Impact of Clinical Factors on the Long-Term Functional and Anatomic Outcomes of Osteo-odonto-keratoprosthesis and Tibial Bone Keratoprosthesis
Impact of Clinical Factors on the Long-Term Functional and Anatomic Outcomes of Osteo-odonto-keratoprosthesis and Tibial Bone Keratoprosthesis
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DOI：
10.1016/j.ajo.2010.11.011
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发表时间：
2011-05-01
影响因子：
4.2
通讯作者：
Michael, Ralph
中科院分区：
文献类型：
--
作者：
Fideliz De la Paz, Maria;Alvarez De Toledo, Juan;Michael, Ralph
目的：报道骨-牙-角膜假体和胫骨角膜假体的长期功能和解剖结果；分析手术技术、初诊、年龄、术后并发症等临床因素对最终结局的影响。设计：回顾性队列研究。方法：地点：Barraquer医学研究中心，1974 - 2005年。参与者：227名患者。干预：采用骨-牙-角膜假体或胫骨角膜假体进行生物角膜假体。主要观察指标：功能生存，定义为最佳矫正视力>= 0.05；解剖生存与成功定义为角膜假体板的保留。结果：骨-牙-角膜假体和胫骨角膜假体在随访5年和10年的解剖存活率相当，但骨-牙-角膜假体在相同时间内的功能成功率明显优于胫骨角膜假体。在原发性诊断中，Stevens-Johnson综合征、化学烧伤和沙眼通常具有良好的功能和解剖结果，而眼部瘢痕性类天疱疮的预后最差。年轻患者的情况比年龄较大的患者好。最常见的并发症是挤压（28%）、视网膜脱离（16%）和不受控制的青光眼（11%）。青光眼组解剖效果最好，但功能效果最差，仅优于视网膜脱离组。结论：手术技术、初诊、年龄、术后并发症等临床因素影响生物角膜假体的远期解剖和功能成功。了解这些因素对生存的影响可以帮助外科医生在每个特定病例中确定最佳方法。[J]中华眼科杂志，2011;51(1):829-839。(C)爱思唯尔公司2011。版权所有。)
PURPOSE: To report the long-term functional and anatomic outcomes of osteo-odonto-keratoprosthesis and tibial bone keratoprosthesis; to analyze the influence of clinical factors, such as surgical technique, primary diagnosis, age, and postoperative complications, on the final outcome.DESIGN: Retrospective cohort study.METHODS: SETTING: Centro de Oftalmologia Barraquer, between 1974 and 2005. PARTICIPANTS: Two hundred twenty-seven patients. INTERVENTION: Biological keratoprosthesis using osteo-odonto-keratoprosthesis or tibial bone keratoprosthesis. MAIN OUTCOME MEASURES: Functional survival with success defined as best-corrected visual acuity >= 0.05; anatomic survival with success defined as retention of the keratoprosthesis lamina.RESULTS: Osteo-odonto-keratoprosthesis and tibial bone keratoprosthesis have comparable anatomic survival at 5 and 10 years of follow-up, but osteo-odonto-keratoprosthesis has a significantly better functional success than tibial bone keratoprosthesis at the same time periods. Among the primary diagnoses, Stevens-Johnson syndrome, chemical burn, and trachoma have generally good functional and anatomic outcomes and the least favorable prognosis is for ocular cicatricial pemphigoid. Younger patients fared better than those in older age groups. The most frequent complications were extrusion (28%), retinal detachment (16%), and uncontrolled glaucoma (11%). The glaucoma group had the best anatomic success but the worst functional results, only exceeded by the retinal detachment group in terms of functional outcome.CONCLUSION: Clinical factors, such as surgical technique, primary diagnosis, age, and postoperative complications, can affect the long-term anatomic and functional successes of biological keratoprosthesis. Knowledge about the impact of each of these factors on survival can help surgeons determine the best approach in every particular case. (Am J Ophthalmol 2011;151:829-839. (C) 2011 by Elsevier Inc. All rights reserved.)