Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL 60612, USA.
Am J Ophthalmol. 2013 May;155(5):814-22. doi: 10.1016/j.ajo.2012.11.019. Epub 2013 Jan 23.
To evaluate whether retro-backplate retroprosthetic membrane is correlated with risk of melt in patients with a type I Boston Keratoprosthesis (KPro).
Retrospective, observational case series.
Study of 50 eyes of 47 patients with type I Boston KPro and postoperative anterior segment optical coherence tomography (AS OCT) imaging performed at the University of Illinois at Chicago. Main outcome measures were presence of retro-backplate membrane and development of melt requiring explantation. For eyes with melt, membrane thickness was measured using the AS OCT images obtained at the last visit before melt occurred. For eyes without melt, the last available AS OCT images were used for measurement.
AS OCT evidence of a retro-backplate membrane was observed in 100% of eyes that melted and in 34.1% of eyes that did not (P = .0034; risk ratio, 2.9; 95% confidence interval, 1.9 to 4.4). Retro-backplate membrane thickness in the melt group was 278 μm versus 193 μm in the nonmelt group (P = .025).
The retro-backplate portion of a retroprosthetic membrane is to be differentiated from the retro-optic portion seen at the slit lamp. The retro-backplate membrane as shown by AS OCT imaging is correlated with an increased risk of sterile keratolysis, possibly because of impedance of nutritional support from the aqueous humor. Further studies are needed to better standardize the AS OCT measurements of retro-backplate membranes as well as to identify early interventions to prevent progression of thin membranes once identified on AS OCT.
评估波士顿Ⅰ型人工角膜（KPro）术后患者中 retro-backplate retroprosthetic 膜与角膜融解风险的相关性。
回顾性、观察性病例系列研究。
该研究纳入了在伊利诺伊大学芝加哥分校接受过Ⅰ型 Boston KPro 手术并进行了术后眼前节光学相干断层扫描（AS OCT）成像的 47 名患者的 50 只眼。主要观察指标为 retro-backplate 膜的存在和需要进行移植的角膜融解。对于发生角膜融解的眼睛，使用发生角膜融解前最后一次就诊时获得的 AS OCT 图像测量膜的厚度。对于没有发生角膜融解的眼睛，使用最后一次可获得的 AS OCT 图像进行测量。
发生角膜融解的眼睛中 100%存在 retro-backplate 膜，而未发生角膜融解的眼睛中仅 34.1%存在 retro-backplate 膜（P =.0034；风险比，2.9；95%置信区间，1.9 至 4.4）。在发生角膜融解的组中，retro-backplate 膜的厚度为 278 μm，而在未发生角膜融解的组中为 193 μm（P =.025）。
AS OCT 成像显示的 retro-backplate 膜应与在裂隙灯检查下看到的 retro-optic 膜区分开来。AS OCT 成像显示的 retro-backplate 膜与无菌性角膜溶解的风险增加相关，这可能是由于房水的营养支持受阻所致。需要进一步研究以更好地规范 AS OCT 对 retro-backplate 膜的测量，并确定一旦在 AS OCT 上发现薄膜，早期干预以防止其进展的方法。
