Risk factors for the development of retroprosthetic membranes with Boston keratoprosthesis type 1: multicenter study results.
Risk factors for the development of retroprosthetic membranes with Boston keratoprosthesis type 1: multicenter study results.
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DOI：
10.1016/j.ophtha.2011.11.030
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发表时间：
2012-05
期刊：
影响因子：
13.7
通讯作者：
Boston Type 1 Keratoprosthesis Study Group
中科院分区：
文献类型：
--
作者：
Rudnisky CJ;Belin MW;Todani A;Al-Arfaj K;Ament JD;Zerbe BJ;Ciolino JB;Boston Type 1 Keratoprosthesis Study Group
本研究的目的是在接受波士顿 1 型角膜假体的大型多中心患者队列中确定人工膜后 (RPM) 发育的可能危险因素。队列研究。最终分析包括 265 名患者的 265 只眼睛，这些患者在 2003 年 1 月至 2008 年 7 月期间由 18 个医疗中心的 19 名外科医生之一接受了波士顿 I 型角膜假体植入术。前瞻性地收集报告术前、术中和术后参数的表格，并随后在中央数据收集站点进行分析。主要结果是随访期间是否存在后修复膜（RPM）。分析中纳入了 18 个外科中心的 19 名外科医生进行的 265 例波士顿 1 型人工角膜手术（265 名患者）。患者的平均年龄为63.3±19.1岁，48.5%的患者为女性，52.5%的手术是在右眼进行的。平均随访时间为17.8±14.9个月。大多数人（85.4%；n=222）在人工角膜植入前平均接受了 2.2±1.2 次（范围 1-8）穿透性角膜移植术，其中 38 只眼睛（14.6%）接受了初次角膜移植。总体 RPM 形成率为 31.7% (n=84)。 RPM 发生的最重要危险因素是感染性角膜炎（作为角膜假体手术本身的手术指征），导致 RPM 形成率为 70.6%。作为一个独立的危险因素，这些眼睛出现 RPM 的风险比 (HR) 为 3.20（95% 置信区间：1.66、6.17）。无虹膜也是 RPM 发展的独立危险因素（HR=3.13；95% 置信区间：1.10、8.89）。 RPM 形成是角膜假体手术的常见并发症，约三分之一的病例发生。发生 RPM 风险最高的眼睛是因感染性角膜炎和无虹膜而接受角膜置换术的眼睛。
The purpose of this study was to identify possible risk factors for retroprosthetic membrane (RPM) development in a large multicenter cohort of patients receiving a Boston type 1 keratoprosthesis. Cohort study. The final analysis included 265 eyes of 265 patients who underwent implantation of a Boston Keratoprosthesis Type I device between January 2003 and July 2008 by one of 19 surgeons at 18 medical centers. Forms reporting preoperative, intraoperative, and postoperative parameters were prospectively collected and subsequently analyzed at a central data collection site. The primary outcome was the presence or absence of a retroprosthetic membrane (RPM) during the follow-up period. 265 Boston Type 1 keratoprosthesis surgical procedures (265 patients) from 19 surgeons at 18 surgical centers were included in the analysis. The average age of patients was 63.3±19.1 years, 48.5% of the patients were female, and 52.5% of procedures were performed on the right eye. The mean follow-up time was 17.8±14.9 months. The majority (85.4%; n=222) had undergone an average of 2.2±1.2 (range 1–8) penetrating keratoplasties prior to keratoprosthesis implantation, and 38 eyes (14.6%) received a primary keratoprosthesis. The overall RPM formation rate was 31.7% (n=84). The most significant risk factor for RPM development was infectious keratitis (as a surgical indication for keratoprosthesis surgery itself), resulting in a rate of RPM formation of 70.6%. As an independent risk factor, the hazard ratio (HR) of RPM development in these eyes was 3.20 (95% confidence interval: 1.66, 6.17). Aniridia was also an independent risk factor for RPM development (HR=3.13; 95% confidence interval: 1.10, 8.89). RPM formation is a common complication of keratoprosthesis surgery, occurring in approximately one third of cases. Eyes at the highest risk of RPM development are those receiving corneal replacement for infectious keratitis and aniridia.
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