Outcomes of Boston keratoprosthesis in aniridia: a retrospective multicenter study

PURPOSE: To evaluate the long-term outcomes of keratoprosthesis as an alternative surgical procedure in the management of aniridic keratopathy. DESIGN: Retrospective, multicenter case series. METHODS: Fifteen adult patients (16 eyes) with aniridia who were deemed at high risk for regular donor corneal transplantation underwent a Boston type I keratoprosthesis procedure for visual rehabilitation. Device retention rate, preoperative and postoperative visual acuity, and intraoperative and postoperative complications were studied. RESULTS: The mean age of the patients was 45 (median 50) years. Six of the patients were females. Eleven patients had previously undergone donor corneal transplantations (average two grafts), with failure. In 10 patients, the keratoprosthesis surgery was combined with other procedures such as cataract extraction, tube shunt implantation, vitrectomy, and intraocular lens removal. No intraoperative complications were encountered. The follow-up ranged from two months to 85 months, with a median of 17 months. All devices remained in situ throughout the entire follow-up period. The visual acuity improved in all but one patient from a median of counting fingers (light perception to 20/300) to 20/200 (hand motions to 20/60). Comorbid preoperative conditions particularly optic nerve and foveal hypoplasia limited the final postoperative vision. No endophthalmitis or extrusion of the device occurred. One device required repair procedure without necessitating a removal. CONCLUSIONS: Keratoprosthesis offers significant vision benefits in this patient group.     

Penetrating keratoplasty combined with vitreoretinal surgery for severe ocular injury with blood-stained cornea and no light perception

OBJECTIVE: To evaluate the effects of treatment of severe ocular injury with blood-stained cornea and no light perception by combined penetrating keratoplasty and vitreoretinal surgery, and to analyze the relevant factors. METHODS: Records of 7 severely injured eyes of 7 patients with blood-stained cornea and no light perception who underwent penetrating keratoplasty combined with vitrectomy using a temporary keratoprosthesis were evaluated retrospectively. The preoperative visual acuity was no light perception in all injured eyes with a mean intraocular pressure of 3 mm Hg and a range from 2 to 5 mm Hg. The average interval from emergency wound closure to vitrectomy was 18 days with a range from 12 to 21 days. The mean follow-up was 28 months with a range from 26 to 30 months. RESULTS: The postoperative visual acuity was better than light perception in 5 eyes with the best corrected visual acuity from light perception to 0.06. The retina was attached in 5 eyes. The postoperative intraocular pressure ranged from 5 to 15 mm Hg with a mean of 12 mm Hg; it was significantly higher than the preoperative one (p < 0.05). The postoperative complications mainly included temporary intraocular elevation (1 eye), corneal neovascularization (4 eyes), corneal rejection (4 eyes), retinal detachment (2 eyes) and ocular atrophy (2 eyes). CONCLUSION: Penetrating keratoplasty combined with vitrectomy using a temporary keratoprosthesis is a safe and effective method in treating severe ocular injury with blood-stained cornea and no light perception.     

Cornea sparing by endoscopically guided vitreoretinal surgery

PURPOSE: To report a series of eyes with acute severe corneal edema and vitreoretinal complications treated with endoscopic vitreous surgery without a keratoprosthesis to the cornea. DESIGN: Retrospective, small, noncomparative case series. PARTICIPANTS: Seven patients with unilateral acute severe corneal edema, poor view of the fundus, and vitreoretinal complications were reviewed. Five eyes were postcataract surgery, one eye was postpenetrating intraocular blunt trauma by a ferrous foreign body, and one eye had endophthalmitis. INTERVENTION: Vitreous surgery was performed on each eye under the guidance of endoscopy. Topical steroid treatment was administered to the cornea for several weeks after the vitreoretinal surgery, until the corneal edema had been completely resolved. MAIN OUTCOME MEASURES AND RESULTS: The edematous corneas recovered within an average of 9 weeks (range, 6-13 weeks). The preoperative visual acuity ranged from 6/90 to hand motion at 0.5 m, and the final postoperative visual acuity was 6/30 or better after an average follow-up of 14 months (range, 3-23 months). CONCLUSIONS: (1) Endoscopic surgery for vitreoretinal complications in eyes with acute severe corneal edema can obviate keratoprosthesis and keratoplasty. (2) By minimizing further damage to the corneal endothelium, endoscopic vitreoretinal surgery might benefit corneal recovery.     

