From the Department of Ophthalmology, Centre hospitalier de l'Université de Montréal (CHUM) (D.G., S.I.H., M.M., R.D., Y.A., M.H.-D.), Montreal, Quebec, Canada; Department of Experimental Surgery, Faculty of Medicine, McGill University (D.G.), Montreal, Quebec, Canada.
Department of Ophthalmology & Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago (S.I.H.), Chicago, Illinois, USA.
Am J Ophthalmol. 2022 Mar;235:249-257. doi: 10.1016/j.ajo.2021.09.005. Epub 2021 Sep 17.
To determine the role and optimal timing of glaucoma surgery in relation to Boston keratoprosthesis type 1 (KPro) implantation.
Retrospective, comparative, nonrandomized clinical study.
Single-center study of a total of 100 eyes (100 patients) implanted with a KPro between 2008 and 2017, and diagnosed with glaucoma before or after KPro. Patients were separated into 2 groups: those with preexisting glaucoma and those who developed de novo glaucoma after KPro. Groups were then divided based on whether patients were medically or surgically managed. Glaucoma surgery included glaucoma drainage device (GDD) implantation, trabeculectomy, and cyclophotocoagulation (CPC). Primary outcomes included best-corrected visual acuity (BCVA), glaucoma progression, and complications. Differences in outcomes were compared using parametric and nonparametric tests, as well as log-rank test to compare time-to-outcome events.
Among 72 eyes with preexisting glaucoma, 27 (38%) had glaucoma surgery before KPro (18 GDD), whereas 45 (62%) were medically managed only. Among the latter, 19 (42%) needed glaucoma surgery post-KPro (16 GDD). Among 28 eyes with de novo glaucoma, 12 (43%) had glaucoma surgery post-KPro (9 GDD). For eyes with preexisting glaucoma, glaucoma progression was greater with glaucoma surgery performed post-KPro (100%) compared with pre-KPro (74%, P = .016) and to medical management (54%, P = .002). No increase in complications were observed with glaucoma surgery compared to medications only (P > .05), whereas fewer eyes maintained a BCVA of 20/200 or better over time with medical management (P = .013). Eyes with de novo glaucoma had similar progression, BCVA, and complications between medical and surgical care (P > .05).
Glaucoma surgery should be performed before or at the same time as KPro implantation in eyes with preexisting glaucoma. Complication rates are not increased when glaucoma surgery is performed in KPro eyes with either preexisting or de novo glaucoma. To ensure optimal glaucoma control, glaucoma surgery should be performed as early as possible in KPro eyes with good visual potential.
确定青光眼手术在波士顿角膜透镜 1 型（KPro）植入中的作用和最佳时机。
回顾性、对比、非随机临床研究。
对 2008 年至 2017 年间共植入 100 只眼（100 例患者）KPro 的单中心研究，这些患者在植入 KPro 之前或之后被诊断为青光眼。患者分为两组：一组为既有青光眼，一组为 KPro 植入后新发青光眼。然后根据患者的药物或手术治疗情况将每组进一步细分。青光眼手术包括青光眼引流装置（GDD）植入、小梁切除术和睫状体光凝术（CPC）。主要结局包括最佳矫正视力（BCVA）、青光眼进展和并发症。使用参数和非参数检验以及对数秩检验比较结局差异，以比较时间到结局事件。
在 72 只既有青光眼的眼中，27 只（38%）在 KPro 植入前（18 只 GDD）接受了青光眼手术，而 45 只（62%）仅接受了药物治疗。在后者中，19 只（42%）在 KPro 后需要青光眼手术（16 只 GDD）。在 28 只新发青光眼眼中，12 只（43%）在 KPro 后接受了青光眼手术（9 只 GDD）。对于既有青光眼的眼睛，与 KPro 植入前相比（74%，P=0.016）和药物治疗相比（54%，P=0.002），KPro 植入后进行青光眼手术导致青光眼进展的可能性更大。与仅使用药物治疗相比，青光眼手术并未增加并发症（P>0.05），但随着时间的推移，药物治疗的眼睛保持 20/200 或更好的 BCVA 的比例更低（P=0.013）。新发青光眼的眼睛在药物和手术治疗之间具有相似的进展、BCVA 和并发症（P>0.05）。
对于既有青光眼的眼睛，应在植入 KPro 之前或同时进行青光眼手术。对于既有或新发青光眼的 KPro 眼，进行青光眼手术并不会增加并发症的发生率。为了确保最佳的青光眼控制，对于具有良好视力潜力的 KPro 眼，应尽早进行青光眼手术。
