Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada.
Br J Ophthalmol. 2022 Jul;106(7):935-940. doi: 10.1136/bjophthalmol-2020-317606. Epub 2021 Feb 23.
BACKGROUND/AIMS: To compare long-term outcomes of primary versus secondary (postgraft failure) Boston keratoprosthesis type 1 (KPro) implantation.
Medical records of patients at the Centre hospitalier de l'Université de Montréal having undergone KPro implantation between 2008 and 2017 were reviewed and included if they had a preoperative Snellen best-corrected visual acuity (BCVA) of 20/100 or worse and a minimum of 5 years of follow-up. Eighty-two eyes were separated into two cohorts (40 primary, 42 secondary KPro) and BCVA, complications and device retention were evaluated between groups.
BCVA improved from baseline in both groups at each year; this was significant at all five postoperative years in the primary group and the first 3 years in the secondary group (p<0.05). Mean BCVA was similar between groups at 5 years (logarithm of minimal angle resolution 1.3±0.8 in the primary group vs 1.5±0.8 p<0.05). Idiopathic vitritis, choroidal detachment and new glaucoma occurred more after primary KPro (n=7, 17.5% vs n=1, 2.4%; n=11, 27.5% vs n=3, 7.14% and n=14, 35% vs n=6, 14%, respectively; p<0.05). Primary KPro had lower retention (n=28, 70% vs n=38, 91%, p<0.05) at final follow-up. There was more aniridia in the primary group (n=19, 48% vs n=6, 14%, p<0.01). Within each group, 50% of removals occurred in aniridic eyes.
Primary KPro yielded favourable long-term visual outcomes but had more complications and lower retention rates than secondary KPro, likely explained by preoperative indications. Primary device implantation represents a favourable option for patients for whom grafts are likely to fail.
背景/目的：比较原发性和继发性（移植后失败）波士顿 1 型角膜移植术（KPro）的长期结果。
回顾了 2008 年至 2017 年间在蒙特利尔大学医疗中心接受 KPro 植入术的患者的病历记录，并纳入术前 Snellen 最佳矫正视力（BCVA）为 20/100 或更差且随访时间至少 5 年的患者。82 只眼分为两组（原发性 40 只，继发性 42 只 KPro），评估两组间 BCVA、并发症和器械保留情况。
两组的 BCVA 在基线水平上均有改善，且在原发性组所有 5 年术后和继发性组前 3 年的改善均具有统计学意义（p<0.05）。两组在 5 年时的平均 BCVA 相似（原发性组的最小角分辨率对数为 1.3±0.8，p<0.05）。原发性 KPro 术后更易发生特发性虹膜炎、脉络膜脱离和新发青光眼（分别为 7 例，17.5%；11 例，27.5%；n=14，35%；n=6，14%；n=1 例，2.4%；n=3 例，7.14%）（p<0.05）。原发性 KPro 的最终随访保留率较低（n=28，70%；n=38，91%）（p<0.05）。原发性组中虹膜缺失更为常见（n=19，48%；n=6，14%）（p<0.01）。每组中，50%的器械移除发生在虹膜缺失的眼中。
原发性 KPro 获得了良好的长期视力结果，但与继发性 KPro 相比，其并发症更多，保留率更低，这可能与术前适应证有关。对于那些可能发生移植物失败的患者，原发性器械植入是一种有利的选择。
