Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty
Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty
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DOI：
10.1016/j.ajo.2004.09.045
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发表时间：
2005-02-01
影响因子：
4.2
通讯作者：
Bourne, WM
中科院分区：
文献类型：
--
作者：
Patel, SV;Hodge, DO;Bourne, WM
目得：确定中央内皮和移植角膜厚度的变化以及穿透性角膜移植术后15年发生青光眼、移植排斥反应和移植失败的累积概率。设计：由一名外科医生对500例连续穿透性角膜移植术进行纵向队列研究。再移植眼、双侧病例的对侧眼和未获得研究授权的患者被排除，留下388例移植物进行分析。手术后，我们每隔一段时间拍摄一次内皮。并使用镜面反射显微镜测量角膜厚度。青光眼，移植排斥反应，移植失败的存在recorded.RESULTS：67例患者检查在15年代表。术前供体水平的内皮细胞损失为71 +/- 12%（平均标准差，n = 67），内皮细胞2密度为872 +/- 348 Cells/mm（2），角膜厚度为0.59 +/- 0.06 mm。（P =.001，n = 55）。术后10 - 15年内皮细胞丢失的平均年发生率为0.2 +/- 5.7%（n = 54）。发生青光眼、移植物排斥反应或移植物衰竭的累积概率分别为20%、23%和28%，10年后8例移植物衰竭中有6例是由于晚期内皮细胞衰竭。穿透性角膜移植术后10 ~ 15年，角膜内皮细胞年丢失率与正常角膜相似，角膜厚度增加，晚期内皮功能衰竭是移植物衰竭的主要原因。
PURPOSE: To determine changes in the central endothelium and thickness of grafted corneas and the cumulative probability of developing glaucoma, of graft rejection, and of graft failure 15 years after penetrating keratoplasty.DESIGN: Longitudinal cohort study of 500 consecutive penetrating keratoplasties by one surgeon.METHODS: Regrafted eyes, fellow eyes of bilateral cases, and patients not granting research authorization were excluded, leaving 388 grafts for analysis. At intervals after surgery, we photographed the endothelium. and measured corneal thickness using specular microscopy. The presence of glaucoma, graft rejection, and graft failure were recorded.RESULTS: The 67 patients examined at 15 years rep. resented 30% of the available clear grafts. Endothelial cell loss from preoperative donor levels was 71 +/- 12% (mean standard deviation, n = 67), endothelial cell 2 density was 872 +/- 348 Cells/mm(2), and corneal thickness was 0.59 +/- 0.06 mm. Endothelial cell density was unchanged between 10 and 15 years, whereas corneal thickness increased (P =.001, n = 55). The mean annual rate of endothelial cell loss from 10 to 15 years after surgery was 0.2 +/- 5.7% (n = 54). The cumulative probability of developing glaucoma, graft rejection, or graft failure was 20%, 23%, and 28%, respectively, and 6 of the 8 graft failures after 10 years resulted from late endothelial failure.CONCLUSIONS: From 10 to 15 years after penetrating keratoplasty, the annual rate of endothelial cell loss was similar to that of normal corneas, corneal thickness increased, and late endothelial failure was the major cause of graft failure.