Abou Shousha Mohamed, Eleiwa Taher, Gibbons Allister, Smith Christopher, Edelstein Sean, Kontadakis George, Schmitz Zachary, Abernathy Joshua, Chod Ross, Bodnar Zachary, McDaniel Kelvin, Bentivegna Rocio, Akduman Levent
Saint Louis University Eye Institute, St Louis, MO, USA.
Bascom Palmer Eye Institute, Miami, FL, USA.
J Ophthalmol. 2019 Jul 25;2019:9648614. doi: 10.1155/2019/9648614. eCollection 2019.
To identify the incidence of endophthalmitis and visual outcomes in eyes with Boston type 1 keratoprosthesis combined with pars plana vitrectomy and silicone oil insertion (KPro + PPV + SOI) as compared to eyes receiving Boston type 1 keratoprosthesis (KPro) alone.
Retrospective chart review of 29 eyes of 27 patients with KPro having at least 12-month follow-up. Thirteen of these eyes had hypotony and/or retinal detachment in addition to corneal pathology and thus received KPro + PPV + SOI. Polymyxin-trimethoprim with a quinolone was used as chronic topical antibiotic prophylaxis in both groups after the first postoperative month. Outcome measures recorded at the 1-, 3-, 6-, 12-, and 24-month follow-up visits included best-corrected visual acuity (BCVA) and rates of postoperative complications.
All the patients had completed 24-month follow-up except one case in the KPro group who lost to follow-up after 12-month visit. In the KPro + PPV + SOI group, no eyes had developed endophthalmitis by the 24-month follow-up visit versus 5 eyes of 5 patients in the uncombined KPro group (=0.048). The 2-year cumulative endophthalmitis incidence was 31.2% in the KPro group versus zero in the KPro + PPV + SOI group (=0.030). Four of these 5 eyes had vitreous taps with positive cultures; 2 were positive with , 1 with coagulase-negative staphylococci, and 1 with . Other complications included KPro extrusion (1 in each group), retinal detachment (2 in the KPro and 1 in the KPro + PPV + SOI group), newly developed glaucoma (2 in each group), and retroprosthetic membrane (9 in the KPro and 5 in the KPro + PPV + SOI group). The KPro group had better average preoperative BCVA compared to those of the KPro + PPV + SOI group (-2.29 ± 0.72 LogMAR, versus -2.95 ± 0.30 LogMAR; =0.004). No statistically significant difference in BCVA was noted in subsequent follow-up visits.
The addition of PPV and SOI to the KPro implantation in the eyes with corneal pathology, as well as hypotony and/or retinal detachment, is a safe and effective procedure for visual rehabilitation. Pars plana vitrectomy and silicone oil insertion may have a protective effect against the development of postoperative endophthalmitis in eyes receiving KPro.
与单纯接受波士顿1型人工角膜（KPro）植入的眼睛相比，确定接受波士顿1型人工角膜联合玻璃体切割术及硅油填充（KPro + PPV + SOI）的眼睛发生眼内炎的发生率及视力转归情况。
对27例接受KPro植入且至少随访12个月的患者的29只眼睛进行回顾性病历分析。其中13只眼睛除角膜病变外还存在低眼压和/或视网膜脱离，因此接受了KPro + PPV + SOI手术。术后第一个月后，两组均使用多粘菌素 - 甲氧苄啶联合喹诺酮类药物作为长期局部抗生素预防用药。在1、3、6、12和24个月的随访中记录的结果指标包括最佳矫正视力（BCVA）和术后并发症发生率。
除KPro组有1例患者在12个月随访后失访外，所有患者均完成了24个月的随访。在KPro + PPV + SOI组中，至24个月随访时无眼发生眼内炎，而未联合手术的KPro组有5例患者的5只眼睛发生眼内炎（P = 0.048）。KPro组2年累积眼内炎发生率为31.2%，而KPro + PPV + SOI组为零（P = 0.030）。这5只发生眼内炎的眼睛中有4只玻璃体穿刺培养阳性；2只培养出金黄色葡萄球菌，1只培养出凝固酶阴性葡萄球菌，1只培养出其他细菌。其他并发症包括KPro脱出（每组各1例）、视网膜脱离（KPro组2例，KPro + PPV + SOI组1例）、新发青光眼（每组各2例）及人工角膜后膜形成（KPro组9例，KPro + PPV + SOI组5例）。KPro组术前平均BCVA优于KPro + PPV + SOI组（-2.29 ± 0.72 LogMAR，对比 -2.95 ± 0.30 LogMAR；P = 0.004）。在随后的随访中，BCVA无统计学显著差异。
对于存在角膜病变以及低眼压和/或视网膜脱离的眼睛，在KPro植入术中增加PPV和SOI是一种安全有效的视力康复手术。玻璃体切割术及硅油填充可能对接受KPro植入的眼睛术后眼内炎的发生具有保护作用。
