Cornea Service, Jules Stein Eye Institute, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA.
Cornea. 2011 Nov;30(11):1187-94. doi: 10.1097/ICO.0b013e3182114467.
To report the outcomes of the Boston type I keratoprosthesis (Massachusetts Eye and Ear Infirmary, Boston, MA) in the management of corneal limbal stem cell deficiency (LSCD).
A retrospective review of all cases of keratoprosthesis implantation performed by a single surgeon (A.J.A.) between May 1, 2004, and March 31, 2010. Procedures performed for the management of LSCD were identified, and data were collected regarding the patients' ocular history, surgical procedure(s) performed, and postoperative outcomes, including interval visual acuities, retention, complications, and required surgical procedures. The outcome data from patients with LSCD were compared with those of individuals who underwent keratoprosthesis implantation for indications other than LSCD.
Twenty-eight keratoprostheses were performed in 23 eyes of 22 patients with LSCD. The most common indications for surgery were chemical injury (7 eyes) and Stevens-Johnson syndrome (6 eyes). Preoperative corrected distance visual acuity (CDVA) was better than counting fingers in 4% of eyes with LSCD and in 9% of eyes without LSCD. Postoperative CDVA was 20/50 or better in 69%, 88%, and 67% of eyes with LSCD at 1, 2, and 3 years after keratoprosthesis implantation, respectively. Each of these percentages is higher than the percentage of eyes without LSCD obtaining CDVA of 20/50 or better at each time point. Whereas the retention failure rate in eyes with LSCD (0.148/eye-year) was higher than the rate in eyes without LSCD (0.114/eye-year), when eyes with Stevens-Johnson syndrome were excluded from the LSCD group, the non-Stevens-Johnson syndrome LSCD retention failure rate (0.056/eye-year) was half that of the non-LSCD group. The most common postoperative complications in eyes with LSCD were persistent corneal epithelial defect (PED) formation (56.5% of eyes) and sterile corneal necrosis (30%), whereas retroprosthetic membrane formation (46%) was the most common postoperative complication in eyes without LSCD, followed by PED formation (23%). The development of a PED was found to be a significant risk factor for sterile corneal stromal necrosis and infectious keratitis.
Boston type I keratoprosthesis implantation results in a significant improvement in CDVA in the majority of patients with LSCD, with CDVA of 20/50 or better in more than two-thirds of eyes up to 3 years after surgery. PED formation is the most common postoperative complication in eyes with LSCD and is associated with an increased rate of sterile stromal necrosis and a lower retention rate in eyes undergoing keratoprosthesis implantation for immune-mediated LSCD. These results support the use of the Boston type I keratoprosthesis in managing bilateral, non-immune-mediated LSCD.
报告波士顿 I 型角膜假体（马萨诸塞州眼耳医院，波士顿，MA）在治疗角膜缘干细胞缺乏症（LSCD）中的结果。
对 2004 年 5 月 1 日至 2010 年 3 月 31 日期间由一位外科医生（A.J.A.）进行的所有角膜假体植入手术进行回顾性分析。确定了用于治疗 LSCD 的手术，并收集了有关患者眼病史、手术程序以及术后结果的数据，包括间隔视力、保留率、并发症和所需的手术程序。将 LSCD 患者的结果数据与因 LSCD 以外的其他原因接受角膜假体植入的患者进行比较。
22 例患者的 23 只眼共进行了 28 次角膜假体植入术。最常见的手术适应证是化学伤（7 只眼）和史蒂文斯-约翰逊综合征（6 只眼）。LSCD 患者术前矫正视力（CDVA）好于指数的占 4%，非 LSCD 患者占 9%。LSCD 患者在接受角膜假体植入后 1、2 和 3 年，分别有 69%、88%和 67%的眼获得 20/50 或更好的 CDVA。与非 LSCD 患者在每个时间点获得 20/50 或更好的 CDVA 的比例相比，这些百分比都更高。虽然 LSCD 眼的保留失败率（0.148/眼年）高于非 LSCD 眼（0.114/眼年），但当排除史蒂文斯-约翰逊综合征患者后，非史蒂文斯-约翰逊综合征 LSCD 的保留失败率（0.056/眼年）为非 LSCD 组的一半。LSCD 眼最常见的术后并发症是持续性角膜上皮缺损（PED）形成（56.5%的眼）和无菌性角膜坏死（30%），而非 LSCD 眼最常见的术后并发症是后弹力层膜形成（46%），其次是 PED 形成（23%）。PED 的形成被发现是无菌性角膜基质坏死和感染性角膜炎的显著危险因素。
波士顿 I 型角膜假体植入术可显著改善大多数 LSCD 患者的 CDVA，术后 3 年内超过三分之二的眼 CDVA 达到 20/50 或更好。PED 形成是 LSCD 眼最常见的术后并发症，与无菌性基质坏死的发生率增加和免疫介导的 LSCD 患者角膜假体植入保留率降低有关。这些结果支持在管理双侧非免疫介导的 LSCD 时使用波士顿 I 型角膜假体。