AlphaCor™ keratoprosthesis: postoperative development of six patients

Purpose  AlphaCor™ (Argus Biomedical Pty. Ltd., Perth, Australia) is an artificial, soft, one-piece keratoprosthesis (KPro) indicated for severe corneal conditions not treatable by a donor graft. To evaluate the efficacy and visual restoring of six patients with complete corneal opacification and deep neovascularizations treated with AlphaCor™. Methods  A retrospective review of six patients with a history of corneal opacification treated with keratoprosthesis surgery. AlphaCor™ synthetic cornea was implanted into the corneal stroma. During the follow-up time, slit-lamp and ultrasound examinations, best corrected visual acuity (BCVA), and intraocular pressure measurements were performed. Results  Six eyes with corneal scarring and vascularizations in three to four quadrants of six patients to years of age underwent a keratoprosthesis procedure. The follow-up time was 13–36 months; mean 23 months. The operation procedure was not limited by severe complications. The preoperative BCVA was hand movement to light perception. The postoperative BCVA ranged between 20/200 and 80/100. Intraocular pressure was controlled in all cases. Three patients developed a melting of the anterior corneal lamella. The keratoprosthesis had to be explanted (15–34 months after implantation) and was replaced by a donor cornea. Conclusions  Further evaluation is needed to evaluate the role of AlphaCor™ as a keratoprosthesis.     

复合型人工角膜植入治疗重度角膜盲及并发症处理

目的 探讨钛支架复合型人工角膜植入治疗重度角膜盲的临床价值,以及并发症的处理.方法 回顾性系统病例研究.2002年3月至2005年6月期间中山大学中山眼科中心共完成永久性人工角膜植入9例(单侧眼9只),均为男性,年龄28～52岁.所有患者均为双眼损伤,受伤时间为1.5～5.0年.其中碱烧伤6只眼,爆炸伤3只眼,术前视力均为光感,其中2例光定位不准;均为多次角膜移植以及眼表重建手术失败的难治性重度角膜盲患者.手术分两阶段:一期手术显微镜下行钛支架复合型人工角膜植入联合自体耳软骨移植加固,二期行人工角膜前膜剪开,建立镜柱光学通路.术后评价视力恢复情况,分析并发症的发生原因,探讨相应的处理对策.结果 患者随诊时间1～3年.术后7只眼裸眼视力≥0.1,其中2只眼经镜片矫正后达到0.6.术前光定位不准的2例患者术后视力为0.02和0.04.术后并发症的发生情况为复发性人工角膜前膜5例,进行前膜切除,其中1例联合施行自体唇黏膜移植;角膜局限性融解1例,进行脱细胞真皮加固;人工角膜后膜1例,显微镜下施行后膜钩除术.以上并发症经相应处理均得到控制.随访期内所有人工角膜均保持原位,未发生人工角膜排出、房水渗漏.结论 人工角膜移植是使严重角膜盲患者复明的有效手段,联合自体耳软骨加固可减少并发症的发生,提高人工角膜植入的生物相容性.(中华眼科杂志,2009,45:104-109)     

Boston type 1 keratoprosthesis for severe blinding vernal keratoconjunctivitis and Mooren’s ulcer

Indications for the Boston keratoprosthesis differ throughout the world depending on the prevailing regional causes of end-stage corneal disease. We report the short term anatomical and functional outcomes of the Boston type 1 keratoprosthesis for severe bilaterally blinding vernal keratoconjunctivitis and Mooren’s ulcer. A retrospective chart review was conducted of 2 patients who underwent several unsuccessful ocular surface reconstruction procedures before Boston type 1 keratoprosthesis implantation. The anatomical and visual outcomes of the Boston type 1 keratoprosthesis at 1 year of follow-up were assessed clinically and by anterior segment optical coherence tomography imaging. The keratoprosthesis was retained in both the eyes at 1 year postoperatively with a best-corrected visual acuity of 20/30 in both patients. To our knowledge this is the first report of successful Boston keratoprosthesis implantation for these two unusual indications.     

