Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ocular Surface Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Ophthalmology. 2017 Oct;124(10):1504-1509. doi: 10.1016/j.ophtha.2017.04.016. Epub 2017 May 17.
To determine the impact of total pars plana vitrectomies (PPVs) with peripheral shaving of the vitreous base on the rates of postoperative complications in patients with aphakic, snap-on type I Boston keratoprostheses (KPros).
Retrospective, consecutive case series.
A total of 48 eyes in 46 patients with implantation of aphakic, snap-on type 1 Boston KPros performed at a tertiary care facility between January 1, 2007, and December 31, 2013, were included.
The cumulative incidences of postoperative complications were compared between patients who underwent total PPVs with shaving of the vitreous base (n = 22) and those who had partial PPVs or anterior vitrectomies (AVs) at the time of KPro implantation (n = 26).
Rates of complications between patients who underwent total PPVs and partial PPVs or AVs.
The rate of total postoperative complications was lower in the total PPV group (P = 0.018, log-rank test). In particular, eyes that underwent total PPVs had lower rates of retroprosthetic membranes (RPMs) requiring intervention (P = 0.049) and less vision loss due to glaucoma progression (P = 0.046). There was also a trend for fewer corneal melts (P = 0.060) and less sight-threatening complications (P = 0.051) in the total vitrectomy group. There was no difference in the rates of KPro extrusion (P = 0.41), endophthalmitis or vitritis (P = 0.15), retinal detachments (P = 0.76), cystoid macular edema (P = 0.83), or timing of complications between the 2 groups. The mean preoperative and postoperative visual acuities were similar between the 2 groups (P = 0.97). The mean follow-up was 49±22 months.
Eyes that underwent total PPVs during implantation of aphakic, snap-on, type I Boston KPros had less postoperative complications than eyes with partial PPVs or AVs during the average 4 years of follow-up.
研究行全玻璃体切除术（PPV）联合玻璃体基底部周边切除对无晶状体、扣式Ⅰ型波士顿人工角膜（KPro）植入术后患者术后并发症发生率的影响。
回顾性连续病例系列研究。
2007 年 1 月 1 日至 2013 年 12 月 31 日，在一家三级保健机构植入无晶状体、扣式Ⅰ型波士顿人工角膜的 46 例（48 只眼）患者纳入本研究。
比较玻璃体基底部全切除（22 例）和玻璃体基底部部分切除或前部玻璃体切除术（26 例）患者术后并发症的累积发生率。
全玻璃体切除组和部分玻璃体切除或前部玻璃体切除术组患者的并发症发生率。
全玻璃体切除组总术后并发症发生率较低（P=0.018，对数秩检验）。特别是，行全玻璃体切除术的患者眼后发性膜（RPM）需要干预的发生率较低（P=0.049），因青光眼进展导致视力丧失的发生率也较低（P=0.046）。全玻璃体切除组角膜溶解的发生率也有降低趋势（P=0.060），严重影响视力的并发症发生率也较低（P=0.051）。两组之间的 KPro 脱出率（P=0.41）、眼内炎或眼内炎（P=0.15）、视网膜脱离（P=0.76）、黄斑囊样水肿（P=0.83）或并发症发生时间均无差异。两组患者术前和术后平均视力相似（P=0.97）。平均随访时间为 49±22 个月。
在植入无晶状体、扣式Ⅰ型波士顿人工角膜时行全玻璃体切除术的患者，与行玻璃体基底部部分切除或前部玻璃体切除术的患者相比，在平均 4 年的随访中术后并发症较少。
