From the Department of Experimental Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Department of Ophthalmology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
Department of Ophthalmology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
Am J Ophthalmol. 2021 Jun;226:56-67. doi: 10.1016/j.ajo.2021.01.006. Epub 2021 Jan 22.
To evaluate glaucoma risk factors and associated outcomes of the Boston keratoprosthesis type I (KPro).
Clinical case-control study.
This is a single-center study of 140 eyes of 118 patients who underwent KPro surgery between October 2008 and March 2017 by a single surgeon. A total of 118 eyes of 118 patients with at least 6 months of follow-up were analyzed to account for intereye correlation. Patients without glaucoma were compared to those diagnosed with glaucoma, which included treatment with intraocular pressure (IOP)-lowering medications or glaucoma surgery. A subgroup analysis compared eyes with pre-KPro glaucoma with those with post-KPro glaucoma. Statistical analysis was performed using univariate and multivariate analyses and Kaplan-Meier survival curves. Main outcome measures were glaucoma diagnosis and progression. Other outcomes included demographics, preoperative diagnosis, best-corrected visual acuity, IOP, cup-to-disc ratio progression and postoperative complications.
The mean age at surgery was 60.7 ± 16.7 years, with a follow-up of 6.9 ± 3.2 years. De novo KPro glaucoma incidence was 24% (n = 28/118), equivalent to 3.4 cases per 100 eye-years, with onset at 2.1 ± 2.2 postoperative years. A total of 17 of 118 eyes (14%) did not have glaucoma. Multiple logistic regression showed that high preoperative IOP was a predictor of higher rates of glaucoma development (odds ratio [OR] = 1.538, 95% confidence interval [CI] = 1.030-2.297, P = .035) and progression (OR = 1.450, 95% CI = 1.084-1.937, P = .012). Stromal and endothelial disorders were protective preoperative diagnoses for glaucoma progression after KPro (OR = 0.002, 95% CI = 0.000-0.227, P = .010). A greater proportion of eyes with autoimmune and ocular surface diseases developed de novo glaucoma after KPro compared with other preoperative diagnoses (P < .05). A total of 45% of glaucomatous KPro eyes suffered postoperative glaucoma progression. The mean final best-corrected visual acuity of the cohort was 1.76 ± 1.0, with no difference between eyes with and without glaucoma (P > .05). The rate of serious vision-threatening complications was higher in KPro eyes without glaucoma (77%) than in those with glaucoma (41%, P = .006).
High preoperative IOP signals a higher risk for glaucoma development and progression after KPro surgery. Autoimmune diseases and ocular surface diseases precipitate de novo glaucoma, whereas stromal and endothelial disorders protect against glaucoma progression after KPro. The minority of KPro eyes without glaucoma remain at high risk of complications that can hinder promising visual outcomes. Despite all available treatments and surgical interventions, a majority of eyes will suffer from glaucoma progression, even later during follow-up.
评估波士顿角膜缘重建术 1 型（KPro）的青光眼危险因素和相关结局。
临床病例对照研究。
这是一项单中心研究，纳入了 2008 年 10 月至 2017 年 3 月间由同一位外科医生实施手术的 118 例患者的 140 只眼。共分析了 118 例患者的 118 只眼，以排除眼间相关性。将无青光眼的患者与诊断为青光眼的患者进行比较，其中包括使用降眼压药物或青光眼手术治疗的患者。亚组分析比较了术前 KPro 青光眼和术后 KPro 青光眼的患者。使用单变量和多变量分析及 Kaplan-Meier 生存曲线进行统计学分析。主要观察指标为青光眼的诊断和进展。其他观察指标包括人口统计学资料、术前诊断、最佳矫正视力、眼压、杯盘比进展和术后并发症。
手术时的平均年龄为 60.7 ± 16.7 岁，随访时间为 6.9 ± 3.2 年。新发 KPro 青光眼的发生率为 24%（n=28/118），相当于每 100 眼年 3.4 例，发病时间为术后 2.1 ± 2.2 年。118 只眼中有 17 只（14%）无青光眼。多变量逻辑回归显示，术前高眼压是青光眼发展（比值比[OR]1.538，95%置信区间[CI]1.030-2.297，P=0.035）和进展（OR 1.450，95%CI 1.084-1.937，P=0.012）的预测因素。术前存在基质和内皮病变是 KPro 术后青光眼进展的保护因素（OR 0.002，95%CI 0.000-0.227，P=0.010）。与其他术前诊断相比，自身免疫性疾病和眼表疾病患者术后发生新发青光眼的比例更高（P<.05）。45%的青光眼 KPro 眼发生术后青光眼进展。本队列的平均最终最佳矫正视力为 1.76 ± 1.0，青光眼眼和无青光眼眼之间无差异（P>.05）。无青光眼的 KPro 眼发生严重威胁视力的并发症的比例（77%）高于有青光眼的眼（41%，P=0.006）。
术前高眼压提示 KPro 术后青光眼发展和进展的风险更高。自身免疫性疾病和眼表疾病会引发新发青光眼，而基质和内皮病变则可预防 KPro 术后青光眼进展。大多数无青光眼的 KPro 眼仍存在严重并发症的高风险，这可能会阻碍有希望的视力结局。尽管有所有可用的治疗和手术干预措施，大多数眼仍会发生青光眼进展，甚至在随访后期也会发生。
