Predicted Long-term Outcome of Corneal Transplantation
Predicted Long-term Outcome of Corneal Transplantation
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DOI：
10.1016/j.ophtha.2009.05.009
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发表时间：
2009-12-01
期刊：
影响因子：
13.7
通讯作者：
Laroche, Laurent
中科院分区：
文献类型：
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作者：
Borderie, Vincent M.;Boelle, Pierre-Yves;Laroche, Laurent
目的：分析单模型角膜移植术后移植体的存活及角膜内皮的状况，预测移植体的远期预后。设计：队列研究。前瞻性记录资料，然后回顾性分析。参与者：在1992年至2006年间，1144例接受角膜移植的1144例患者的1144只连续眼睛。介入：穿透性角膜移植术和深前板层角膜移植术。主要观察指标：裂隙灯检查和广角镜面显微镜检查结果。我们进行了内皮细胞损失和移植失败时间的联合分析。通过中期同时分析移植物存活和内皮细胞损失，预测移植物的长期存活。结果：观察到的5年和10年移植物存活率分别为74%和64%。平均内皮细胞密度（细胞损失）术前为2270个细胞/mm(2)，术后6年为1058个细胞/mm(2)(-53%)，术后10年为865个细胞/mm(2)（-61%）。总体而言，预测移植20年生存率为27%，30年生存率为2%。观察到的和预测的移植存活率，行板层角膜移植术的患者高于行穿透性角膜移植术且受体内皮正常的患者，而行穿透性角膜移植术且受体内皮正常的患者高于行穿透性角膜移植术且受体内皮受损的患者。结论：对于累及内皮细胞的角膜疾病，穿透性角膜移植术似乎是一种很好的治疗方法，因为移植物的寿命可能与患者的预期寿命相似。相反，对于年轻患者，穿透性角膜移植术只是一种中期治疗方法。对于不涉及内皮的角膜疾病，深前板层角膜移植术似乎是一种有希望的治疗方法，具有较高的长期预期生存率。
Objective: To analyze graft survival and the outcome of the corneal endothelium after corneal transplantation in a single model to predict the long-term prognosis of these grafts.Design: Cohort study. Data were recorded prospectively and then analyzed retrospectively.Participants: One thousand one hundred forty-four consecutive eyes of 1144 patients who underwent corneal transplantation between 1992 and 2006.Interventions: Penetrating keratoplasty and deep anterior lamellar keratoplasty.Main Outcome Measures: Slit-lamp examination and wide-field specular microscopy results. A joint analysis of endothelial cell loss and time to graft failure was undertaken. From midterm simultaneous analysis of graft survival and endothelial cell loss, long-term graft survival was predicted.Results: The observed 5- and 10-year graft survival estimates were, respectively, 74% And 64%. The average endothelial cell density (cell loss) was 2270 cells/mm(2) before surgery, 1058 cells/mm(2) (-53%) during the sixth postoperative year, and 865 cells/mm(2) (-61%) during the 10th postoperative year. Overall, the predicted graft survival estimate was 27% at 20 years and 2% at 30 years. Both observed and predicted graft survival were higher in patients who had undergone lamellar keratoplasty than in patients who had undergone penetrating keratoplasty and had normal recipient endothelium and higher in patients who had undergone penetrating keratoplasty and had normal recipient endothelium than in patients who had undergone penetrating keratoplasty and had impaired recipient endothelium.Conclusions: For corneal diseases involving the endothelium, penetrating keratoplasty seems to be a good therapeutic approach in elderly patients because the graft life-span may be similar to the patient life expectancy. Conversely, for younger patients, penetrating keratoplasty is only a midterm therapeutic approach. For corneal diseases not involving the endothelium, deep anterior lamellar keratoplasty seems to be a promising therapeutic approach with higher long-term expected survival.