Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA.
Department of Ophthalmology, University of Alberta, Edmonton, Alta.
Can J Ophthalmol. 2018 Jun;53(3):284-290. doi: 10.1016/j.jcjo.2017.10.021. Epub 2017 Dec 11.
To investigate the visual and anatomical outcomes of Boston keratoprosthesis (Kpro) type 1 reimplantation.
Subgroup analysis of multicentre prospective cohort study.
Of 303 eyes that underwent Kpro implantation between January 2003 and July 2008 by 1 of 19 surgeons at 18 medical centres, 13 eyes of 13 patients who underwent reimplantation of Boston Kpro type 1 were compared with 13 eyes of 13 diagnosis-matched patients who underwent initial implantation.
Forms reporting preoperative, intraoperative, and postoperative parameters were prospectively collected and analyzed. Main outcome measures were Kpro retention and logMAR visual acuity.
After a mean follow-up time of 17.1 ± 17.6 months, the retention of both initial and repeat Kpro implantation was 92.3% (12/13 in both groups), and 62% of initial implantation and 58% of repeat implantation eyes achieved visual acuity better than 20/200. Vision worse than 20/200 was often due to glaucoma or posterior segment pathology. Best-recorded logMAR visual acuity was significantly improved postoperatively in both groups (p < 0.001), and there was no statistically significant difference in final logMAR visual acuity between the 2 groups (p = 0.89). Sterile keratolysis (n = 4) and fungal infection (n = 5) were the most common causes of initial Kpro failure in the repeat Kpro group. The single failure in the repeat Kpro implantation group was due to fungal keratitis, and in the control group it was related to Kpro extrusion.
Repeat Kpro implantation is a viable option after failed initial Kpro, with visual and anatomical outcomes comparable to those of initial procedures.
研究波士顿角膜透镜（Kpro）1 型再植入的视觉和解剖结果。
多中心前瞻性队列研究的亚组分析。
在 2003 年 1 月至 2008 年 7 月期间，由 19 位外科医生中的 1 位在 18 个医疗中心对 303 只眼睛进行了 Kpro 植入手术，其中 13 只眼睛的 13 位患者进行了波士顿 Kpro 1 型的再植入手术，与 13 只眼睛的 13 位诊断匹配的患者进行了初次植入手术进行了比较。
前瞻性收集并分析报告术前、术中及术后参数的表格。主要观察指标是 Kpro 保留率和 logMAR 视力。
平均随访时间为 17.1±17.6 个月后，初次和重复 Kpro 植入的保留率分别为 92.3%（两组均为 12/13），初次植入的 62%和重复植入的 58%的眼睛视力优于 20/200。视力低于 20/200 通常是由于青光眼或后段病变所致。两组术后最佳记录的 logMAR 视力均显著提高（p<0.001），两组最终 logMAR 视力无统计学差异（p=0.89）。初次 Kpro 失败的重复 Kpro 组中，无菌性角膜溶解（n=4）和真菌感染（n=5）是最常见的原因。重复 Kpro 植入组中的单次失败是由于真菌性角膜炎引起的，而在对照组中，它与 Kpro 挤出有关。
初次 Kpro 失败后，重复 Kpro 植入是一种可行的选择，其视觉和解剖结果与初次手术相当。
