Dobbins K R, Price F W, Whitson W E
Cornea Research Foundation of America, Indianapolis, Indiana, USA.
Cornea. 2000 Nov;19(6):813-6. doi: 10.1097/00003226-200011000-00010.
To examine the leading indications and identify the changing trends for penetrating keratoplasty (PKP) in the midwestern United States.
The indications for PKPs at a single center tertiary care referral practice were tabulated to assess trends from 1982 to 1996. The data analysis was prospective after 1985. Age, gender, clinical indication for PKP, date of surgery, status of the lens at the time of surgery (phakic, aphakic, pseudophakic, cataract), and any secondary diagnoses were recorded. In pseudophakic eyes, the type of intraocular lens (IOL) present at the time of surgery was noted. Correlation analysis and linear regression were used in the SAS system, version 6.12, to test for the statistical significance in increasing or decreasing trends over the span of the study.
A total of 4,217 PKPs were performed on 3,263 patients. The leading indication for PKP was pseudophakic bullous keratopathy (31.5%), with 73% of these cases associated with an anterior chamber IOL, 21% associated with a posterior chamber IOL, and 6% associated with an iris-fixated IOL. Fuchs' dystrophy (23.2%), keratoconus (11.4%), corneal scarring (11.2%), failed graft (8.9%), and aphakic bullous keratopathy (7.5%) followed pseudophakic bullous keratopathy in frequency. These six groups accounted for approximately 93% of all cases performed. There were significant increasing trends in the incidence of failed grafts (p = 0.0001) and corneal scarring (p = 0.0001), and decreasing trends in the incidence of aphakic bullous keratopathy (p = 0.0001). There was a significant decreasing trend in pseudophakic bullous keratopathy from 1989 to 1996 (p = 0.0031).
Pseudophakic bullous keratopathy was the leading indication for PKP in our series. This is in agreement with the data reported in other similar studies done in North America. However, unlike most of these studies, our second leading indication was Fuchs' dystrophy. This contrast may be secondary to different genetic demographics in the midwestern United States.
研究美国中西部穿透性角膜移植术（PKP）的主要适应证并确定其变化趋势。
将一家三级医疗转诊中心的PKP适应证制成表格，以评估1982年至1996年的趋势。1985年后进行前瞻性数据分析。记录年龄、性别、PKP的临床适应证、手术日期、手术时晶状体状态（有晶状体眼、无晶状体眼、人工晶状体眼、白内障）以及任何次要诊断。对于人工晶状体眼，记录手术时存在的人工晶状体（IOL）类型。在SAS系统6.12版中使用相关分析和线性回归来检验研究期间上升或下降趋势的统计学显著性。
共对3263例患者进行了4217次PKP。PKP的主要适应证是人工晶状体性大泡性角膜病变（31.5%），其中73%的病例与前房型IOL相关，21%与后房型IOL相关，6%与虹膜固定型IOL相关。富克斯营养不良（23.2%）、圆锥角膜（11.4%）、角膜瘢痕（11.2%）、移植失败（8.9%）和无晶状体性大泡性角膜病变（7.5%）的发生频率仅次于人工晶状体性大泡性角膜病变。这六组约占所有手术病例的93%。移植失败（p = 0.0001）和角膜瘢痕（p = 0.0001）的发生率有显著上升趋势，无晶状体性大泡性角膜病变的发生率有下降趋势（p = 0.0001）。1989年至1996年人工晶状体性大泡性角膜病变有显著下降趋势（p = 0.0031）。
人工晶状体性大泡性角膜病变是我们系列研究中PKP的主要适应证。这与北美其他类似研究报告的数据一致。然而，与这些研究中的大多数不同，我们的第二主要适应证是富克斯营养不良。这种差异可能与美国中西部不同的遗传人口统计学有关。
