Purpose: Boston keratoprosthesis (KPro) is a widely used treatment for corneal diseases unsuitable for traditional keratoplasty. Postoperative complications, notably retroprosthetic membrane (RPM) formation and secondary glaucoma, significantly affect patient outcomes. Anterior segment optical coherence tomography (AS-OCT) enables precise visualization of KPro-related complications, such as angle closure and RPM formation. This study aimed to investigate the association between RPM formation and de novo angle closure in eyes with Boston KPro.

Methods: A retrospective analysis of patients who underwent Boston KPro type 1 implantation was conducted. Patients with preoperative angles documented by AS-OCT and a minimum 1-year follow-up with serial AS-OCT imaging were included. Demographic data, surgical details, visual acuity, intraocular pressure, and complications were recorded. The presence of RPM and angle closure was assessed clinically and via AS-OCT.

Results: This study included 18 eyes from 18 patients who underwent KPro implantation with a follow-up period averaging 4.7 years. Preoperative visual acuity was poor (20/400 or worse) in all eyes, with an improvement in 78% of cases to 20/200 or better postoperatively. Complications included angle closure in 61% of eyes, with a significant association between retroprosthetic membrane (RPM) formation and angle closure (P = 0.0012). De novo glaucoma developed in 4 eyes, primarily associated with RPM and angle closure, and was managed medically.

Conclusions: This study highlights a significant association between RPM formation and de novo angle closure in eyes with Boston KPro. Our study findings strongly suggest that RPM formation plays a role in inducing angle closure, contributing to glaucoma development, and is the first study to provide AS-OCT evidence of potential causality. Understanding these associations can improve patient care and outcomes after KPro implantation. Strategies aimed at reducing RPM formation could potentially mitigate other KPro-related complications, including angle closure and de novo glaucoma.

Keywords: angle closure; glaucoma; keratoplasty; keratoprosthesis; retroprosthetic membrane.

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目的： 波士顿角膜假体（KPro）是治疗不适合传统角膜移植的角膜疾病的一种广泛应用的方法。术后并发症，尤其是后部假体膜（RPM）形成和继发性青光眼，显著影响患者的预后。前段光学相干断层扫描（AS-OCT）能够精确地可视化与KPro相关的并发症，如房角闭合和RPM形成。本研究旨在探讨RPM形成与波士顿KPro植入眼中新发房角闭合之间的关联。

方法： 对接受波士顿KPro类型1植入的患者进行了回顾性分析。纳入标准为术前有AS-OCT记录的房角，并且至少有一年的随访期，期间需进行连续的AS-OCT成像。记录患者的临床数据、手术详情、视力、眼内压和并发症情况。通过临床检查和AS-OCT评估RPM的存在及房角闭合。

结果： 本研究共纳入了18名患者，这些患者接受了KPro植入术，并且随访期平均为4.7年。所有患者的术前视力较差（20/400或更差），术后有78%的病例改善到20/200或更好。并发症包括61%的眼出现房角闭合，RPM形成与房角闭合之间存在显著关联（P = 0.0012）。新发青光眼出现在4眼中，主要与RPM和房角闭合相关，并且通过药物治疗管理。

结论： 本研究表明，在接受波士顿KPro植入的眼中，RPM形成与新发房角闭合之间存在显著关联。研究结果强烈表明，RPM的形成在诱发房角闭合、促进青光眼发展方面起着一定作用，并且是首个提供AS-OCT证据来证明潜在因果关系的研究。了解这些关联可以改善KPro植入后的患者护理和预后。旨在减少RPM形成的策略可能有助于缓解其他与KPro相关的并发症，包括房角闭合和新发青光眼。

关键词： 房角闭合；青光眼；角膜移植；角膜假体；后部假体膜。