Legeais BioKpro III keratoprosthesis implantation: long term results in seven patients

AIMS: The long term results of the Legeais BioKpro III keratoprosthesis are presented for seven patients with severe corneal scarring. METHODS: The study took place at Moorfields Eye Hospital, London. Patients had either end stage ocular surface disease or corneal opacification after multiple failed graft surgery, with the potential for significant visual improvement. After insertion the device was covered with a conjunctival flap or buccal mucous membrane graft, which was later opened to expose the optic. The outcome measures were vision, complications, and retention of the device. RESULTS: The BioKpro III was inserted into seven patients with severe corneal scarring: ocular cicatricial pemphigoid, measles keratitis, thermal injury, Stevens-Johnson syndrome, aniridia, chemical injury, and congenital rubella. The follow up was 18-48 months. The keratoprosthesis failed in six, because of extrusion occurring 2-28 months postoperatively. Retroprosthetic membranes occurred in three patients, and endophthalmitis in one. Vision improved from hand movements to 6/12 in the only patient who retained the KPro; however he was troubled by mucus accumulation on the optic. CONCLUSIONS: The one success has been in a patient with thermal burns. The remaining results have been poor, with the KPro extruding in six of the seven patients.     

Five year follow up of biocolonisable microporous fluorocarbon haptic (BIOKOP) keratoprosthesis implantation in patients with high risk of corneal graft failure

AIM: To study the anatomical and visual performance following implantation of a model of artificial cornea and to evaluate the postoperative long term complications. METHODS: 11 eyes of 11 patients with bilateral corneal blindness considered as potentially having high risk of failure of penetrating corneal keratoplasty were implanted with biocolonisable Kpro keratoprosthesis (BIOKOP I, FCI, Rantigny, France) in the period between January 1996 and May 1998. Only one eye was implanted in all patients and followed up for a period of 60 months. The visual outcome, anatomical and functional stability, complications, and the general performance of the keratoprosthesis were evaluated. RESULTS: The keratoprosthesis (BIOKOP I) only 36.3% remained in position to date. In the patients' last visit five eyes (45.4%) were blind and one (9.0%) showed a slight improvement in the best corrected visual acuity (BCVA) in comparison to preoperative tests. Six eyes (54.5%) showed improved BCVA before having postoperative complications. Four eyes underwent replacement of a BIOKOP I Kpro with a BIOKOP II as a result of extrusion. The keratoprostheses remained anatomically in situ for a mean of 25.5 months and their functional performance period was limited to a mean of 22 months. CONCLUSION: Corneal keratoprosthesis (BIOKOP I, II) does not provide a stable anatomical relation with the surrounding ocular structures. Its ability to restore vision is limited to a short postoperative period in eyes implanted with severe ocular surface disease.     

Boston keratoprosthesis restoring vision in an unusual case of end-stage limbal stem cell deficiency following exposure to Euphorbia latex

We report the functional outcome of a patient who had undergone Boston keratoprosthesis type I for extensive ocular surface damage caused by latex of Euphorbia. The milky sap or latex of the Euphorbia plant is highly toxic and an irritant to the skin and eye. Damage to the eye ranges from mild to severe corneal edema, epithelial defects, anterior uveitis, secondary elevated intraocular pressure and, rarely, limbal stem cell deficiency with corneal neovascularization. A restrospective review was conducted of this patient for more than 1 year. During this period he was given subconjunctival bevacizumab injection to regress the corneal vascularization without much benefit, before finally performing Boston keratoprosthesis type I. The patient was evaluated periodically for both anatomical and visual outcome. At the end of 1-year follow-up the keratoprosthesis is well retained with a best-corrected visual acuity of 20/40 in the affected eye.     

