Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States of America.
PLoS One. 2024 Oct 3;19(10):e0311413. doi: 10.1371/journal.pone.0311413. eCollection 2024.
Primary keratoprosthesis (Kpro) implantation may be indicated in eyes that have an expected poor prognosis following initial penetrating keratoplasty, such as eyes with limbal stem cell deficiency (LSCD). We compare visual outcomes of eyes undergoing primary Kpro to eyes that had a secondary Kpro following penetrating keratoplasty.
Retrospective review of all patients who had Kpro implantation at a tertiary academic medical center from 2005-2020. Among those, eyes that had undergone primary Kpro implantation without a history of prior corneal transplantation were also identified.
Eighty-four eyes of 77 patients that had undergone Kpro implantation were identified. Of those 84, 12 eyes (21.4%) of 12 patients were receiving primary Kpro since they were corneal transplant-naïve. Among individuals undergoing primary Kpro implantation compared to secondary Kpro implantation, the most common underlying diagnoses were limbal stem cell deficiency (41.7% vs 10.0%, p = 0.01304), corneal scarring not otherwise specified (25.0% vs 2.86%, p = 0.02077), and neurotrophic cornea (16.7% vs 2.86%, p = 0.1002). Eyes undergoing primary Kpro implantation had similar mean visual acuity to eyes undergoing secondary Kpro preoperatively (20/2118 vs 20/3786, p = 0.271), 3 months postoperatively (20/264 vs 20/758, p = 0.174), and at final follow up (average 3.06 years, 20/907 vs 20/3446, p = 0.070). Average follow-up time and rates of glaucoma, endophthalmitis, retroprosthetic membrane, and retinal detachment did not significantly differ between groups (all p > 0.05). All eyes that progressed to no light perception (n = 13) had undergone secondary Kpro implantation.
Visual acuity outcomes were similar between primary Kpro implantation and secondary Kpro implantation. Eyes that underwent primary Kpro implantation trended toward better postoperative VA at final follow-up than secondary Kpro eyes.
原发性角膜移植术（Kpro）可能适用于初次穿透性角膜移植术后预后较差的眼睛，例如患有边缘干细胞缺乏症（LSCD）的眼睛。我们比较了原发性 Kpro 手术后眼睛和穿透性角膜移植术后继发性 Kpro 手术后眼睛的视力结果。
回顾性分析 2005 年至 2020 年在一家三级学术医疗中心接受 Kpro 植入的所有患者。在这些患者中，还确定了没有先前角膜移植史的原发性 Kpro 植入的患者。
确定了 77 名患者的 84 只眼接受了 Kpro 植入。在这 84 只眼中，12 只眼（21.4%）的 12 名患者由于是角膜移植初治患者，因此接受了原发性 Kpro。与继发性 Kpro 植入相比，接受原发性 Kpro 植入的个体中，最常见的潜在诊断是边缘干细胞缺乏症（41.7%比 10.0%，p = 0.01304），未特指的角膜瘢痕（25.0%比 2.86%，p = 0.02077）和神经营养性角膜（16.7%比 2.86%，p = 0.1002）。接受原发性 Kpro 植入的眼睛在术前、术后 3 个月和最终随访时的平均视力与接受继发性 Kpro 植入的眼睛相似（术前 20/2118 与 20/3786，p = 0.271），术后 3 个月（20/264 与 20/758，p = 0.174）和最终随访时（平均 3.06 年，20/907 与 20/3446，p = 0.070）。两组之间的平均随访时间和青光眼、眼内炎、后发性白内障和视网膜脱离的发生率无显著差异（均 p>0.05）。所有进展为无光感的眼睛（n = 13）均接受了继发性 Kpro 植入。
原发性 Kpro 植入和继发性 Kpro 植入的视力结果相似。在最终随访时，接受原发性 Kpro 植入的眼睛在术后 VA 方面的趋势要好于继发性 Kpro 眼睛。
