Prevention and Treatment of Corneal Graft Rejection: Current Practice Patterns of the Cornea Society (2011)
Prevention and Treatment of Corneal Graft Rejection: Current Practice Patterns of the Cornea Society (2011)
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DOI：
10.1097/ico.0000000000000403
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发表时间：
2015-06-01
期刊：
影响因子：
2.8
通讯作者：
Stulting, R. Doyle
中科院分区：
文献类型：
--
作者：
Kharod-Dholakia, Bhairavi;Randleman, J. Bradley;Stulting, R. Doyle
目的：分析穿透性角膜移植术（PK）和内皮角膜移植术（EK）预防和治疗角膜移植排斥反应的当前实践模式，并将这些模式与先前报道的实践进行比较。2011年，向全球角膜协会的670名成员发送了一份电子调查，内容涉及不同时间点角膜移植的常规术后管理，角膜移植排斥反应的各种表现的治疗，以及首选的手术技术。结果：670份调查中，共有204份（30%）被返回并进行了评估。所有受访者均使用局部皮质类固醇进行常规术后管理和治疗内皮移植物排斥反应。泼尼松龙是在所有临床情况下选择的局部类固醇，类似于1989年至2004年的调查。结膜下和全身类固醇的使用增加了许多可能和明确的移植排斥反应的情况。泼尼松龙的常规使用比以前的调查减少了约10%，而在前6个月内，13%的高危眼使用了二氟泼尼酯。地塞米松、氟米龙和氯替泼诺的使用保持稳定。辅助局部环孢素使用对PK和EK的影响显著增加。EK是内皮功能障碍的首选技术，而PK和深前板层角膜移植术均用于圆锥角膜和前瘢痕。大多数受访者（75%）认为，移植排斥反应发生后，PK比后EK.Conclusions：泼尼松龙仍然是管理和治疗移植排斥反应的治疗选择，但是，由于引进二氟泼尼酯，其使用略有下降，因为引进二氟泼尼酯。尽管排斥率存在明显差异，但PK和EK的预防性类固醇治疗无差异。
Purpose: To analyze current practice patterns in the prevention and treatment of corneal graft rejection for both penetrating keratoplasty (PK) and endothelial keratoplasty (EK) and to compare these patterns with previously reported practices.Methods: In 2011, an electronic survey was sent to 670 members of the Cornea Society worldwide addressing the routine postoperative management of corneal transplants at different time points, treatment of various manifestations of corneal graft rejection, and preferred surgical techniques.Results: A total of 204 of 670 surveys (30%) were returned and evaluated. All respondents used topical corticosteroids for routine postoperative management and treatment of endothelial graft rejection. Prednisolone was the topical steroid of choice in all clinical scenarios, similar to previous surveys from 1989 to 2004. Use of subconjunctival and systemic steroids increased for many scenarios of probable and definite graft rejection. Routine use of prednisolone decreased by approximately 10% from previous surveys, whereas difluprednate was used in 13% of high-risk eyes during the first 6 months. Dexamethasone, fluorometholone, and loteprednol use remained stable. Adjunctive topical cyclosporine use increased significantly for PK and EK. EK was the preferred technique for endothelial dysfunction, whereas PK and deep anterior lamellar keratoplasty were both used for keratoconus and anterior scars. Most respondents (75%) felt that graft rejection occurs more frequently after PK than after EK.Conclusions: Prednisolone remains the treatment of choice for management and treatment of graft rejection; however, since the introduction of difluprednate, its use has declined slightly since the introduction of difluprednate. Despite perceived differences in rejection rates, there were no differences in prophylactic steroid treatment for PK and EK.