Temporary Keratoprosthesis and Primary Corneal Graft for Ocular Trauma: A Systematic Review and Meta-Analysis.

Autor: McMaster D; From the Imperial College London (D.M.), London, UK., Halliday S; BRAVO VICTOR (S.H., R.S.G.), London, UK., Bapty J; Portsmouth Hospitals University NHS Trust (J.B.), Portsmouth, UK., McClellan SF; Vision Center of Excellence, Research & Development Directorate (J-9), Defence Health Agency (S.F.M.), Silver Spring, Maryland, USA., Miller SC; Wilmer Eye Institute, Johns Hopkins University School of Medicine (S.C.M.), Baltimore, Maryland, USA., Justin GA; Uniformed Services University of the Health Sciences (G.A.J., F.A.W., J.C., K.E.M., R.A.M., M.C.), Bethesda, Maryland, USA; Duke Eye Center, Duke University Hospitals (G.A.J.), Durham, North Carolina, USA., Agrawal R; National Healthcare Group Eye Institute, Tan Tock Seng Hospital (R.A.), Singapore; Singapore Eye Research Institute (R.A.), Singapore; Lee Kong Chian School of Medicine (R.A.), Singapore; Duke NUS Medical School (R.A.), Singapore., Hoskin AK; Save Sight Institute, Faculty of Medicine and Health, The University of Sydney (A.K.H., S.L.W.), Sydney, New South Wales, Australia; Lions Eye Institute, University of Western Australia (A.K.H.), Perth, Western Australia, Australia., Cavuoto K; Bascom Palmer Eye Institute, University of Miami (K.C.), Miami, Florida, USA., Leong J; Sydney Eye Hospital (J.L., S.L.W.), Sydney, New South Wales, Australia., Ascarza AR; Consultorios Oftalmológicos Benisek-Ascarza, Ciudad Autónoma de Buenos Aires (A.R.A.), Buenos Aires, Argentina., Woreta FA; Uniformed Services University of the Health Sciences (G.A.J., F.A.W., J.C., K.E.M., R.A.M., M.C.), Bethesda, Maryland, USA., Cason J; Uniformed Services University of the Health Sciences (G.A.J., F.A.W., J.C., K.E.M., R.A.M., M.C.), Bethesda, Maryland, USA., Miller KE; Uniformed Services University of the Health Sciences (G.A.J., F.A.W., J.C., K.E.M., R.A.M., M.C.), Bethesda, Maryland, USA; Department of Ophthalmology, Navy Medical Center Portsmouth (K.E.M.), Portsmouth, Virginia, USA., Caldwell MC; Department of Ophthalmology, San Antonio Uniformed Services Health Education Consortium (M.C.C.), Houston, Texas, USA., Gensheimer WG; White River Junction Veterans Administration Medical Center (W.G.G.), White River Junction, Vermont, USA; Dartmouth-Hitchcock Medical Center (W.G.G.), Lebanon, New Hampshire, USA., Williamson TH; Department of Engineering and Biological Sciences, University of Surrey (T.H.W.), Surrey, UK; Department of Ophthalmology, St Thomas' Hospital (T.H.W.), London, UK., Dhawahir-Scala F; Manchester Royal Eye Hospital (F.D.-S.), Manchester, UK., Shah P; Birmingham Institute for Glaucoma Research (P.S.), Birmingham, UK; Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust (P.S., R.J.B.), Birmingham, UK., Coombes A; Department of Ophthalmology, The Royal London Hospital (A.C.), London, UK., Sundar G; Department of Ophthalmology, National University Hospital (G.S.), Singapore., Mazzoli RA; Uniformed Services University of the Health Sciences (G.A.J., F.A.W., J.C., K.E.M., R.A.M., M.C.), Bethesda, Maryland, USA., Woodcock M; Worcestershire Acute Hospitals NHS Trust (M.W.), Worcester, UK., Watson SL; Save Sight Institute, Faculty of Medicine and Health, The University of Sydney (A.K.H., S.L.W.), Sydney, New South Wales, Australia; Sydney Eye Hospital (J.L., S.L.W.), Sydney, New South Wales, Australia., Kuhn F; Helen Keller Foundation for Research and Education (F.K.), Birmingham, Alabama, USA; Department of Ophthalmology, University of Pécs Medical School (F.K.), Pécs, Hungary., Colyer M; Uniformed Services University of the Health Sciences (G.A.J., F.A.W., J.C., K.E.M., R.A.M., M.C.), Bethesda, Maryland, USA., Gomes RS; BRAVO VICTOR (S.H., R.S.G.), London, UK; Northern Hub for Veterans and Military Families Research, Northumbria University (R.S.G.), Newcastle, UK., Blanch RJ; Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust (P.S., R.J.B.), Birmingham, UK; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine (R.J.B.), Birmingham, UK; Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham (R.J.B.), Birmingham, UK. Electronic address: r.j.blanch@bham.ac.uk.
Jazyk: angličtina
Zdroj: American journal of ophthalmology [Am J Ophthalmol] 2024 Sep 28; Vol. 268, pp. 378-387. Date of Electronic Publication: 2024 Sep 28.
DOI: 10.1016/j.ajo.2024.09.025
Abstrakt: Purpose: When severe retinal and corneal injury occur together, a temporary keratoprosthesis (TKP) is often a last resort to allow posterior segment visualization to enable vitreoretinal surgery, followed by a penetrating keratoplasty (PKP) which can restore corneal clarity in a single operation. We aimed to assess visual outcomes following combined PKP and vitreoretinal surgery with the use of a TKP for cases of ocular trauma.
Design: A systematic literature review was performed following PRISMA guidelines (PROSPERO registration number: CRD42023423518).
Methods: CENTRAL, MEDLINE, Embase, ISRCTN registry, and ClinicalTrials.gov were searched from inception to 27 April 2023. Randomized and nonrandomized studies assessing visual outcomes after combined vitreoretinal surgery and PKP with the use of a TKP after ocular trauma were eligible for inclusion. Outcomes included change in best corrected visual acuity, corneal graft survival and retinal reattachment at final follow up. Proportional meta-analysis was used to estimate the overall rate of the primary outcomes. Risk of bias for nonrandomized studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist for case series.
Results: A total of 19 studies met inclusion criteria reporting a total of 352 eyes. All studies were retrospective and nonrandomized with follow up times ranging from 6 to 91 months, with at least 79% of outcomes reported after 6 months. After combined surgery the rate of corneal graft survival was 52% (95% CI 0.41-0.62; I 2 60%) successful retinal attachment was 79% (95% CI 0.73-0.84; I 2 0%). and improved visual acuity, when compared to no change or decrease in visual acuity, was 45% (95% CI 0.32-0.59; I 2 66%).
Conclusion: Patients with severe injury affecting the anterior and posterior segments have very limited treatment options. This systematic review found that when combined vitreoretinal surgery and PKP with a TKP are performed, approximately half of corneal grafts survive, anatomically successful retinal reattachment is likely, and a similar proportion of patients benefit in terms of improved visual acuity, compared to their preoperative function. This systematic review of the available literature may help inform surgeons of the benefits of using a TKP for cases of ocular trauma.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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