Outcomes of therapeutic penetrating keratoplasty in 198 eyes with fungal keratitis
Outcomes of therapeutic penetrating keratoplasty in 198 eyes with fungal keratitis
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DOI：
10.4103/ijo.ijo_1952_18
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发表时间：
2019-10-01
影响因子：
3.1
通讯作者：
Murthy, Somasheila
中科院分区：
文献类型：
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作者：
Mundra, Jyothi;Dhakal, Rohit;Murthy, Somasheila
目的：探讨穿透性角膜移植治疗真菌性角膜炎的疗效。研究方法：该回顾性、观察性、干预性病例系列涉及对2008年1月至2010年12月期间在LV Prasad眼科研究所接受治疗性穿透性角膜移植术（ThPK）治疗真菌性角膜炎的198只连续患眼进行稽查。记录了人口统计学、临床特征、术中和术后晚期并发症的数据。主要结局指标为感染根除和术后解剖成功。次要结果指标为移植物存活率、危险因素、临床特征和ThPK后复发性真菌性角膜炎的处理。结果：ThPK后的平均随访时间为24 ± 17个月。真菌感染完全根除178眼（89.9%），复发20眼（10.1%）。大部分病例（192只眼; 97%）实现了解剖恢复。浸润面积越大，感染复发的风险越高。中位移植物存活率为5.9个月。移植物存活率在8 mm时更好（P = 0.026），与真菌种类无显著相关性。27眼行再次角膜移植术，其中穿透性角膜移植术14眼，后弹力层剥脱内皮角膜移植术13眼。结论：由于治疗性角膜移植术前浸润较大，复发的风险要高得多;对于药物治疗无效的病例，应考虑及时手术干预。需要考虑术后炎症管理的替代策略以防止移植物失败。
Purpose: To study the outcomes of therapeutic penetrating keratoplasty in fungal keratitis. Methods: This retrospective, observational, interventional case series involved an audit of 198 consecutive eyes that underwent therapeutic penetrating keratoplasty (ThPK) for fungal keratitis at L V Prasad Eye Institute between January 2008 and December 2010 was performed. The data on demographics, clinical characteristics, intraoperative, and late postoperative complications were noted. The primary outcome measure was eradication of infection and postoperative anatomical success. Secondary outcome measures were graft survival, risk factors, clinical features, and management of recurrent fungal keratitis post ThPK. Results: Mean follow-up after ThPK was 24 +/- 17 months. A total of 178 (89.9%) eyes had complete eradication of fungal infection, whereas 20 (10.1%) eyes developed recurrence. Anatomical restoration was achieved in majority of cases (192 eyes; 97%). Larger infiltrate size was associated with a higher risk of recurrence of infection. The median graft survival rate was 5.9 months. The graft survival was better for grafts 8 mm (P = 0.026) and not found significantly related to the species of fungus. Twenty-seven eyes underwent re-grafting: penetrating keratoplasty in 14 eyes, and Descemet's stripping endothelial keratoplasty in 13 eyes. Conclusion: As larger infiltrate prior to therapeutic keratoplasty had much higher risk of recurrences; timely surgical intervention should be considered in cases not responding to medical therapy. Alternative strategies of management of postoperative inflammation need to be considered to prevent graft failures.