Boston Keratoprosthesis Outcomes and Complications
Boston Keratoprosthesis Outcomes and Complications
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DOI：
10.1097/ico.0b013e3181a186dc
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发表时间：
2009-10-01
期刊：
影响因子：
2.8
通讯作者：
Cohen, Elisabeth J.
中科院分区：
文献类型：
--
作者：
Chew, Hall F.;Ayres, Brandon D.;Cohen, Elisabeth J.
目的：评价波士顿角膜假体（KPro）在我院的应用效果。方法：回顾性分析2005年8月至2007年10月接受波士顿KPro治疗的所有患者。结果：37例患者中，男性24例（65%）。平均年龄66.3岁（中位69岁，范围24-93岁；SD = 18.1岁）。平均随访16个月（范围6 ~ 28个月，SD = 6.0个月）。1型KPros 36例（97%），2型KPros 1例（3%）。29例(78%)-22例（59%）患者多次手术失败，主要适应症为穿透性角膜移植术失败。术前合并症包括青光眼[27例（73%）]和角膜缘梢细胞缺乏[13例（35%）]。无术中并发症发生。术后并发症包括假体后膜[24例（65%）]，眼压升高[14例（38%）]，青光眼进展[5例（13.5%）]，眼内炎[4例(11%)-3因依从性停用预防性抗生素]。36个KPro（97%）被保留，1个2型KPro（3%）在一个眼部瘢痕性类天疱疮患者被挤出并被替换。平均最佳矫正视力为术前手指计数（范围：光知觉至20/100）和最后随访时20/90（范围：光知觉至20/25）。最后随访，31例（84%）患者视力改善2线以上，3例（8%）患者视力恶化。结论：绝大多数患者保留率高，最佳矫正视力得到改善。并发症可能发生，需要经常随访监测和治疗青光眼进展、眼内炎和炎症。患者的依从性是至关重要的。尽管有潜在的并发症，波士顿KPro为预后不良的患者提供了视力改善。
Purpose: To evaluate the outcomes of the Boston Keratoprosthesis (KPro) at our institution.Methods: A computerized database retrospectively identified all patients who received a Boston KPro from August 2005 to October 2007.Results: There were 37 patients, 24 (65%) were male. Mean age was 66.3 years (median 69 years, range: 24-93 years; SD = 18.1 years). Mean follow-up was 16 months (range: 6-28 months; SD = 6.0 months). There were 36 type 1 (97%) and I type 2 (3%) KPros. The primary indication was failed penetrating keratoplasty in 29 patients (78%)-22 (59%) from multiple failures, Preoperative comorbidities included glaucoma [27 patients (73%)] and limbal stern cell deficiency [13 patients (35%)]. No intraoperative complications occurred. Postoperative complications included retroprosthetic membrane [24 patients (65%)], increased intraocular pressure [14 patients (38%)], glaucoma progression [5 patients (13.5%)], and endophthalmitis [4 patients (11%)-3 who discontinued prophylactic antibiotics secondary to compliance]. Thirty-six KPros (97%) were retained-1 type 2 KPro (3%) in a patient with ocular cicatricial pemphigoid extruded and was replaced. Mean best-corrected visual acuities were counting fingers preoperatively (range: light perception to 20/100) and 20/90 at last follow-up (range: light perception to 20/25). At last follow-up, 31 patients (84%) improved 2 lines or greater-3 patients (8%) had worse vision.Conclusions: Retention rates were excellent, and best-corrected Visual acuities improved in the vast majority of patients. Complications can occur and require frequent follow-up to monitor and treat glaucoma progression, endophthalmitis, and inflammation. Patient compliance is of paramount importance. Despite the potential complications, the Boston KPro provides visual improvement in patients with an otherwise poor prognosis.