Purpose

To analyze and review the clinical features and main outcomes of laminar resorption from the UK osteo-odonto-keratoprosthesis (OOKP) cohort.

Methods

A retrospective review of case records was undertaken for patients who underwent keratoprostheses between 1996 and 2014 at the Sussex Eye Hospital, Brighton, UK. The main clinical outcomes of resorption, including its clinical signs, complications, treatments, and laminar survival, were evaluated.

Results

Sixty-four patients (25-females, 39-males) were included, and in total, 74 laminae (3-tibial, 11-allografts, 60-autografts) were implanted. The age of the patients ranged from 20 to 91 years. Focal laminar thinning was the first sign of detectable resorption in 50% of autografts and 27% of allografts. All the tibial grafts and 55% of allografts presented with complications of resorption like endophthalmitis and aqueous leakage as the first signs of resorption. The survival of first implanted autografts was 82.4%(±6.3%) at 18 years, which was enhanced to 91.5%(±5.0%) by prophylactic exchanges of critically resorbed laminae with new laminae. Visual acuity survival analysis did not reveal a statistically significant difference between grafts with and without resorption for all graft types (p = 0.825). Patients treated with Alendronic acid and acetazolamide demonstrated trends toward the slower progression of resorption, but this was not statistically significant.

Conclusions

Focal laminar thinning was the common presenting feature of resorption in autografts. Timely replacement of the resorbed laminae with new laminae should be considered to avoid complications. Alendronic acid supplementation may be considered in high-risk cases of resorption to reduce further progression.

中文翻译：

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层流吸收的临床研究：第 2 部分 - 结果、审查和分类建议

目的

分析和回顾来自英国骨-牙-角膜假体 (OOKP) 队列的层流吸收的临床特征和主要结果。

方法

对 1996 年至 2014 年间在英国布莱顿苏塞克斯眼科医院接受角膜假体术的患者的病例记录进行了回顾性审查。评估了吸收的主要临床结果，包括其临床症状、并发症、治疗和层流生存。

结果

包括 64 名患者（25 名女性，39 名男性），总共植入了 74 块椎板（3 块胫骨、11 块同种异体移植物、60 块自体移植物）。患者的年龄从 20 岁到 91 岁不等。在 50% 的自体移植物和 27% 的同种异体移植物中，局部层流变薄是可检测到的吸收的第一个迹象。所有胫骨移植物和 55% 的同种异体移植物均出现吸收并发症，如眼内炎和房水渗漏，这是吸收的第一个迹象。首次植入的自体移植物在 18 年时的存活率为 82.4%(±6.3%)，通过将严重吸收的椎板与新的椎板进行预防性交换，存活率提高到 91.5%(±5.0%)。视力存活分析未显示所有移植物类型有和无吸收的移植物之间的统计学显着差异（p = 0.825）。

结论

局部层流变薄是自体移植物吸收的常见特征。应考虑及时用新的椎板更换吸收的椎板以避免并发症。在吸收的高风险病例中可以考虑补充阿仑膦酸以减少进一步的进展。