Graft survival after penetrating keratoplasty.
Graft survival after penetrating keratoplasty.
复制标题
穿透性角膜移植术后移植物存活。
DOI：
10.1016/j.ajo.2010.10.006
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发表时间：
2011
影响因子：
4.2
通讯作者：
Patel,SanjayV
中科院分区：
文献类型：
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作者：
Patel,SanjayV
在过去的十年中，角膜移植已发展为选择性组织移植，许多角膜疾病可以通过各种前层和后层移植手术来治疗。由于这些新技术比穿透性角膜移植术 (PK) 具有明显的优势，外科医生很快就采用了这些新技术。 1 同时，对组织工程角膜替代物的探索取得了快速进展，角膜替代物的植入可能成为角膜手术的未来。 2 尽管角膜手术取得了令人兴奋的进展，但 PK 仍然是目前世界上最常见的角膜移植形式，尽管 PK 的重要性在未来可能会降低，但它仍将是某些眼睛的默认或选择手术。 PK 的成功通常通过移植物存活的时间（即移植物失败的时间）来衡量。在过去的三十年里，我们从个人外科医生系列、3-5 项随机临床试验、6 项和角膜移植登记处等来源积累了大量的移植物存活和结果数据。 7-9 新加坡角膜移植研究 (SCTS) 就是此类数据来源之一，其独特之处在于它反映了亚洲人群中 PK 的指征和结果。 10 自 1991 年以来，新加坡国家眼科中心（占新加坡所有移植手术的 80-90%）的所有角膜移植手术均已输入 SCTS，并且每年记录术后结果。在研究的前 13 年中，进行了 1130 次 PK，报告了 901 只眼睛的 901 次 PK 的初步结果。 10 其中，87% 用于光学（视觉康复）适应症，而 13% 用于治疗（传染病的手术治疗）和构造（保护眼球完整性）适应症。光学适应症的移植物存活率最高（5 年时为 64%，10 年时为 52%），而治疗性适应症（5 年时为 37%）和构造适应症（3 年时为 42%）移植物存活率较低。在 SCTS 首次报告时，已知有 10±31% 的穿透移植物失败，其中一半是由于内皮移植排斥和晚期内皮失败。 SCTS 中光学 PK 的初步结果与亚洲以外其他大型系列的结果相当（亚洲 PK 结果的数据有限11），并且证明了亚洲角膜移植和眼库的成功。毫不奇怪，亚洲治疗性和构造性 PK 的比例占所有 PK 的 12-13%，10, 11 远高于亚洲以外地区。
Corneal transplantation has evolved toward selective tissue transplantation over the last decade, with many corneal diseases being treated by a variety of anterior and posterior lamellar graft procedures. Surgeons have rapidly adopted these new techniques because of distinct advantages over penetrating keratoplasty (PK). 1 Simultaneously, the quest for a tissue-engineered corneal substitute has made rapid progress, and implantation of corneal substitutes might become the future of corneal surgery. 2 Despite the exciting progress in corneal surgery, PK remains the commonest form of corneal transplantation in the world at present, and although PK might diminish in importance in the future, it will remain the default or procedure of choice for some eyes.The success of PK has generally been measured by the longevity of graft survival, which is the time to graft failure. A wealth of graft survival and outcomes data have been amassed over the last three decades from sources such as individual surgeon series, 3–5 randomized clinical trials, 6 and corneal graft registries. 7–9 The Singapore Corneal Transplant Study (SCTS) is one such source of data, and is unique because it reflects the indications for and outcomes of PK in an Asian population. 10 Since 1991, all corneal transplant procedures at the Singapore National Eye Center, which performs 80–90% of all transplants in Singapore, have been entered into the SCTS, and postoperative outcomes have been recorded annually. During the first 13 years of the study, there were 1130 PKs, and the initial outcomes of 901 PKs in 901 eyes were reported. 10 Of these, 87% were for optical (visual rehabilitation) indications, whereas 13% were for therapeutic (surgical treatment of infectious disease) and tectonic (preservation of globe integrity) indications. The graft survival rate was highest for optical indications (64% at 5 years and 52% at 10 years) and was lower for therapeutic (37% at 5 years) and tectonic (42% at 3 years) indications. At the time of the first report of the SCTS, 10 31% of penetrating grafts were known to have failed, and half of these were because of endothelial graft rejection and late endothelial failure. The initial results of optical PK in the SCTS are comparable to those of other large series outside of Asia (there are limited data for outcomes of PK in Asia11), and are a testament to successful corneal transplantation and eye banking in Asia. Not surprisingly, the proportion of therapeutic and tectonic PKs in Asia, accounting for 12–13% of all PKs, 10, 11 is much higher than outside of Asia.