Basu Sayan, Nagpal Ritu, Serna-Ojeda Juan Carlos, Bhalekar Swapnil, Bagga Bhupesh, Sangwan Virender
Tej Kohli Cornea Institute, LV Prasad Eye Institute, Hyderabad, India
Tej Kohli Cornea Institute, LV Prasad Eye Institute, Hyderabad, India.
Br J Ophthalmol. 2018 Jun 11. doi: 10.1136/bjophthalmol-2017-311649.
To describe the anatomical and functional outcomes of the novel LVP keratoprosthesis (Kpro), developed as an alternative to the modified osteo-odonto keratoprosthesis (MOOKP), in eyes with end-stage corneal blindness where conventional corneal surgeries are contraindicated.
This prospective case series included 58 eyes of 56 patients (12 children and 44 adults) with severe bilateral keratopathy and completely dry, dermalised ocular surfaces who underwent unilateral LVP Kpro implantation from 2012 to 2016. In this two-stage procedure, an ocular surface labial mucous membrane grafting was performed, followed for 3 months by the implantation of the device under the engrafted mucosal flap. The primary outcome measures were anatomical retention rate and improvement in best corrected visual acuity (BCVA). The secondary outcome measure was rate of occurrence of complications.
Mean postoperative follow-up was 2.5±1.1 years. Kaplan-Meier survival analysis showed an anatomical retention rate of 90.8%±3.9% at 1 year, 80%±5.7% at 2 years and 76.6%±6.5% at 3-5 years. The survival rates were comparable in children and adults (91% vs 72% at 5 years, p=0.258). About 61.5% of eyes maintained 20/400 or better vision and median BCVA improved from perception of light to 20/70 at 1 year postoperatively (p<0.0001). Complications like retroprosthetic membrane formation, glaucoma, vitritis, endophthalmitis and panophthalmitis occurred in 43%, 26%, 22%, 12% and 3% of the eyes, respectively.
The LVP Kpro is an effective procedure for the treatment of end-stage corneal blindness in completely dry eyes. The LVP Kpro can be particularly useful in situations where the MOOKP is contraindicated or difficult to perform.
描述新型唇下睑板移植角膜假体（LVP Kpro）的解剖学和功能结果，该假体是作为改良骨 - 牙角膜假体（MOOKP）的替代方案而开发的，用于传统角膜手术禁忌的终末期角膜盲眼中。
该前瞻性病例系列纳入了56例患者（12名儿童和44名成人）的58只眼，这些患者患有严重的双侧角膜病变且眼表完全干燥、皮肤化，于2012年至2016年接受了单侧LVP Kpro植入。在这个两阶段手术中，先进行眼表唇黏膜移植，3个月后在移植的黏膜瓣下植入该装置。主要结局指标是解剖学保留率和最佳矫正视力（BCVA）的改善情况。次要结局指标是并发症的发生率。
术后平均随访时间为2.5±1.1年。Kaplan-Meier生存分析显示，1年时解剖学保留率为90.8%±3.9%，2年时为80%±5.7%，3至5年时为76.6%±6.5%。儿童和成人的生存率相当（5年时分别为91%和72%，p = 0.258）。约61.5%的眼睛维持20/400或更好的视力，术后1年时BCVA中位数从光感提高到20/70（p<0.0001）。分别有43%、26%、22%、12%和3%的眼睛发生了如人工晶状体后膜形成、青光眼、玻璃体炎、眼内炎和全眼球炎等并发症。
LVP Kpro是治疗眼表完全干燥的终末期角膜盲的有效方法。在MOOKP禁忌或难以实施的情况下，LVP Kpro可能特别有用。
