Moderately Long-Term Safety and Efficacy of Repeat Penetrating Keratoplasty
Moderately Long-Term Safety and Efficacy of Repeat Penetrating Keratoplasty
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DOI：
10.1097/ico.0000000000001694
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发表时间：
2018-10-01
期刊：
影响因子：
2.8
通讯作者：
Kinoshita, Shigeru
中科院分区：
文献类型：
--
作者：
Kitazawa, Koji;Wakimasu, Koichi;Kinoshita, Shigeru
目的：探讨反复穿透性角膜移植术（PK）治疗角膜移植失败的中远期安全性和有效性。方法：回顾性连续临床病例系列。对1998年4月至2013年9月在日本京都浸会眼科研究所连续行PK的992例患者进行回顾性分析，其中96例术后随访3年以上重复PK。评估手术结果，包括供体移植存活率、最佳眼镜矫正视力、内皮细胞密度和重复PK后的并发症。结果：在重复PK后1、3和5年，供体移植物存活率分别为91%、75%和64%，存活移植物的平均内皮细胞密度分别为1778、1207和989个细胞/mm(2)。术后1年最佳眼镜矫正视力超过20/200和20/40的分别为71%和27%，术后3年最佳眼镜矫正视力超过20/200和20/40的分别为59%和31%，5年最佳眼镜矫正视力达到53%和29%。重复PK最常见的并发症是需要额外的青光眼手术[n = 11例（11.5%）]。Cox比例风险回归分析显示，既往青光眼手术和排斥事件是重复PK中移植物失败的高危因素[风险比(HR) = 6.7；95%置信区间（CI）为2.1 ~ 21.2,HR = 5.6；95% CI分别为1.8 ~ 18.0]。结论：重复PK提供了相对安全有效的中等长期手术结果。
Purpose:To investigate the moderately long-term safety and efficacy of repeat penetrating keratoplasty (PK) for treatment of a failed PK graft.Methods:Retrospective consecutive clinical case series. Of 992 consecutive cases that underwent PK at Baptist Eye Institute, Kyoto, Japan, between April 1998 and September 2013, 96 cases that underwent repeat PK with more than 3 years postoperatively follow-up were retrospectively reviewed. Surgical outcomes including donor graft survival rate, best spectacle-corrected visual acuity, endothelial cell density, and complications afeter repeat PK were assessed.Results:At 1, 3, and 5 years after repeat PK, the donor graft survival rate was 91%, 75%, and 64%, respectively, and the mean endothelial cell density in those survived grafts was 1778, 1207, and 989 cells/mm(2), respectively. Best spectacle-corrected visual acuity over 20/200 and 20/40 was achieved in 71% and 27% of the patients, respectively, at 1 year postoperatively, in 59% and 31% of the patients, respectively, at 3 years postoperatively, and in 53% and 29% of the patients, respectively, at 5 years postoperatively. The most common complication for repeat PK was the need for additional glaucoma surgery [n = 11 patients (11.5%)]. Cox proportional hazard regression analyses revealed that previous glaucoma surgery and a rejection episode were high risk factors for graft failure in repeat PK [hazard ratio (HR) = 6.7; 95% confidence interval (CI), 2.1-21.2 and HR = 5.6; 95% CI, 1.8-18.0, respectively].Conclusions:Repeat PK provided relatively safe and effective moderately long-term surgical outcomes.