Corneal transplant rejection rate and severity after endothelial keratoplasty
Corneal transplant rejection rate and severity after endothelial keratoplasty
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DOI：
10.1097/ico.0b013e31812f66e5
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发表时间：
2007-10-01
期刊：
影响因子：
2.8
通讯作者：
Claesson, Margareta
中科院分区：
文献类型：
--
作者：
Allan, Bruce D. S.;Terry, Mark A.;Claesson, Margareta
目的：研究内皮角膜移植术（EK）后前2年内角膜移植排斥反应率和排斥反应后移植失败率，并将其与穿透性角膜移植术（PK）类似病例的背景数据进行比较。方法：EK [深板层（DLEK）或后弹力层剥脱（DSEK）]连续病例的分析数据对于Fuchs角膜内皮营养不良或人工晶状体大泡性角膜病变，收集了4个参与中心2004年8月之前手术的病例。记录排斥反应发生的次数和时间以及随后移植失败的病例，以及停止局部类固醇药物治疗的时间。两年的术后结果进行了比较，类似的患者接受PK记录在瑞典角膜移植registry.Results的背景数据：排斥反应发作后EK比PK（P = 0.035）。199例EK病例中有15例（7.5%）在术后前2年发生排斥反应，而708例PK病例中有92例（13%）发生排斥反应。排斥反应后移植物失败在EK中的发生率可能低于PK（P = 0.063），EK后仅有1例（6.7%）排斥反应，而PK后26例（28.3%）排斥反应进展为移植物失败。在EK组中观察到持续使用低剂量局部类固醇药物的强烈趋势。80%的EK患者手术后2年仍在服用局部类固醇药物，而局部类固醇药物已停止在一年内的手术几乎所有的PK患者在comparatorgroup.Conclusions：角膜移植排斥反应是不太频繁，可能是不太严重后EK比PK。目前尚不清楚这些明显的差异是否仅仅是EK患者术后局部类固醇覆盖时间相对较长的产物。
Purpose: To examine the corneal transplant rejection rate and the rate of graft failure subsequent to rejection in the first 2 years after endothelial keratoplasty (EK) and to compare this to background data for similar cases of penetrating keratoplasty (PK).Methods: Anonymized data from consecutive cases of EK [deep lamellar (DLEK) or Descemet stripping (DSEK)] for Fuchs corneal endothelial dystrophy or pseudophakic bullous keratopathy operated on before August 2004 were collected in 4 participating centers. The number and timing of rejection episodes and cases of subsequent graft failure were recorded, together with the time to cessation of topical steroid medication. Two-year postoperative findings were compared with background data for similar patients undergoing PK recorded in the Swedish Corneal Transplant Registry.Results: Rejection episodes were less frequent after EK than PK (P = 0.035). Fifteen (7.5%) of 199 EK cases had a rejection episode in the first 2 years after surgery versus 92 (13%) of 708 PK cases. Graft failure after rejection in EK may have been less frequent than in PK (P = 0.063), with only 1 (6.7%) case of rejection after EK versus 26 (28.3%) cases of rejection after PK proceeding to graft failure. A strong trend toward continued use of low-dose topical steroid medication was observed in the EK group. Eighty percent of EK patients were still taking topical steroid medication 2 years after surgery, whereas topical steroid medication had been ceased within a year of surgery in almost all PK patients in the comparator group.Conclusions: Corneal transplant rejection is less frequent and may be less severe after EK than after PK. It is not yet clear whether these apparent differences are simply a product of relatively prolonged postoperative topical steroid cover in EK patients.