Muzychuk Adam K, Durr Georges M, Shine Julien J, Robert Marie-Claude, Harissi-Dagher Mona
Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, Quebec, Canada.
Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, Quebec, Canada.
Am J Ophthalmol. 2017 Sep;181:46-54. doi: 10.1016/j.ajo.2017.06.012. Epub 2017 Jun 27.
To determine the incidence rate, principal causes, and clinical course of eyes developing no light perception (NLP) visual acuity (VA) following Boston Keratoprosthesis (B-KPro) type 1 surgery. Secondary objectives include determining the incidence rate, relative risk (RR), and survival probability with respect to NLP outcomes among eyes with congenital aniridia.
Retrospective, interventional case series.
All patients undergoing B-KPro type 1 surgery between October 2008 and June 2016 by a single surgeon at CHUM - Hôpital Notre-Dame.
Records of patients having undergone B-KPro implantation were reviewed. Eyes with a final outcome of NLP were further reviewed to determine best recorded postoperative VA, time to NLP onset, clinical course, and principal cause. Descriptive statistics, incidence rates, Kaplan-Meier survival curves, and the RR of NLP outcomes among eyes with aniridia were determined. Statistical significance was defined as P < .05.
Records of 119 patients were included, with an average follow-up of 49.1 ± 26.8 months postoperatively. Nineteen eyes had a final outcome of NLP, representing 16.0%. The incidence rate of NLP was 0.04 cases per eye-year of follow-up. The most common principal causes were inoperable retinal detachment (n = 7, 36.8%), terminal glaucoma (n = 6, 31.6%), and carrier graft melt-related complications (n = 5, 26.3%). The RR of developing NLP among eyes with aniridia was 3.04 (P = .01).
No light perception is a devastating but uncommon outcome of B-KPro surgery. Patients with aniridia seem to be at increased risk. In spite of all available medical and surgical interventions, some eyes may still suffer this outcome.
确定接受1型波士顿人工角膜（B-KPro）手术后出现无光感（NLP）视力（VA）的眼睛的发病率、主要病因及临床病程。次要目标包括确定先天性无虹膜患者眼睛出现NLP结局的发病率、相对风险（RR）及生存概率。
回顾性干预性病例系列研究。
2008年10月至2016年6月期间在蒙特利尔大学中心医院圣母医院由同一位外科医生进行1型B-KPro手术的所有患者。
回顾接受B-KPro植入手术患者的记录。对最终结局为NLP的眼睛进行进一步评估，以确定术后最佳记录视力、NLP发生时间、临床病程及主要病因。确定描述性统计数据、发病率、Kaplan-Meier生存曲线以及无虹膜患者眼睛出现NLP结局的RR。统计学显著性定义为P < 0.05。
纳入119例患者的记录，术后平均随访时间为49.1 ± 26.8个月。19只眼睛最终结局为NLP，占16.0%。NLP的发病率为每眼随访年0.04例。最常见的主要病因是无法手术的视网膜脱离（n = 7，36.8%）、终末期青光眼（n = 6，31.6%）以及供体植片融化相关并发症（n = 5，26.3%）。无虹膜患者眼睛出现NLP的RR为3.04（P = 0.01）。
无光感是B-KPro手术的一种严重但不常见的结局。无虹膜患者似乎风险更高。尽管采取了所有可用的药物和手术干预措施，一些眼睛仍可能出现这种结局。
