Purpose

To evaluate outcomes of Boston keratoprosthesis (KPro) repair versus repeat KPro as treatment for corneal melt in KPro patients.

Methods

Retrospective study of adult KPro patients with melt managed by KPro repair or repeat KPro by one surgeon (MH-D). Incidence of sight- or globe-threatening complications, risk of recurrence of melt and change in BCVA before and 3 months after the procedure were compared between both treatment groups. Change from pre-melt BCVA to final BCVA was compared between primary versus secondary repeat KPro after repair attempt.

Results

This study included 19 eyes of 19 patients with melt and mean follow-up of 8.7 years. Primary repeat KPro was performed in 6 eyes (32%) and KPro repair in 13 eyes (68%). There were no significant differences in gender, age, or incidence of complications after KPro repair versus after repeat KPro (92% and 83% complication rate respectively, p > 0.05). The odds ratio for melt recurrence after KPro repair versus repeat KPro was 24 (95% CI 1.68–340). Change in BCVA was not significantly different in KPro repair versus repeat KPro nor in primary versus secondary repeat KPro (p > 0.05).

Conclusions

Repeat KPro offers a lower risk of recurrence of melt compared to KPro repair. However, repair may be considered when timely access to a new KPro and corneal graft is not possible. Delaying repeat KPro does not significantly affect final BCVA. Finally, repeat KPro is the only effective treatment when melt has led to extrusion or uncontrollable infection.

中文翻译：

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1型波士顿角膜置换术患者的角膜融化处理：修复与重复。

目的

为了评估波士顿角膜修复术（KPro）修复与重复KPro修复KPro患者角膜融化的效果。

方法

回顾性研究由一名KPro修复或一名外科医师重复进行KPro的成年KPro合并熔化的患者（MH-D）。比较两个治疗组在手术前和手术后3个月内发生视力或眼球威胁性并发症的发生率，融化复发的风险和BCVA的变化。尝试修复后，比较主要重复序列和次要重复序列KPro之间从熔化前BCVA到最终BCVA的变化。

结果

这项研究包括19例融化患者的19眼，平均随访8.7年。进行6眼（32％）的初次重复KPro，对13眼（68％）的KPro修复。KPro修复后的性别，年龄或并发症发生率与重复KPro后没有显着差异（并发症发生率分别为92％和83％，p> 0.05）。KPro修复后与重复KPro相比，熔体复发的比值比为24（95％CI 1.68–340）。BCVA的变化在KPro修复与重复KPro修复之间以及在主要与次要KPro修复之间无显着差异（p> 0.05）。

结论

与KPro维修相比，Repeat KPro降低了熔体复发的风险。但是，当无法及时使用新的KPro且无法进行角膜移植时，可以考虑进行修复。延迟重复KPro不会显着影响最终的BCVA。最后，当熔体导致挤出或无法控制的感染时，重复KPro是唯一有效的治疗方法。