Department of Ophthalmology, College of Medicine, Jouf University, Sakakah, Al-Jouf, Saudi Arabia.
Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College Street, Toronto, ON, M5T 3A9, Canada.
BMC Ophthalmol. 2024 Aug 12;24(1):337. doi: 10.1186/s12886-024-03603-6.
The purpose of the study was to assess visual outcomes, complications, intraocular lens (IOL) stability, and corneal status after sutured scleral-fixated intraocular lens implantation combined with penetrating keratoplasty (PKP).
This retrospective single-arm cohort study included patients who underwent PKP and sutured scleral-fixated intraocular lens implantation between 2013 and 2018 at the Dhahran Eye Specialty Hospital. The eyes were examined postoperatively at 1, 3, 6, 12, and 24 months. Corneal status, complications, and IOL status were also evaluated periodically, and the number of eyes with a BCVA of > 20/200 was recorded.
Twenty-two eyes from 22 patients were included. The median duration of follow-up was 3 (IQR 1.8; 4.4) years. Reasons for surgery were traumatic globe rupture (six eyes, 27.3%), bullous keratopathy (nine eyes, 40.1%), failed previous graft (five eyes, 22.7%), and corneal scarring (two eyes, 9.1%). Twelve (54.5%) eyes showed a BCVA of > 20/200 (non-blind) at 12 months after surgery and only five (22.7%) before surgery. Twelve months after surgery, 13 patients showed an improvement in BCVA in two lines (59.1%), seven remained the same (31.8%), and 2 deteriorated (9.1%). The indication for surgery (p = 0.2) and the stability of the sutured-scleral fixated IOL (p = 0.8) were not associated with an improvement in BCVA at the final follow-up. The corneal graft remained clear in nine eyes (40.9%) at a median duration of 3 years. The overall average survival period for all corneal grafts was 42.9 months.
The combination of sutured scleral-fixated intraocular lens implants and PKP is an effective intervention for preserving visual acuity in patients with complex cases. However, the risk of graft failure and then need for repeat transplantation should be taken into consideration.
本研究旨在评估经巩膜缝合固定人工晶状体植入联合穿透性角膜移植（PKP）后的视力结果、并发症、人工晶状体（IOL）稳定性和角膜状况。
这是一项回顾性单臂队列研究，纳入了 2013 年至 2018 年在达兰眼科专科医院接受 PKP 和经巩膜缝合固定人工晶状体植入的患者。术后 1、3、6、12 和 24 个月对眼睛进行检查。定期评估角膜状况、并发症和 IOL 状况，并记录最佳矫正视力（BCVA）>20/200 的眼数。
纳入了 22 例 22 只眼。中位随访时间为 3（IQR 1.8；4.4）年。手术原因包括外伤性眼球破裂（6 只眼，27.3%）、大泡性角膜病变（9 只眼，40.1%）、先前移植失败（5 只眼，22.7%）和角膜瘢痕（2 只眼，9.1%）。术后 12 个月，12 只眼（54.5%）的 BCVA>20/200（非盲），而术前仅 5 只眼（22.7%）。术后 12 个月时，13 例患者 BCVA 提高两行（59.1%），7 例保持不变（31.8%），2 例下降（9.1%）。手术适应证（p=0.2）和巩膜缝线固定人工晶状体的稳定性（p=0.8）与最终随访时 BCVA 的改善无关。9 只眼（40.9%）的角膜移植物在中位 3 年时仍保持透明。所有角膜移植物的总体平均存活期为 42.9 个月。
经巩膜缝合固定人工晶状体植入联合 PKP 是一种有效保留复杂病例视力的干预措施。然而，应该考虑到移植物失败和需要再次移植的风险。
