State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China.
Guangdong Visual and Ophthalmology Research Institute, Guangzhou, China.
Adv Ther. 2020 Jul;37(7):3206-3222. doi: 10.1007/s12325-020-01381-3. Epub 2020 May 20.
This study aimed to describe the clinical features, surgical management of the eyelid and ocular surface, and outcomes of 16 patients implanted with a Boston type I keratoprosthesis (KPro).
A retrospective, single-center, consecutive case series of 16 patients with Stevens-Johnson syndrome (1), ocular chemical burns (12), and ocular thermal burns (3) implanted with KPro was studied. All subjects were men aged 27-51 years. Surgical treatment and outcomes for eyelid malposition, symblepharon, and glaucoma were assessed.
From September 2010 to February 2019, 29 patients were admitted to Zhongshan Ophthalmic Center for KPro implantation, of whom 16 (55%) required eyelid or ocular surface surgeries to maintain hydration and protect the corneal tissue, which is vulnerable to epithelial defects. Forty-one adnexal surgical procedures were performed. The most common indication for surgery was symblepharon, and the most frequent procedures were symblepharon lysis with ocular mucous membrane grafts and amniotic membranes (7) and full-thickness skin grafts to the eyelids (7). Preoperative conjunctival injection and corneal staining were documented in 9 (56%) and 8 (50%) eyes, respectively, and at up to 4 months postoperative follow-up (the last adnexal surgery before KPro) were recorded in 3 (19%, p = 0.03) and 2 (12%, p = 0.02) eyes, respectively. Glaucoma drainage devices were inserted in six patients. One patient with Stevens-Johnson syndrome underwent FP7 Ahmed glaucoma valve (AGV) implantation inferotemporally and developed plate exposure 2 months postoperatively. Five patients underwent FP8 AGV implantation with tube insertion into the vitreous cavity due to the scarred conjunctiva and limited subconjunctival space. In the study period, intraocular pressure (IOP) was in the normal range, and no tube or plate exposure was observed.
The ocular environment is critical for successful KPro surgery. A multidisciplinary approach for any lid and ocular surface abnormality in ocular burns or Stevens-Johnson syndrome is important to improve the quality of the ocular surface and accommodate KPro and AGV, which is vital for maintaining vision after KPro surgery. FP8 AGV may be feasible for IOP control in adult KPro cases with restricted subconjunctival space.
本研究旨在描述 16 例植入 Boston Ⅰ型角膜（KPro）的患者的临床特征、眼睑和眼表的手术处理方法及结果。
回顾性分析 2010 年 9 月至 2019 年 2 月在中山大学中山眼科中心植入 KPro 的 16 例史蒂文斯-约翰逊综合征（1 例）、眼部化学烧伤（12 例）和眼部热烧伤（3 例）患者的临床资料。所有患者均为 27-51 岁男性。评估眼睑位置异常、睑球粘连和青光眼的手术治疗和结果。
2010 年 9 月至 2019 年 2 月，共有 29 例患者因 KPro 植入而入住中山大学中山眼科中心，其中 16 例（55%）需要进行眼睑或眼表手术以保持眼表湿润，保护角膜组织，因为角膜组织易发生上皮缺损。共进行了 41 次附属手术。最常见的手术指征是睑球粘连，最常见的手术是分离睑球粘连并用眼黏膜移植物和羊膜（7 次）和全厚皮片移植到眼睑（7 次）。术前记录了 9 只（56%）眼的结膜充血和 8 只（50%）眼的角膜染色，在最后一次附属手术（KPro 前的最后一次眼表手术）前的 4 个月随访中，分别记录了 3 只（19%，p=0.03）和 2 只（12%，p=0.02）眼的结膜充血和角膜染色。有 6 例患者植入了青光眼引流装置。1 例史蒂文斯-约翰逊综合征患者行 FP7 Ahmed 青光眼阀（AGV）下颞侧植入术，术后 2 个月发生巩膜瓣暴露。由于结膜瘢痕和有限的结膜下空间，5 例患者行 FP8 AGV 植入，将管插入玻璃体腔。研究期间，眼压（IOP）处于正常范围，未观察到管或板暴露。
眼部环境对 KPro 手术的成功至关重要。对于眼部烧伤或史蒂文斯-约翰逊综合征的任何眼睑和眼表异常，采用多学科方法进行治疗，以改善眼表质量并适应 KPro 和 AGV，这对于 KPro 手术后维持视力非常重要。对于限制在结膜下空间的成人 KPro 病例，FP8 AGV 可能是控制 IOP 的可行方法。
