Long-term outcome and prognostic factor analysis for keratolimbal allografts
Long-term outcome and prognostic factor analysis for keratolimbal allografts
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DOI：
10.1007/s00417-011-1760-3
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发表时间：
2011-11-01
影响因子：
2.7
通讯作者：
Kim, Mee Kum
中科院分区：
文献类型：
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作者：
Han, Eui Seok;Wee, Won Ryang;Kim, Mee Kum
为评价同种异体角膜缘移植(KLAL)的远期疗效，探讨影响KLAL存活率的因素，对22例(24眼)患者行1次或多次KLAL，术后随访1年以上。他们的医疗记录被复查了。评价KLAL和穿透性角膜移植(PKP)手术的成功率。KLAL成功定义为植片边缘无持续性角膜上皮缺损、角膜结膜形成或新生血管形成。分析影响KLAL生存的预后因素，包括术前诊断、移植物排斥史、睑粘连、同期手术、免疫抑制剂剂量和完全上皮化时间间隔。预后因素采用单因素生存分析或多因素Cox比例风险生存回归分析，平均47.9个月KLAL成功率为33.3%。10眼(41.7%)发生15次KLAL排斥反应，但13例(86.7%)为可逆性排斥反应。在45例KLAL手术中，单因素分析显示，眼睑畸形、粘连和完全上皮化间隔与KLAL手术的成功率显著相关，多因素COX回归分析表明，粘连的存在是影响KLAL预后的最重要的预后因素(p=0.010)。KLAL已部分成功地重建了角膜缘干细胞缺乏症，而粘连已被确定为影响KLAL存活率的重要预后因素。在KLAL和PKP前，手术矫正睑粘连是非常重要的。
To evaluate the long-term results of keratolimbal allograft (KLAL) and elucidate the prognostic factors of KLAL survival.Twenty-four eyes of 22 patients underwent KLAL one or more times, and were followed up more than 1 year postoperatively. Their medical records were reviewed. The success of KLAL and penetrating keratoplasty (PKP) was evaluated. KLAL success was defined as absence of persistent corneal epithelial defect, corneal conjunctivalization, or neovascularization on the corneal edge of the graft. Prognostic factors for survival of KLAL were analyzed, including preoperative diagnosis, history of graft rejection, symblepharon, concurrent surgery, immunosuppressant dose, and interval for full epithelialization time. The prognostic factors were evaluated by univariate survival analysis or multivariate Cox proportional hazards survival regression.KLAL had been successful in 33.3% of the eyes over an average of 47.9 months. Fifteen episodes of KLAL rejection developed in ten eyes (41.7%), but 13 cases (86.7%) were reversible. Of 45 KLAL procedures, eyelid deformity, symblepharon, and the interval of full epithelialization were significantly associated with KLAL success by univariate analysis, and the presence of symblepharon was identified by multivariate Cox regression analysis as the most important prognostic factor to affect KLAL outcome (p = 0.010).KLAL has been partly successful for reconstruction of limbal stem cell deficiency, and symblepharon has been identified as a significant prognostic factor for KLAL survival. Surgical correction of symblepharon is important before KLAL and PKP.