Moyal L, Adam R, Boumendil J, Meney J, Rodallec T, Akesbi J, Nordmann J-P
Service d'ophtalmologie II, centre hospitalier national des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France.
Service d'ophtalmologie II, centre hospitalier national des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France.
J Fr Ophtalmol. 2018 Nov;41(9):830-835. doi: 10.1016/j.jfo.2018.01.010. Epub 2018 Oct 19.
To report cases of patients with severe bilateral corneal blindness and recurrent refractory perforation to keratoplasty and conventional treatment, for whom Boston keratoprosthesis (KP) was a satisfactory alternative when combined with a temporalis aponeurosis graft.
The first patient had progressive Lyell syndrome with spontaneous corneal perforation. The second had a severe graft vs. host reaction with a persistent Seidel-positive descemetocele. Despite repeated penetrating keratoplasties, amniotic membrane (AM) transplantations, and buccal mucosal (BM) grafts, they both experienced recurrent corneal perforation. The only solution thus appeared to be Boston Type I KP surgery. One month postoperatively, the first patient had to receive a temporalis aponeurosis (TA) graft, due to thinning of the recipient graft. Six months postoperatively, his visual acuity (VA) was 1/10 without correction, and the corneal status had been stabilized. The second patient underwent KP and TA graft concurrently. Six months after surgery, VA was 2/10 uncorrected, and the local inflammation had been stabilized.
Boston type I keratoprostheses constitute an alternative in cases of severe bilateral corneal blindness with perforation refractory to conventional treatment and surgery, with satisfactory visual results.
Patients with preoperative severe ocular surface disease are at greater risk of postoperative keratolysis. For our patients with a higher risk, TA graft prevented corneal melt. TA seems to be more effective than AM or BM in preventing corneal thinning or melt.
We would recommend performing a TA graft in combination with Boston KP surgery concurrently as first line treatment in eyes with severe ocular surface inflammation.
报告双侧严重角膜盲且角膜移植术和传统治疗反复出现难治性穿孔的患者病例，对于这些患者，波士顿人工角膜（KP）联合颞肌筋膜移植是一种令人满意的替代方案。
首例患者患有进行性中毒性表皮坏死松解症伴自发性角膜穿孔。第二例患者发生严重的移植物抗宿主反应，伴有持续的Seidel阳性后弹力层膨出。尽管反复进行穿透性角膜移植术、羊膜（AM）移植术和颊黏膜（BM）移植术，但他们均出现角膜反复穿孔。因此，唯一的解决办法似乎是进行波士顿I型KP手术。术后1个月，首例患者因受体移植物变薄而不得不接受颞肌筋膜（TA）移植。术后6个月，其视力（VA）为1/10，未矫正，角膜状况已稳定。第二例患者同时接受了KP和TA移植。术后6个月，未矫正视力为2/10，局部炎症已稳定。
波士顿I型人工角膜是传统治疗和手术难治性穿孔的严重双侧角膜盲病例的一种替代方案，视觉效果良好。
术前患有严重眼表疾病的患者术后发生角膜溶解的风险更高。对于我们的高危患者，TA移植可预防角膜融解。TA在预防角膜变薄或融解方面似乎比AM或BM更有效。
我们建议在严重眼表炎症的眼中，将TA移植与波士顿KP手术同时作为一线治疗联合进行
