背景:这项研究的目的是评估视觉结果,并发症,人工晶状体(IOL)稳定性,缝合巩膜固定人工晶状体植入术联合穿透性角膜移植术(PKP)后的角膜状态。
方法:这项回顾性单臂队列研究包括2013年至2018年在Dhahran眼科专科医院接受PKP和巩膜固定人工晶状体植入术的患者。术后1、3、6、12和24个月检查眼睛。角膜状况,并发症,并定期评估IOL状态,并记录BCVA>20/200的眼睛数量。
结果:纳入22例患者的22只眼。中位随访时间为3年(IQR1.8;4.4)。手术的原因是外伤性眼球破裂(六只眼睛,27.3%),大疱性角膜病变(九只眼睛,40.1%),先前的移植失败(五只眼睛,22.7%),和角膜疤痕(两只眼睛,9.1%)。手术后12个月,12只(54.5%)眼的BCVA>20/200(非失明),手术前仅5只(22.7%)。手术后12个月,13例患者表现出两行BCVA的改善(59.1%),七个保持不变(31.8%),和2恶化(9.1%)。手术指征(p=0.2)和缝合巩膜固定IOL的稳定性(p=0.8)与最终随访时BCVA的改善无关。在中位持续时间为3年的9只眼(40.9%)中,角膜移植物保持清晰。所有角膜移植物的总体平均生存期为42.9个月。
结论:缝合巩膜固定人工晶状体植入物和PKP的组合是复杂病例患者保持视力的有效干预措施。然而,应考虑移植物失败的风险,然后需要重复移植。
BACKGROUND: The purpose of the study was to assess visual outcomes, complications, intraocular lens (IOL) stability, and corneal status after sutured scleral-fixated intraocular lens implantation combined with penetrating keratoplasty (PKP).
METHODS: This retrospective single-arm cohort study included patients who underwent PKP and sutured scleral-fixated intraocular lens implantation between 2013 and 2018 at the Dhahran Eye Specialty Hospital. The eyes were examined postoperatively at 1, 3, 6, 12, and 24 months. Corneal status, complications, and IOL status were also evaluated periodically, and the number of eyes with a BCVA of > 20/200 was recorded.
RESULTS: Twenty-two eyes from 22 patients were included. The median duration of follow-up was 3 (IQR 1.8; 4.4) years. Reasons for surgery were traumatic globe rupture (six eyes, 27.3%), bullous keratopathy (nine eyes, 40.1%), failed previous graft (five eyes, 22.7%), and corneal scarring (two eyes, 9.1%). Twelve (54.5%) eyes showed a BCVA of > 20/200 (non-blind) at 12 months after surgery and only five (22.7%) before surgery. Twelve months after surgery, 13 patients showed an improvement in BCVA in two lines (59.1%), seven remained the same (31.8%), and 2 deteriorated (9.1%). The indication for surgery (p = 0.2) and the stability of the sutured-scleral fixated IOL (p = 0.8) were not associated with an improvement in BCVA at the final follow-up. The corneal graft remained clear in nine eyes (40.9%) at a median duration of 3 years. The overall average survival period for all corneal grafts was 42.9 months.
CONCLUSIONS: The combination of sutured scleral-fixated intraocular lens implants and PKP is an effective intervention for preserving visual acuity in patients with complex cases. However, the risk of graft failure and then need for repeat transplantation should be taken into consideration.