Ten-year postoperative results of penetrating keratoplasty
Ten-year postoperative results of penetrating keratoplasty
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DOI：
10.1016/s0161-6420(98)91030-2
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发表时间：
1998-10-01
期刊：
影响因子：
13.7
通讯作者：
Bourne, WM
中科院分区：
文献类型：
--
作者：
Ing, JJ;Ing, HH;Bourne, WM
目的：目的观察角膜移植术后5 ~ 10年中央角膜内皮细胞和角膜厚度的变化。本研究还旨在调查术后前10年内青光眼、移植排斥和移植失败的发生情况。设计/参与者。由1名外科医生进行的500例连续穿透性角膜移植术的纵向队列研究。要求患者在移植后2个月和1年、3年、5年和10年返回进行随访检查。作者排除了研究期间再次移植的眼和双侧病例的对侧眼，留下394例患者的394个移植物进行分析。干预：进行穿透性角膜移植术。主要结果测量：利用角膜内皮显微镜，作者测量了内皮细胞密度、细胞面积变异系数、六边形细胞百分比和角膜厚度，作者进行了临床检查，以确定移植排斥反应或失败和青光眼的发展。结果：角膜移植术后10年，394例患者中有80例死亡，68例移植失败。在其余246例患者中，119例（48%）返回进行10年检查。72例患者在所有计划的术后访视中返回，并且没有排斥反应、再次手术或失败，10年时术前供体水平的内皮细胞损失为67 +/- 18%。（平均值+/-标准差），内皮细胞密度为958 +/- 471个细胞/mm（2），变异系数为0.32 +/- 0.11，六边形细胞为56 +/-12%，角膜厚度为0.58 ± 0.05 mm。所有这些值的5- 10年变化均具有显著性（P小于或等于0.004）。角膜移植术后5 - 10年的平均晚期内皮细胞丢失率为每年4.2%。移植后无晶状体眼的内皮细胞丢失率最低（57 +/- 24%），角膜移植术后5 - 10年的间隔细胞丢失率最低（4 +/- 19%）。有晶状体眼的内皮细胞丢失率最高（73 +/- 8%），5- 10年间隔的细胞丢失率最高（17 +/- 31%）。后房型晶状体眼的内皮细胞丢失率（71 +/- 9%）高于前房型晶状体眼（51 +/-25%，P = 0.03）。青光眼、排斥反应或失败的10年累积风险分别为21%、21%和22%。迟发性内皮细胞衰竭是导致移植失败的主要原因，术后5年11例中有9例发生内皮细胞衰竭。结论：穿透性角膜移植术后5 ~ 10年，内皮细胞年丢失率是正常的7倍。在此期间，内皮细胞丢失、多形性、多形性和角膜厚度显著增加，表明持续的内皮不稳定和功能障碍，导致晚期内皮衰竭的发生率增加。
Objective: To investigate the changes in central corneal endothelial cells and corneal thickness in transplanted corneas from 5 to 10 years after grafting. This study also aimed to investigate the development of glaucoma, graft rejection, and graft failure during the first 10 postoperative years.Design/Participants. Longitudinal cohort study of 500 consecutive penetrating keratoplasties by 1 surgeon. Patients were asked to return for follow-up examinations at 2 months and at 1, 3, 5, and 10 years after grafting. The authors excluded eyes regrafted during the study and the fellow eyes of bilateral cases, leaving 394 grafts in 394 patients for analysis.Intervention: Penetrating keratoplasty was performed.Main Outcome Measures: Using specular microscopy, the authors measured endothelial cell density, coefficient of variation of cell area, percentage of hexagonal cells, and corneal thickness, The authors performed clinical examinations to determine graft rejection or failure and the development of glaucoma.Results: By 10 years postkeratoplasty, 80 of the 394 patients had died and 68 grafts had failed. Of the remaining 246 patients, 119 (48%) returned for their 10-year examinations. For the 72 patients who returned for all of the scheduled postoperative visits and had no rejection episodes, reoperations, or failure, endothelial cell loss from preoperative donor levels at 10 years was 67 +/- 18% (mean +/- standard deviation), endothelial cell density was 958 +/- 471 cells/mm(2), coefficient of variation was 0.32 +/- 0.11, hexagonal cells were 56 +/- 12%, and corneal thickness was 0.58 +/- 0.05 mm. The 5- to 10-year changes for all these values were significant (P less than or equal to 0.004). The mean rate of late endothelial cell loss from 5 to 10 years postkeratoplasty was 4.2% per year, Eyes that were aphakic after grafting had the lowest endothelial cell loss (57 +/- 24%) and the lowest interval cell loss from 5 to 10 years postkeratoplasty (4 +/- 19%). Eyes that were phakic had the highest endothelial cell loss (73 +/- 8%) and 5- to IO-year-interval cell loss (17 +/- 31%). Eyes with posterior chamber lenses had a greater endothelial cell loss (71 +/- 9%) than did eyes with anterior chamber lenses (51 +/- 25%, P = 0.03). The 10-year cumulative risk of glaucoma, rejection, or failure was 21%, 21%, and 22%, respectively. Late endothelial failure became the major cause for graft failure, accounting for 9 of the 11 failures after 5 postoperative years.Conclusions: From 5 to 10 years after penetrating keratoplasty, the annual rate of endothelial cell loss was seven times the normal rate. The endothelial cell loss, pleomorphism, polymegethism, and corneal thickness increased significantly during this time, indicating continued endothelial instability and dysfunction, resulting in an increasing rate of late endothelial failure.