Magalhães Fernanda Pedreira, Hirai Flavio Eduardo, Sousa Luciene Barbosa de, Oliveira Lauro Augusto de
Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Arq Bras Oftalmol. 2018 Jun;81(3):177-182. doi: 10.5935/0004-2749.20180038.
To evaluate the long-term outcomes of Boston type I keratoprosthesis (B-Kpro) in the management of patients with ocular burn injuries.
This prospective study included all patients with ocular burns who underwent B-Kpro implantation at a tertiary eye care center between February 2008 and November 2015. Twelve patients (12 eyes) were enrolled. The procedures performed for managing ocular injury were identified, and information on ocular history, surgical procedures performed, and postoperative outcomes was collected. The main outcome measures were visual acuity, prosthesis retention, postoperative complications, and required surgical procedures.
Twelve eyes from 12 patients met the inclusion criteria for B-Kpro implantation, including nine eyes with alkali burns and three eyes with thermal burns. A total of 13 B-Kpro devices were implanted in the 12 eyes. The mean follow-up period was 60.8 months (range, 13-91 months). Preoperative best-corrected visual acuity ranged from counting fingers to light perception. Postoperative best-corrected visual acuity was better than 20/200 in 83.3%, 66.6%, and 57.1% of patients at 12, 48, and 60 months, respectively. The initial keratoprosthesis was retained in 10 (83.3%) eyes and was successfully replaced in one eye. The major cause of worsening of initial visual acuity was advanced glaucoma (four of 12 eyes).
The anatomical and functional results support the use of B-Kpro for managing bilateral limbal stem cell deficiency secondary to ocular burns. However, glaucoma should be carefully evaluated, as it is a continuous threat that may result in irreversible visual loss in this population.
评估波士顿I型人工角膜（B-Kpro）在眼烧伤患者治疗中的长期疗效。
本前瞻性研究纳入了2008年2月至2015年11月期间在一家三级眼科护理中心接受B-Kpro植入的所有眼烧伤患者。共纳入12例患者（12只眼）。确定了用于处理眼外伤的手术操作，并收集了眼部病史、所进行的外科手术及术后结果的信息。主要观察指标为视力、义眼留存情况、术后并发症及所需的外科手术。
12例患者的12只眼符合B-Kpro植入的纳入标准，其中9只眼为碱烧伤，3只眼为热烧伤。12只眼中共植入了13个B-Kpro装置。平均随访期为60.8个月（范围13 - 91个月）。术前最佳矫正视力从数指到光感不等。术后12个月、48个月和60个月时，分别有83.3%、66.6%和57.1%的患者最佳矫正视力优于20/200。最初的人工角膜在10只眼（83.3%）中留存，1只眼成功更换。初始视力恶化的主要原因是晚期青光眼（12只眼中有4只）。
解剖和功能结果支持使用B-Kpro治疗眼烧伤继发的双侧角膜缘干细胞缺乏。然而，应仔细评估青光眼，因为它是一种持续的威胁，可能导致该人群不可逆转的视力丧失。
