Hager Jonathan L, Phillips David L, Goins Kenneth M, Kitzmann Anna S, Greiner Mark A, Cohen Alex W, Welder Jeffrey D, Wagoner Michael D
Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242-1091, USA.
Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242-1091, USA.
Int Ophthalmol. 2016 Feb;36(1):73-78. doi: 10.1007/s10792-015-0078-2. Epub 2015 May 16.
The purpose of this study was to evaluate the outcomes of the Boston type 1 keratoprosthesis (Kpro-1) in eyes with failed keratoplasty. A retrospective review was performed of every patient treated with a Kpro-1 at a tertiary eye care center between January 1, 2008 and July 1, 2013. Eyes with a failed keratoplasty originally performed for corneal edema, trauma, or keratoconus were included in the statistical analysis. The main outcome measures were visual outcome, prosthesis retention, and postoperative complications. Twenty-four eyes met the inclusion criteria, including 13 eyes with corneal edema, 8 eyes with trauma, and 3 eyes with keratoconus. After a mean follow-up period of 28.9 months (range 7-63 months), the median best corrected visual acuity (BCVA) was 20/125. The BCVA was ≥ 20/40 in 4 (16.7 %) eyes, ≥ 20/70 in 9 (37.5 %) eyes, and ≥ 20/200 in 14 (58.3 %) eyes. Overall, the postoperative BCVA improved in 17 (70.9 %) eyes, was unchanged in 3 (12.5 %) eyes, and was worse in 4 (16.7 %) eyes. The initial Kpro-1 was retained in 22 (91.7 %) eyes, and was successfully repeated in the other 2 eyes. One or more serious prosthesis- or sight-threatening complications occurred in 8 (33.3 %) eyes. These included 1 case of wound dehiscence leading to prosthesis extrusion, 1 case of fungal keratitis leading to prosthesis extrusion, 4 cases of endophthalmitis, and 5 retinal detachments. The Boston Kpro-1 is associated with an excellent prognosis for prosthesis retention and satisfactory visual improvement in eyes with previous failed keratoplasty.
本研究的目的是评估波士顿1型人工角膜（Kpro-1）在角膜移植失败眼中的治疗效果。对2008年1月1日至2013年7月1日期间在一家三级眼科护理中心接受Kpro-1治疗的每位患者进行了回顾性研究。最初因角膜水肿、外伤或圆锥角膜而角膜移植失败的眼睛被纳入统计分析。主要观察指标为视力结果、人工角膜留存率和术后并发症。24只眼睛符合纳入标准，其中13只眼睛因角膜水肿、8只眼睛因外伤、3只眼睛因圆锥角膜。平均随访28.9个月（范围7 - 63个月）后，最佳矫正视力（BCVA）中位数为20/125。BCVA≥20/40的有4只眼睛（16.7%），≥20/70的有9只眼睛（37.5%），≥20/200的有14只眼睛（58.3%）。总体而言，17只眼睛（70.9%）术后BCVA提高，3只眼睛（12.5%）不变，4只眼睛（16.7%）变差。最初的Kpro-1在22只眼睛（91.7%）中留存，另外2只眼睛成功进行了再次手术。8只眼睛（33.3%）发生了一种或多种严重的人工角膜相关或威胁视力的并发症。其中包括1例伤口裂开导致人工角膜脱出，1例真菌性角膜炎导致人工角膜脱出，4例眼内炎，以及5例视网膜脱离。波士顿Kpro-1对于既往角膜移植失败的眼睛，在人工角膜留存方面预后良好，视力改善令人满意。
