Design and Outcomes of a Novel Keratoprosthesis: Addressing Unmet Needs in End-Stage Cicatricial Corneal Blindness
Design and Outcomes of a Novel Keratoprosthesis: Addressing Unmet Needs in End-Stage Cicatricial Corneal Blindness
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DOI：
10.1097/ico.0000000000002207
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发表时间：
2020-04-01
期刊：
影响因子：
2.8
通讯作者：
Chodosh, James
中科院分区：
文献类型：
--
作者：
Bakshi, Shaunak K.;Graney, John;Chodosh, James
目的：在严重瘢痕性角膜结膜炎的情况下，最常用于治疗角膜失明的假体装置是波士顿 II 型角膜假体和改良的骨齿状角膜假体，它们分别需要正常的眼睑皮肤或健康的尖牙。对于这两种属性的患者，我们开发了一种新的角膜假体装置，结合了波士顿 II 型角膜假体和改良骨齿状角膜假体的优点，我们将其命名为“Lux”。方法：对 4 个中心植入的 9 名患者的 9 只眼睛进行回顾性病例系列检查，检查 Lux 角膜假体的短期术后结果、最佳矫正视力 (BCVA)、装置保留和并发症。结果：9 只眼睛中的 7 只（77.8%）因自身免疫性疾病而出现瘢痕性角膜失明，另外 2 只（22.2%）因严重烧伤而出现瘢痕性角膜失明。术前 BCVA = 1 治疗性角膜移植术。一名患者之前曾做过 19 次眼部手术。术后随访的平均持续时间为 18.7 个月（范围 7-28 个月）。所有9例患者BCVA均达到≥20/200，其中2例（22.2%）末次检查时达到20/20，所有9例（100%）装置均保留。一名受者在植入后两个月出现视网膜脱离。两名 (22.2%) 患者需要放置青光眼引流装置。结论：Lux 角膜假体是为患有严重瘢痕性角膜结膜炎的患者开发的，这些患者不适合现有角膜假体设计。 Lux 人工角膜植入后的短期结果令人鼓舞。
Purpose: The most commonly applied prosthetic devices for corneal blindness in the setting of severe cicatricial keratoconjunctivitis are the Boston keratoprosthesis type II and the modified osteo-odonto-keratoprosthesis, with these requiring either normal eyelid skin or a healthy cuspid tooth, respectively. For patients with neither attribute, we developed a new keratoprosthesis device combining positive aspects of both Boston keratoprosthesis type II and modified osteo-odonto-keratoprosthesis, which we have named the "Lux." Methods: Short-term postoperative outcomes for the Lux keratoprosthesis, best-corrected visual acuity (BCVA), device retention, and complications, were examined in a retrospective case series of 9 eyes of 9 patients implanted at 4 centers. Results: Seven of 9 (77.8%) eyes had cicatricial corneal blindness due to autoimmune disease and 2 (22.2%) from severe burns. Preoperative BCVA was = 1 therapeutic keratoplasty. One patient had 19 previous eye surgeries. The mean duration of postoperative follow-up was 18.7 months (range 7-28 months). BCVA of >= 20/200 was achieved in all 9 patients, with 2 (22.2%) reaching 20/20 at the last examination, and all 9 (100%) of the devices were retained. One recipient developed a retinal detachment 2 months after implantation. Two (22.2%) patients required placement of a glaucoma drainage device. Conclusions: The Lux keratoprosthesis was developed for patients with severe cicatricial keratoconjunctivitis who were otherwise not candidates for existing keratoprosthesis designs. Short-term outcomes after implantation of the Lux keratoprosthesis were encouraging.