Deep anterior lamellar keratoplasty combined with autologous limbal stem cell transplantation in unilateral severe chemical injury

PURPOSE: To evaluate the efficacy of deep anterior lamellar keratoplasty combined with autologous limbal stem cell transplantation for ocular surface reconstruction and visual rehabilitation in eyes with unilateral, late-stage, severe chemical injury. METHODS: This was a retrospective, noncomparative, interventional case series that included 7 eyes of 7 patients, with severe unilateral late stage chemical injury, exhibiting corneal vascularization, conjunctivalization, and extensive corneal scarring were treated at the C. J. Shah Cornea Service, Sankara Nethralaya, a tertiary care center. Surgical procedures included releasing symblepharon adhesions, excising epibulbar fibrous tissue, superficial keratectomy to remove fibrovascular tissues over cornea, deep anterior lamellar dissection, grafting a lamellar corneal button, and transplanting autologous limbal graft, with or without amniotic membrane transplantation. The main outcome measures were relief of patient symptoms, postoperative recovery of the ocular surface, corneal clarity, corneal epithelial stability, and best corrected visual acuity. RESULTS: The mean duration between the injury and surgery was 24.4 +/- 21.8 months. No intraoperative complications were noted. Successful epithelialization was achieved in all eyes. The reconstructed corneal surface remained stable during the entire follow-up period (mean follow-up, 16.57 +/- 5.12 months). All patients had resolution of ocular symptoms. Remarkable improvement in vision was noted in all (85.7%) except 1 eye in which recovery was limited due to amblyopia. The average best corrected visual acuity at last follow-up was 20/50. No complications were noted in the donor fellow eye. CONCLUSIONS: DALK combined with autologous limbal transplantation can restore a healthy, stable ocular surface, besides providing a clear cornea that remarkably improves the visual acuity, in patients with unilateral, late stage, severe chemical injury.     

Forty-five years of keratoprosthesis study and application at the Filatov Institute:a retrospective analysis of 1 060 cases

AIM: To present results of the keratoprosthesis method used at The Filatov Institute of Eye Diseases and Tissue Therapy.METHODS:A retrospective case series analysis was used to describe the development of new types of keratoprostheses and methods of implantation as well as different ways of leukoma strengthening.RESULTS:Keratoprosthesis was performed in 1 060 eyes of 1 040 patients with leukomas of different etiology:burns, 725 eyes (68.4%); trauma, 120 eyes (11.3%); keratitis and ocular pemphigoid, 108 eyes (10.2%); and bullous keratopathy, 107 eyes (10.1%). Visual acuity before keratoprosthesis consisted of light perception in 962 eyes (92%), and 98 eyes (8%) had minimal visual acuity (1/200-1/50). Both eyes were blind (visual acuity less than 1/200) in 955 patients (91.8%). The period of blindness varied from 1 to 52 years. As a result of keratoprosthesis, visual acuity of ≥1/200 was restored in 1 023 of 1 060 eyes (96.5%). Visual acuity of 20/200-20/20 was achieved in 716 eyes (67.5%). At the last follow-up visit visual acuity of ≥1/200 was preserved in 806 eyes (76%), visual acuity of 20/200-20/20 was measured in 583 of 1 060 eyes (55%) and good keratoprosthesis fixation in the cornea was achieved in 986 of 1 060 eyes (93%). The minimal follow-up was 12 months (range, 12 months to 37 years, median 5 years).CONCLUSION: Our techniques of keratoprosthesis effectively restore vision in patients with leukomas that cannot be treated by optical corneal grafting.     

无晶状体眼二期人工晶状体植入20例临床观察

目的:观察无晶状体眼二期人工晶状体植入的疗效。方法:对20例无晶状体眼的患者,采用睫状沟悬吊固定手术二期植入人工晶状体。随诊3～12mo,观察术后视力、眼压、人工晶状体位置及术中术后并发症。结果:所选20例患者术后第1d裸眼视力0.1～0.3者1例,0.4～0.5者6例,0.6～0.8者12例。眼压平均18～20mmHg。术后角膜水肿1例,经氯化钠眼药水及复方妥布霉素眼药水治疗1wk后吸收。角膜切口处水肿5例,1wk后自行吸收。结膜下出血5例,5～10d吸收。随访3～12mo,20眼手术后人工晶状体位置居中,未发现明显偏斜。无青光眼、视网膜脱离等严重的并发症。老年性白内障术后无晶状体眼的患者二期人工晶状体植入后视力恢复较理想。结论:对于白内障术后无晶状体眼患者,采用睫状沟悬吊固定手术二期植入人工晶状体,不仅获得良好的裸眼视力和矫正视力,同时可减少一系列并发症。     

Successful surgical rehabilitation of children with traumatic corneal laceration and cataract

