Li Zhao, Wang Qun, Zhang Shi-Feng, Huang Yi-Fei, Wang Li-Qiang
Department of Ophthalmology, The Chinese People's Liberation Army of China (PLA) General Hospital, Beijing, China.
Department of Medical School, Nankai University, Tianjin, China.
Front Med (Lausanne). 2022 Sep 29;9:986176. doi: 10.3389/fmed.2022.986176. eCollection 2022.
To summarize and discuss the treatment and timing of glaucoma in patients with MICOF keratoprosthesis implantation to guide follow-up clinical treatment.
The data of 39 eyes (39 patients) with the Moscow Eye Microsurgery Complex in Russia (MICOF) keratoprosthesis implantation in our hospital from 1 January 2002 to 31 December 2017 were collected, including patients with preexisting glaucoma and those who developed glaucoma after MICOF. The sex, age, preoperative diagnosis, glaucoma surgery, keratoplasty, times of keratoplasty, best corrected visual acuity (BCVA) and final follow-up corrected visual acuity, visual field (VF) defect, and cup-to-disk ratio (CDR) were statistically analyzed.
Among 16 eyes with preexisting glaucoma, eight eyes underwent glaucoma surgery before MICOF, 4 eyes underwent glaucoma surgery combined with MICOF, and four eyes were managed medically. Among 23 eyes with glaucoma, seven eyes were treated with surgery and 16 eyes were treated with medication only. A total of 9 (56.3%) eyes had corneal transplants with preexisting glaucoma, which was a higher percentage than that in the patients with glaucoma ( = 5, 21.7%, = 0.043). In both the preexisting glaucoma group and the glaucoma group, the most common causes were alkali burns (56.3% of preexisting glaucoma and 43.5% of glaucoma). There was no significant difference between the operation and initial visual acuity, postoperative visual acuity, BCVA, CDR, or VF defect. In the glaucoma group, the final follow-up visual acuity of the glaucoma surgery group (1.56 ± 1.07) was worse than that of the mediation group (0.44 ± 0.53) ( < 0.017). Among the complications, the incidence of cornea melting in the patients treated with medications only (=10) was significantly higher than that in the patients treated with glaucoma surgery ( = 0, = 0.007), but there was no significant difference in the other complications.
Among patients with MICOF, those patients who have undergone keratoplasty are more likely to develop glaucoma before surgery and glaucoma needs to be prevented. Surgical treatment can be selected according to the ocular surface condition in the patients with glaucoma to reduce the occurrence of complications.
总结并讨论接受莫斯科眼显微手术联合体（MICOF）角膜移植术患者青光眼的治疗方法及时机，以指导后续临床治疗。
收集我院2002年1月1日至2017年12月31日期间39例（39眼）接受俄罗斯MICOF角膜移植术患者的数据，包括术前已存在青光眼的患者以及MICOF术后发生青光眼的患者。对患者的性别、年龄、术前诊断、青光眼手术、角膜移植术、角膜移植次数、最佳矫正视力（BCVA）及末次随访矫正视力、视野（VF）缺损和杯盘比（CDR）进行统计学分析。
在16例术前已存在青光眼的患者中，8眼在MICOF术前接受了青光眼手术，4眼接受了青光眼手术联合MICOF手术，4眼采用药物治疗。在23例发生青光眼的患者中，7眼接受了手术治疗，16眼仅接受药物治疗。共有9例（56.3%）术前已存在青光眼的患者接受了角膜移植，这一比例高于发生青光眼的患者（5例，21.7%，P = 0.043）。在术前已存在青光眼组和发生青光眼组中，最常见的病因均为碱烧伤（术前已存在青光眼组占56.3%，发生青光眼组占43.5%）。手术与初始视力、术后视力、BCVA、CDR或VF缺损之间无显著差异。在发生青光眼组中，青光眼手术组末次随访视力（1.56±1.07）低于药物治疗组（0.44±0.53）（P < 0.017）。在并发症方面，仅接受药物治疗的患者（n = 10）角膜溶解发生率显著高于接受青光眼手术的患者（n = 0，P = 0.007），但其他并发症无显著差异。
在接受MICOF手术的患者中，接受过角膜移植术的患者术前更易发生青光眼，需预防青光眼。对于发生青光眼的患者，可根据眼表情况选择手术治疗，以减少并发症的发生。
