Outcomes of Boston Keratoprosthesis Implantation for Failed Keratoplasty After Keratolimbal Allograft
Outcomes of Boston Keratoprosthesis Implantation for Failed Keratoplasty After Keratolimbal Allograft
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DOI：
10.1097/ico.0b013e31823e2ac6
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发表时间：
2012-12-01
期刊：
影响因子：
2.8
通讯作者：
Djalilian, Ali R.
中科院分区：
文献类型：
--
作者：
Hou, Joshua H.;de la Cruz, Jose;Djalilian, Ali R.
目的：探讨同种异体角膜缘移植(KLAL)后角膜移植失败的原因，并报道波士顿I型人工角膜(KPro)作为抢救治疗的结果。方法：对连续7例(7只眼)眼表疾病及角膜缘干细胞缺乏症患者在KLAL失败后应用KPro治疗的非对照病例进行回顾性研究。结果：在研究的队列中，角膜移植失败发生的时间平均为9.9个月(范围为1-17个月)。在回顾的7只眼中，4只眼有导管分流，其中3只眼直接导致内皮移植失败。1只眼因真菌性角膜炎失败，1只眼因免疫介导的内皮排斥反应失败，2只眼因复发的表面疾病而失败。在KPro术后平均585天(19.5个月)的随访中，最佳矫正视力从数指的中位数Cf@2 ft(手部运动至20/400)提高到中位数20/400(Cf@3 ft至20/25)。有85.7%(6/7)的植入装置在最后一次随访时被保留，其中1只眼在免疫抑制突然停止后需要重复使用KPro进行角膜融化和植入物挤出。结论：尽管KLAL的结果和全身免疫抑制成功，但接受KLAL眼表重建的患者仍有随后角膜移植失败的风险。对于这些患者的视力康复，人工角膜是一种可行的挽救疗法。在这些患者的术后处理中，适当的免疫抑制是重要的。
Purpose: To evaluate factors that contribute to keratoplasty failure after keratolimbal allograft (KLAL) and report the outcomes of Boston keratoprosthesis type I (KPro) as salvage therapy.Methods: Retrospective noncomparative case series of 7 eyes in 7 consecutive patients with ocular surface disease and limbal stem cell deficiency treated with KPro after failed KLAL. Mechanisms of graft failure, KPro device retention rate, and preoperative and postoperative best-corrected visual acuities were studied.Results: In the studied cohort, keratoplasty graft failure occurred at an average of 9.9 months (range, 1-17 months) after KLAL. Among the 7 eyes reviewed, 4 had tube shunts, 3 of which contributed directly to endothelial graft failure. One eye failed due to fungal keratitis, 1 eye failed due to immune-mediated endothelial rejection, and 2 eyes failed due to recurrent surface disease. During an average follow-up of 585 days (19.5 months) after KPro, best-corrected visual acuity improved from a median of counting fingers CF@2ft (range, hand motions to 20/400) to a median of 20/400 (range, CF@3ft to 20/25). There was 85.7% (6 of 7) retention of implanted devices at the last follow-up, with 1 eye requiring repeat KPro for corneal melt and implant extrusion after abrupt cessation of immunosuppression.Conclusions: Despite successful KLAL outcomes and systemic immunosuppression, patients who undergo ocular surface reconstruction with KLAL are still at risk for subsequent keratoplasty failure. Keratoprosthesis is a viable salvage therapy for visual rehabilitation in these patients. Adequate immunosuppression is important in postoperative management of these patients.