OBJECTIVE: To evaluate the visual and refractive outcome of corneal transplant surgery, cataract extraction, and intraocular lens (IOL) implantation in children with traumatic corneal laceration and cataract. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Five patients, 7 years of age or younger, who underwent penetrating keratoplasty, cataract extraction, and IOL implantation for traumatic corneal laceration and cataract were identified. MAIN OUTCOME MEASURES: Each case was analyzed retrospectively for the following factors: preoperative findings; surgical technique, including management of the posterior capsule; measurement of axial length and keratometry; calculation of IOL power, style, and type of IOL implanted; graft clarity; final visual acuity; and final refraction. RESULTS: The five children ranged from 3 to 7 years of age at the time of trauma. All had primary repair of their injury before referral. Each patient was observed for more than 2 years. Each had a posterior chamber IOL placed in the sulcus. After surgery, no severe complications were observed. The preoperative visual acuity ranged from 20/400 to light perception. After surgery, all five patients had clear grafts and an improved visual acuity ranging from 20/20 to 20/400. The final spherical refraction in each patient was within 3.75 diopters (D) of plano, with 1.50 to 3.25 D of cylinder. CONCLUSIONS: Successful surgical rehabilitation was accomplished in these patients. Despite their young age and the difficulty in determining IOL power, combining surgery and aggressive amblyopia therapy resulted in visual rehabilitation with refractions approaching emmetropia.     

角膜溃疡清创联合结膜瓣遮盖术治疗感染性角膜溃疡的临床疗效

目的探讨角膜溃疡清创联合结膜瓣遮盖术治疗感染性角膜溃疡的临床疗效。方法回顾性系列病例研究。对2002年5月至2014年6月在青岛眼科医院行角膜溃疡清创联合结膜瓣遮盖术的感染性角膜溃疡患者102例（102眼）的临床资料进行分析。统计感染性质、手术并发症、手术效果及视力（logMAR）变化等资料,采用配对样本秩和检验对数据进行统计分析。结果102例患者中,除2例（2.0%）手术失败改行穿透性角膜移植术（PKP）及1例（1.0%）发生结膜瓣回退拒绝治疗随后失访的患者外,其余99例（97.0%）患者角膜感染均成功控制。89例（87.3%）患者术后随访过程中未见明显异常。13例（12.7%）患者出现异常改变：6例（5.9%）患者发生结膜瓣回退,其中1例合并角膜穿孔改行PKP术,另有1例术后发生结膜瓣回退,患者拒绝二次手术,出院之后失访,其余4例行结膜瓣重缝术后溃疡愈合;4例（3.9%）术后角膜溃疡愈合后随访过程中再次发生角膜溃疡;1例因术后感染加重改行PKP术;1例发生大泡性角膜病变;1例出现结膜瓣下上皮植入性囊肿。感染成功控制的99例患者中,术前裸眼视力（UCVA）为3.90（2.60,4.30）,出院时UCVA为4.00（2.60,4.48）,差异无统计学意义（Z=-1.77,P>0.05）。72例患者随访资料齐全,随访时间（6.1±5.0）个月;术前UCVA为4.00（2.60,4.40）,术后3个月为4.30（3.40,4.70）,差异具有统计学意义（Z=-2.74,P<0.01）。结论角膜溃疡清创联合结膜瓣遮盖术是控制感染性角膜溃疡的一种有效手术方式。该手术成功率高,并发症少,有助于挽救患者眼球并保留一定的视力。     

严重眼球破裂伤无光感眼合并角膜血染的手术治疗

目的 探讨严重眼球破裂伤无光感眼合并角膜血染的手术治疗效果，并分析相关因素。 方法 7例患者7只眼因严重眼球破裂伤无光感合并角膜血染接受2期临时人工角膜下玻璃体切割联合角膜移植手术。2期手术前7只眼均角膜血染，前房及玻璃体积血，视网膜脉络膜脱离。1期与2期手术间隔时间平均18d(12～21d)。手术前视力均无光感，眼压平均3 mm Hg(1mm Hg=0.133 kPa)(2～5 mm Hg)。随访平均时间12个月(6～30个月)。 结果 5只眼恢复光感以上视力，矫正视力从光感至0.05。视网膜复位5只眼(5/7)。眼压平均12 mm Hg(5～15 mm Hg)，明显高于手术前眼压(P＜0.05)。并发症包括一过性高眼压(1 只眼)，角膜新生血管(4只眼)，角膜排斥反应(4只眼)，眼球萎缩(2只眼)。 结论 临时人工角膜下玻璃体切割联合角膜移植手术是挽球严重眼球破裂伤无光感眼合并角膜血染的安全有效的方法。（中华眼底病杂志，2004，20：212-214）     

