LVP keratoprosthesis: anatomical and functional outcomes in bilateral end-stage corneal blindness
LVP keratoprosthesis: anatomical and functional outcomes in bilateral end-stage corneal blindness
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DOI：
10.1136/bjophthalmol-2017-311649
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发表时间：
2019-05-01
影响因子：
4.1
通讯作者：
Sangwan, Virender
中科院分区：
文献类型：
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作者：
Basu, Sayan;Nagpal, Ritu;Sangwan, Virender
目的描述新型LVP人工角膜（Kpro）在常规角膜手术禁忌的终末期角膜盲患者中的解剖学和功能结果，以替代改良骨齿人工角膜（MOOKP）（12名儿童和44名成人），患有重度双侧角膜病变，眼表完全干燥、真皮化，2012年至2016年接受单侧LVP Kpro植入术。在这两个阶段的程序，眼表唇粘膜移植，随后3个月的植入装置下移植的粘膜瓣。主要结果指标为解剖学留存率和最佳矫正视力（BCVA）的改善。次要结局指标是并发症的发生率。结果平均术后随访时间为2.5 ± 1.1年。Kaplan-Meier生存分析显示，1年时解剖结构留存率为90.8% ± 3.9%，2年时为80% ± 5.7%，3-5年时为76.6% ± 6.5%。儿童和成人的生存率相当（5年时91% vs 72%，p=0.258）。约61.5%的患眼保持20/ 400或更好的视力，术后1年时中位BCVA从光感改善至20/ 70（p< 0.0001）。术后并发症发生率分别为43%、26%、22%、12%和3%。结论LVP Kpro是治疗干眼终末期角膜盲的有效方法。LVP Kpro在MOOKP禁忌或难以执行的情况下特别有用。
Purpose To describe the anatomical and functional outcomes of the novel LVP keratoprosthesis (Kpro), developed as an alternative to the modified osteoodonto keratoprosthesis (MOOKP), in eyes with endstage corneal blindness where conventional corneal surgeries are contraindicated.Methods This prospective case series included 58 eyes of 56 patients (12 children and 44 adults) with severe bilateral keratopathy and completely dry, dermalised ocular surfaces who underwent unilateral LVP Kpro implantation from 2012 to 2016. In this two-stage procedure, an ocular surface labial mucous membrane grafting was performed, followed for 3 months by the implantation of the device under the engrafted mucosal flap. The primary outcome measures were anatomical retention rate and improvement in best corrected visual acuity (BCVA). The secondary outcome measure was rate of occurrence of complications.Results Mean postoperative follow-up was 2.5 +/- 1.1 years. Kaplan-Meier survival analysis showed an anatomical retention rate of 90.8%+/- 3.9% at 1 year, 80%+/- 5.7% at 2 years and 76.6%+/- 6.5% at 3-5 years. The survival rates were comparable in children and adults (91% vs 72% at 5 years, p=0.258). About 61.5% of eyes maintained 20/ 400 or better vision and median BCVA improved from perception of light to 20/ 70 at 1 year postoperatively (p< 0.0001). Complications like retroprosthetic membrane formation, glaucoma, vitritis, endophthalmitis and panophthalmitis occurred in 43%, 26%, 22%, 12% and 3% of the eyes, respectively.Conclusion The LVP Kpro is an effective procedure for the treatment of end-stage corneal blindness in completely dry eyes. The LVP Kpro can be particularly useful in situations where the MOOKP is contraindicated or difficult to perform.