Corneal Transplantation Activity Over 7 Years: Changing Trends for Indications, Patient Demographics and Surgical Techniques From the Corneal Transplant Epidemiological Study (CORTES)
Corneal Transplantation Activity Over 7 Years: Changing Trends for Indications, Patient Demographics and Surgical Techniques From the Corneal Transplant Epidemiological Study (CORTES)
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DOI：
10.1016/j.transproceed.2014.10.040
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发表时间：
2015-03-01
影响因子：
0.9
通讯作者：
Ponzin, D.
中科院分区：
文献类型：
--
作者：
Frigo, A. C.;Fasolo, A.;Ponzin, D.
本研究旨在探讨意大利角膜移植的不断变化的适应症和变化趋势。对 2002 年至 2008 年间使用威尼托眼库基金会分发的供体组织进行的角膜移植进行了前瞻性评估。在对 11,337 名患者进行的 13,173 例角膜移植术中，10,742 例（81.5%）为穿透性角膜移植术（PK），1644 例（12.5%）为前板层角膜移植术（ALK），787 例（6.0%）为内皮性角膜移植术（EK）。圆锥角膜 (42.5%)、再移植 (18.9%) 和人工晶体眼大疱性角膜病 (PBK，11.9%) 是 PK 的主要指征，其中圆锥角膜 (69.6%) 和再移植 (6.5%) 显示出较高的 ALK 指征，而人工晶体眼大疱性角膜病 (50.1%) 和再移植 (18.7%) 是 ALK 的主要指征。 BK的主要适应症。圆锥角膜的角膜移植总体减少 (P = .0048)，而 PBK (P = .0653) 和再移植 (P = .0137) 则有所增加。这些适应症因年龄和性别而异。 7年来角膜移植手术的数量保持稳定（P = .2394），尽管每年 PK 数量下降了 34.0%（P = .0250），ALK 从 2005 年开始上升（P = .0600），而 EK 则呈现出巨大的增长，其数量在 2007 年增加了两倍，在 2008 年进一步增加了一倍（P = .0600）。 .0004）。角膜移植术的主要适应症显示了过去几十年来西方国家其他地方报道的类似数据，尽管圆锥角膜的比例更高。然而，圆锥角膜的角膜移植总数正在下降，而由于新的角膜移植手术技术的应用，再移植角膜病和 PK 有所增加。这凸显了角膜疾病治疗的重要转变，转向选择性和更保守的手术以及角膜移植适应症的变化。
This study aims to examine evolving indications and changing trends for corneal transplantation in Italy. Corneal transplantations performed with donor tissues distributed by the Veneto Eye Bank Foundation between 2002 and 2008 were prospectively evaluated. Of the 13,173 keratoplasties performed on 11,337 patients, 10,742 (81.5%) were penetrating (PK), 1644 (12.5%) were anterior lamellar (ALK), and 787 (6.0%) were endothelial (EK). Keratoconus (42.5%), regraft (18.9%), and pseudophakic bullous keratopathy (PBK, 11.9%) were the leading indications for PK, with keratoconus (69.6%) and regraft (6.5%) showing higher indications for ALK, whereas pseudophakic bullous keratopathy (50.1%) and regraft (18.7%) were the major indications for BK. There was an overall decrease observed in corneal grafting for keratoconus (P = .0048) and an increase for PBK (P = .0653) and regrafting (P = .0137). These indications differed by age and gender. The number of keratoplasties over 7 years was stable (P = .2394), although the annual number of PKs declined by 34.0% (P = .0250), ALKs began to rise from 2005 (P = .0600), whereas EKs showed a huge growth, with their number tripling in 2007 and further doubling in 2008 (P = .0004). Leading indications for keratoplasty showed similar data that have been reported elsewhere for Western countries over the past few decades, albeit with a higher percentage of keratoconus. However, the overall number of keratoplasties for keratoconus was in decline, whereas regraft keratopathy and PKs increased due to the application of the newer surgical techniques for corneal grafting. This highlights an important shift in managing corneal diseases toward the application of selective and more conservative surgeries and changes in indications in corneal transplantation.