同期穿透性角膜移植白内障摘除人工晶状体植入三联手术的远期疗效评价

目的:评价穿透性角膜移植联合白内障摘除人工晶状体植入三联手术的效果和优点。方法:对9例中央性角膜白斑合并白内障患者,从角膜移植孔行开放式白内障囊外摘除,植入后房型人工晶状体。结果:经5～9a随访观察,角膜植片透明7例,半透明2例;术后矫正视力0.06～0.08者2例,0.1～0.2者2例,0.3～0.4者4例,0.5者1例。所有病例眼压正常,有轻度后发性白内障1例,未作处理,1次角膜植片术后发生免疫排斥反应2例,2次免疫排斥反应1例。结论:同期穿透性角膜移植白内障摘除人工晶状体植入三联手术是治疗角膜白斑合并白内障较理想的治疗方法。     

The Boston Keratoprosthesis in severe ocular trauma

BACKGROUND: In eyes with corneal disease and opacity so severe that standard corneal transplantation carries a poor prognosis, a keratoprosthesis (KPro) may still be successful in providing functional visual acuity. The purpose of this study was to determine the outcome of Boston KPro implantation in the rehabilitation of severe ocular trauma. METHODS: This is a retrospective study of 30 eyes (30 patients) with severe ocular trauma that underwent Boston KPro type I implantation at the Massachusetts Eye and Ear Infirmary. Of these 30 eyes, 6 had mechanical trauma, 21 had chemical burns, and 3 had thermal burns. The measures used in this review are 5-fold: (i) anatomic success; (ii) number of postoperative repair procedures performed; (iii) preoperative and postoperative visual acuity; (iv) number of eyes with concomitant preoperative retinal or optic nerve damage prior to KPro surgery; and (v) incidence of postoperative complications. RESULTS: Preoperative visual acuity ranged from counting fingers to light perception (median: hand motion). Best-corrected postoperative visual acuity ranged from 20/20 to no light perception (median: 20/80). Anatomic success was achieved in 5 out of 5 mechanically traumatized eyes, 14 out of 17 eyes with chemical burns, and 3 out of 3 eyes with thermal burns. Repair procedures were done in 8 of the 17 chemically burned eyes. The number of eyes with concomitant preoperative ocular disease was 2 out of 6 in the mechanical trauma group, 10 out of 21 in the chemical burn group, and 1 out of 3 in the thermal burn group. The incidence of postoperative complications was greater in the chemical burn group than in either the mechanical trauma or the thermal burn group. INTERPRETATION: The Boston KPro can provide considerable visual improvement and a long-term anatomic retention rate in severely traumatized eyes. The overwhelming danger in severe chemical burns is glaucoma progression despite a functioning tube implant and normal intraocular pressure.     

人工角膜植入术的临床研究

评价复杂性角膜混浊患者行人工角膜植入术的临床效果和并发症等。方法选择15例双眼盲目患者的单侧眼15只,术前视力均为光感,角膜混浊病变无法用常规角膜移植手术达到复明目的。其中严重碱烧伤6只眼,严重酸烧伤3只眼,铝水烧伤2只眼,爆炸伤1只眼,严重实质性眼干燥症1只眼,多次穿透性角膜移植失败角膜严重血管化2只眼。人工角膜(MICOF)由俄罗斯费德洛夫眼外科中心制造。手术分两期：一期手术将人工角膜支架植入角膜层问,选择病例行角膜表面或层问加固性手术。约3个月后行二期手术,植入带螺纹的人工角膜光学部。常规行晶状体、部分虹膜及前部玻璃体切除术,将外1／3上、下睑缘做永久性缝合。对完全睑球粘连者,用上、下睑皮肤覆盖角膜表面,仅暴露人工角膜光学部。结果二期术后观察4～26个月,平均9．5个月,除1只眼视力光感外,其余眼裸眼视力0．12～1．0。手术并发症包括分离角膜板层时穿入前房,晶状体皮质残留,柱镜前表面结膜上皮遮盖,柱镜前表面纤维增生组织遮盖,柱镜后壁沉着物,角膜溶解。结论人工角膜特别适合于穿透性角膜移植难于成功的双眼盲目者,而且是对目前严重角膜瘢痕血管化、严重眼睑或泪液功能不良患者有效的复明手段。该术式结合自体结膜遮盖、骨膜层问移植及睑裂部分缝合等,有利于人工角膜的长期存留。     

