移植体在 32 只眼（80%）中得以保留。
角膜移植术仍然是挽救视力的可行选择。术后许多患者视力下降。青光眼和与青光眼手术相关的并发症是角膜移植术后保持良好视力的重大挑战。本研究强调了长期随访和团队管理的必要性，并指出手术后的长期视力预后更为保守。
作者在本文讨论的材料中没有任何专有或商业利益。
