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使用胫骨的骨人工角膜:外科技术和成果

Charoenrook V, Michael R, de la Paz MF, et al.

期刊名称:The Ocular Surface

卷期:2016年第14卷第4期

关键词:
胫骨 角膜 外科

摘要

目的:分析使用胫骨自体移植的人工角膜的解剖和功能结果。方法:我们回顾了Centro de Oftalmologia Barraquer 113例经历胫骨骨人工角膜移植的患者。通过Kaplan-Meier存活曲线95%可信区间计算功能性成功,定义为最佳矫正视力十进制上(BCVA³0.05,计算解剖学成功,定义为保留人工角膜板。采用多变量分析检测临床因素对解剖和功能生存率的影响。结果:基于Kaplan-Meier分析,胫骨人工角膜5年和10年解剖生存率分别是69.5%53.5%5年功能生存率是33%10年功能生存率是19.2%。考虑到初级诊断,化学烧伤比自身免疫或传染病具有更好的解剖和功能生存率。患者年龄对人工角膜生存率没有显著影响。经历外科手术的大约48.7%的患者有并发症:人工角膜挤压,青光眼,视网膜脱落和粘膜坏死最常见。结论:胫骨KPro患者中有一半的人手术后10年保留人工角膜,五分之一的人视力达到0.05或者好于同期。考虑到这些患者没有其它途径恢复视力,因为他们没有犬齿或颊或牙科条件不足以做OOKP,这种修饰手术是他们的唯一希望。

PURPOSE:To analyze the anatomical and functional results of keratoprosthesis using tibial bone autograft.METHODS:We reviewed 113 charts of patients who underwent tibial bone osteokeratoprothesis implantation at the Centro de Oftalmologia Barraquer. Kaplan-Meier survival curves with 95% confidence interval were calculated for functional success, defined as best corrected visual acuity (BCVA) 0.05 on the decimal scale, and for anatomical success, defined as retention of the keratoprosthesis lamina. Multivariate analysis was used to test the impact of clinical factors on anatomical and functional survival rates.RESULTS:Based on Kaplan-Meier analyses, tibial bone keratoprosthesis 5-year and 10-year anatomical survival rates were 69.5% and 53.5%, respectively. Functional survival rate at 5years was 33% and at 10years was 19.2%. Considering primary diagnosis, chemical burn had better anatomical and functional survival rates than autoimmune or infectious diseases. Patient age did not have a significant effect on keratoprosthesis survival rates. About 48.7% of the patients who underwent surgery had complications: keratoprosthesis extrusion, glaucoma, retinal detachment and buccal mucosa necrosis were the most frequent ones.CONCLUSION:Half of the patients with tibial bone KPro had retained the keratoprosthesis after 10years post-surgery and one-fifth of them had visual acuity of 0.05 or better at the same period. Considering that these patients have no other way to recover their vision either because they have no canine tooth or their buccal or dental conditions are not adequate for OOKP, this modified surgery is their only hope.


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