Netland P A, Terada H, Dohlman C H
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA.
Ophthalmology. 1998 Apr;105(4):751-7. doi: 10.1016/S0161-6420(98)94034-9.
This study aimed to review the authors clinical experience with glaucoma associated with keratoprosthesis in patients with severe corneal disease.
The study design was a retrospective review of case series.
The authors studied 55 eyes in 52 patients with keratoprostheses with follow-up of 21 +/- 16 months (range, 3-77 months).
Glaucoma drainage devices were implanted in 36 eyes (35 Ahmed valves, 1 Krupin valve) with 21 +/- 15 months' follow-up (range, 3-64 months).
Clinical outcome assessment included vision, intraocular pressure (IOP), visual fields, optic disc appearance, and identification of complications.
Glaucoma was found in the majority (64%) of eyes treated with keratoprostheses, identified in 20 eyes (36%) before surgery and an additional 15 eyes (28%) after surgery. Of the 36 eyes treated with glaucoma drainage devices, IOP was controlled in 29 eyes (81%), with 9 eyes (25%) requiring additional medications. Continued progression of glaucoma occurred in 5 (14%) of 36 eyes with keratoprostheses and glaucoma drainage implants (4 of these eyes had advanced glaucomatous optic nerve damage before surgery). There were nine nonvision-threatening complications due to drainage implants. Compared with the preoperative visual acuity, vision was markedly improved in 63%, unchanged in 17%, and worse in 20% of eyes after keratoprosthesis surgery.
Elevation of IOP is common in patients with keratoprosthesis, and prevention or treatment with glaucoma drainage implants is effective.
本研究旨在回顾作者对患有严重角膜疾病患者的角膜移植术后青光眼的临床经验。
本研究设计为病例系列的回顾性研究。
作者研究了52例角膜移植患者的55只眼睛，随访时间为21±16个月（范围3 - 77个月）。
36只眼睛植入了青光眼引流装置（35个艾哈迈德瓣膜，1个克鲁平瓣膜），随访时间为21±15个月（范围3 - 64个月）。
临床结果评估包括视力、眼压（IOP）、视野、视盘外观以及并发症的识别。
在接受角膜移植术治疗的大多数（64%）眼睛中发现了青光眼，其中20只眼睛（36%）在手术前被确诊，另外15只眼睛（28%）在手术后被确诊。在接受青光眼引流装置治疗的36只眼睛中，29只眼睛（81%）的眼压得到控制，9只眼睛（25%）需要额外用药。36只角膜移植且植入青光眼引流装置的眼睛中有5只（14%）青光眼持续进展（其中4只眼睛在手术前已有晚期青光眼性视神经损伤）。因引流植入物出现了9例不威胁视力的并发症。与术前视力相比，角膜移植术后63%的眼睛视力明显改善，17%的眼睛视力不变，20%的眼睛视力变差。
角膜移植患者眼压升高很常见，使用青光眼引流植入物进行预防或治疗是有效的。
