Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Am J Ophthalmol. 2021 Dec;232:40-48. doi: 10.1016/j.ajo.2021.05.022. Epub 2021 Jun 5.
To evaluate the long-term outcomes, anatomic retention, and complications of Boston type I keratoprosthesis (KPro).
Retrospective, interventional case series METHODS: A retrospective chart review of implantations performed January 2008-December 2017 was conducted. Risk factors for anatomical retention and functional success were analyzed. The incidences of infections with and without antimicrobial medications were compared.
Twenty-seven eyes of 26 patients were recruited. The most common indication for KPro surgery was failed penetrating keratoplasties (22 eyes, 81.5%). All patients had preoperative best-corrected visual acuity (BCVA) worse than 3/60. Over the mean follow-up of 83.4 ± 28.4 months, 15 eyes (55.6%) demonstrated improved BCVA. The anatomical retention rate was 88.9%, and the functional success rate was 44.4% (retained KPro with BCVA ≥ 3/60). Eyes with ocular surface disease (OSD) had significantly more complications than those without OSD. The most common complications were retroprosthetic membrane formation (15 eyes, 55.6%) and infection (13 eyes, 48.1%). Infectious keratitis was primarily caused by gram-positive bacteria, whereas endophthalmitis was chiefly caused by fungal infection. The infection incidence was significantly lower in eyes using topical 0.1% amphotericin B and 5% povidone iodine (P = .008 and .021, respectively).
With its good retention rate and visual outcomes, Boston type I KPro could be an alternative treatment for patients with conventional penetrating keratoplasty failure, especially with appropriate patient selection and complication prevention. Standard prophylactic antibiotics with the addition of topical 0.1% amphotericin B and 5% povidone iodine might be optional effective regimens for infection prevention, especially in tropical countries.
评估波士顿 I 型角膜（KPro）长期效果、解剖学保留和并发症。
回顾性、干预性病例系列研究
对 2008 年 1 月至 2017 年 12 月期间进行的植入手术进行回顾性图表审查。分析解剖学保留和功能成功的危险因素。比较有和没有抗菌药物治疗的感染发生率。
共纳入 26 名患者的 27 只眼。KPro 手术最常见的适应证是穿透性角膜移植失败（22 只眼，81.5%）。所有患者术前最佳矫正视力（BCVA）均差于 3/60。在平均 83.4±28.4 个月的随访中，15 只眼（55.6%）BCVA 得到改善。解剖学保留率为 88.9%，功能成功率为 44.4%（保留的 KPro 视力≥3/60）。有眼表疾病（OSD）的眼比没有 OSD 的眼并发症明显更多。最常见的并发症是后弹力膜形成（15 只眼，55.6%）和感染（13 只眼，48.1%）。感染性角膜炎主要由革兰氏阳性菌引起，而眼内炎主要由真菌感染引起。使用局部 0.1%两性霉素 B 和 5%聚维酮碘的眼感染发生率显著降低（P=.008 和 P=.021）。
波士顿 I 型 KPro 具有良好的保留率和视力结果，可为常规穿透性角膜移植失败的患者提供替代治疗方法，尤其是在适当的患者选择和并发症预防方面。标准预防性抗生素联合局部使用 0.1%两性霉素 B 和 5%聚维酮碘可能是预防感染的有效选择方案，特别是在热带国家。
