Corneal thickness as a predictor of corneal transplant outcome.
Corneal thickness as a predictor of corneal transplant outcome.
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DOI：
10.1097/ico.0b013e31827b14c7
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发表时间：
2013-06
期刊：
影响因子：
2.8
通讯作者：
Cornea Donor Study Investigator Group
中科院分区：
文献类型：
--
作者：
Verdier DD;Sugar A;Baratz K;Beck R;Dontchev M;Dunn S;Gal RL;Holland EJ;Kollman C;Lass JH;Mannis MJ;Penta J;Cornea Donor Study Investigator Group
在角膜供体研究中评估角膜厚度(CT)及其与穿透性角膜移植术后移植结果的相关性。887名中等危险状况(主要是Fuchs或人工晶状体型角膜水肿者)接受角膜移植的受试者在术后5年内进行了CT测量。探讨基线(受者、供者和手术)因素与CT的关系。比例风险模型被用来评估CT和移植物失败之间的关联。使用纵向重复测量模型和Spearman相关估计来评估CT与细胞密度的关系。较高的纵向CT测量值与人工晶状体或无晶状体角膜水肿的诊断(P<；0.001)、术后第一个月的眼压和眼压(P=0.003)、白人(非西班牙裔)捐献者(P=0.002)和供者死亡的呼吸道原因(P<；0.001)相关。在术后1年内未发生移植物功能衰竭的患者中，CT≤为500μ、CT501~550μ、CT551~600μ、CT>；600μ分别为5%±5%、5%±3%、7%±4%、20%±11%。多因素分析显示，1年CT和细胞密度均与移植失败相关(P=0.002和0.009)。CT升高与随访期内皮细胞丢失有一定的相关性(r=-0.29)。在穿透性角膜移植后的头5年内，CT可作为移植物存活的预测指标。然而，CT不能替代细胞密度测量，因为这两种测量都独立地预测移植物失败。
Assess corneal thickness (CT) and correlation with graft outcome after penetrating keratoplasty in the Cornea Donor Study. 887 subjects with a corneal transplant for a moderate risk condition (principally Fuchs or pseudophakic corneal edema) had post-operative CT measurements throughout a 5 year follow up time. Relationships between baseline (recipient, donor, and operative) factors and CT were explored. Proportional hazards models were used to assess association between CT and graft failure. Relationship between CT and cell density was assessed with a longitudinal repeated measures model and Spearman correlation estimates. Higher longitudinal CT measurements were associated with diagnosis of pseudophakic or aphakic corneal edema (P<0.001), intraocular pressure > 25mmHg during the first post-operative month (P=0.003), white (non-Hispanic) donor race (P=0.002) and respiratory causes of donor death (P<0.001). Among those without graft failure within the first post-operative year, the 5-year cumulative incidence (±95% CI) of graft failure was 5% ± 5% in those with a 1-year CT ≤500μm, 5% ± 3% for CT 501 – 550μm, 7% ± 4% for CT 551 – 600μm and 20% ± 11% for CT >600μm. In multivariate analysis, both 1 year CT and cell density were associated with subsequent graft failure (P=0.002 and 0.009). CT increase was modestly associated with endothelial cell loss during follow up (r=-0.29). During the first 5 years following penetrating keratoplasty, CT can serve as a predictor of graft survival. However, CT is not a substitute for cell density measurement as both measures were independently predictive of graft failure.