Risk factors for the first episode of corneal graft rejection in keratoconus
Risk factors for the first episode of corneal graft rejection in keratoconus
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DOI：
10.1097/01.ico.0000240098.01468.4c
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发表时间：
2006-10-01
期刊：
影响因子：
2.8
通讯作者：
Rapuano, Christopher J.
中科院分区：
文献类型：
--
作者：
Epstein, Andrew J.;de Castro, Terla N.;Rapuano, Christopher J.
目的：为了评估局部皮质类固醇和其他变量之间的关系和排斥反应的风险，穿透性角膜移植术后圆锥keratoconus.Methods：所有圆锥角膜患者的记录，他们的第一次穿透性角膜移植术后，在该眼，经历了第一次发作的角膜移植排斥反应在一个特定的3年期间进行了回顾性分析，在病例对照的方式。确定了23例病例，并将其与各3名对照进行匹配，总共有69名对照和92名患者。分析了多个变量，包括类固醇效力，最近的类固醇减量，以及当前类固醇水平的时间长度，以确定术后类固醇管理变化与排斥反应之间是否存在任何显着关系。此外，还检查了其他变量，如移植物尺寸、缝合技术、最近的缝线拆除、排斥反应发生时的缝线状态以及对侧眼的既往移植，以确定这些因素中是否有任何因素与移植物排斥反应的高风险相关。大多数建议的风险因素，包括类固醇剂量和逐渐减少，不同的缝合技术，排斥反应时缝线松动和/或断裂，排斥反应发生时剩余缝线的百分比和对侧眼移植前的缝线百分比与排斥反应的风险无关。只有移植物尺寸与排斥反应相关，宿主环钻尺寸> 8.25 mm的排斥反应风险增加近6倍（P = 0.015）。大多数患者（70%）在预定的办公室就诊时而不是在急诊就诊时被诊断为排斥反应，相应地，近一半（43%）在确定排斥反应时没有症状。有没有显着差异，最终最佳矫正视力的情况下，对照组之间，和91%的角膜，接受排斥反应没有进展到移植失败，保持中央明确在最近follow.Conclusion：在这项研究中，圆锥角膜角膜移植后排斥反应的最重要的危险因素是移植物的大小。医生对排斥反应的检测是至关重要的，因为移植物排斥反应事件更经常在预定的办公室就诊时而不是在急诊就诊时被诊断出来。幸运的是，如果治疗及时和集中，通常可以防止移植物衰竭的进展。
Purpose: To evaluate the relationship between topical corticosteroids and other variables and the risk for rejection after penetrating keratoplasty for keratoconus.Methods: The records of all keratoconus patients who, after their first penetrating keratoplasty in that eye, experienced a first episode of corneal graft rejection during a specific 3-year period were retrospectively reviewed in a case control fashion. Twenty-three cases were identified, and they were matched with 3 controls each, for a total of 69 controls and 92 total patients. Multiple variables including steroid potency, recent steroid tapering, and length of time on the current level of steroids were analyzed to see whether there were any significant relationships between postoperative changes in steroid management and rejection. In addition, other variables such as graft size, suture technique, recent suture removal, suture status at the time of the rejection episode, and prior grafting in the fellow eye were examined to determine if any of these factors were associated with a higher risk of graft rejection.Results: Most of the proposed risk factors, including steroid dose and tapering, differing suturing techniques, loose and/or broken sutures at the time of rejection, percentage of sutures remaining at the time of rejection, and prior grafting in the fellow eye, did not correlate with the risk of rejection. Only graft size had a correlation, with host trephination size > 8.25 mm having a nearly sixfold increased risk of rejection (P = 0.015). Most patients (70%) were diagnosed with rejection at a scheduled office visit rather than at an emergency visit, and correspondingly, nearly one half (43%) had no symptoms when rejection was identified. There was no significant difference in final best-corrected visual acuities between the cases and controls, and 91% of the corneas that underwent rejection did not progress to graft failure, remaining centrally clear at most recent follow-up.Conclusion: in this study, the most important risk factor for rejection after corneal transplantation for keratoconus was the size of the graft. Physician detection of rejection is paramount, because a graft rejection episode is more often diagnosed at a scheduled office visit than at an emergency visit. Fortunately, progression to graft failure can usually be prevented if treatment is started promptly and intensively.