Long-term outcomes of the MICOF keratoprosthesis surgery

PurposeTo evaluate long-term anatomical and functional outcomes of the MICOF keratoprosthesis to treat end-stage corneal blindness.DesignRetrospective review of consecutive clinical case series.ParticipantsBetween October 2000 and October 2015, at the Department of Ophthalmology of Chinese PLA General Hospital (PLAGH), a total of 132 eyes of 131 patients had undergone a MICOF keratoprosthesis implantation. Of those, 91 eyes of 90 patients were included in this study.MethodsPreoperative information, surgical procedures, and postoperative data were collected for each included eye.Main outcome measuresBest-corrected visual acuity (BCVA), keratoprosthesis retention, and significant postoperative complications were reported.ResultsThe most common indications for surgery were chemical or thermal burns (68.1%, 62 of 91 eyes) and explosive injury (12.1%, 11 of 91 eyes), followed by Stevens-Johnson Syndrome (10.0%, 9 of 91 eyes), Sjögren's syndrome (4.4%, 4 of 91 eyes), mucous membrane pemphigoid (3.3%, 3 of 91 eyes) and multi-penetrating keratoplasty failure (2.2%, 2 of 91 eyes). The mean follow-up duration was 8.38 ± 3.22 years (range: 5–17.25 years, median: 7.67 years).All patbients had a preoperative visual acuity of hand motions or worse. A MICOF keratoprosthesis significantly improved patients' visual function with bilateral end-stage corneal blindness. Postoperative visual acuity improved to 20/200 or better in 41 eyes (45.1%, of 91 eyes) and to 20/100 or better in 32 eyes (35.2% of 91 eyes) at the last follow-up visit. Preexisting glaucoma was present in 17 (18.7% of 91 eyes). The most common postoperative complications were overgrowth of the surface mucosa (31.9%, 29 of 91 eyes), glaucoma (25.3%, 23 of 91 eyes), retro-prosthetic membrane (15.4%, 14 of 91 eyes), keratoprosthesis device extrusion (15.4%, 14 of 91 eyes), superficial tissue thinning (14.3%, 13 of 91 eyes), endophthalmitis (13.2%, 12 of 91 eyes), titanium frame exposure (13.2%, 12 of 91 eyes), optical cylinder ante-displacement (13.2%, 12 of 91 eyes), cornea melting (7.7%, 7 of 91 eyes), retinal detachment (6.6%, 6 of 91 eyes) and aqueous humour leakage (2.2%, 2 of 91 eyes). 84.6% (77 of 91 eyes) of the eyes retained their initial keratoprosthesis at the latest follow-up.ConclusionsA MICOF keratoprosthesis is a reliable approach to rescue vision in end-stage corneal blinded patients and has better retention than a Boston Kpro TypeⅡ.     

人工晶状体眼并发大泡性角膜病变及视网膜脱离时应用临时人工角膜进行眼前后节联合手术

目的探讨在人工晶状体眼合并大泡性角膜病变及视网膜脱离病例中应用临时人工角膜行玻璃体切割联合穿透性角膜移植的临床价值。方法对6例(6眼)人工晶状体眼合并大泡性角膜病变及视网膜脱离患者行临时人工角膜下玻璃体切割联合穿透性角膜移植术。结果6例患者术后视网膜均复位良好，5例角膜植片透明，1例患者视力达0．1．2例患者手术中取出人工晶状体。结论该手术是一种安全、有效的治疗手段，对保留人工晶状体眼合并大泡性角膜病变及视网膜脱离患者的眼球及部分视力起到了积极的作用。