Price Marianne O, Thompson Robert W, Price Francis W
Cornea Research Foundation of America, Indianapolis, IN 46260, USA.
Arch Ophthalmol. 2003 Aug;121(8):1087-92. doi: 10.1001/archopht.121.8.1087.
To determine the risk factors for specific causes of initial corneal graft failure.
This study analyzed corneal graft survival rates in a longitudinal noncomparative case series of 3992 consecutive penetrating keratoplasties performed at a single large referral center. Regrafts (n = 352) were excluded from the analysis of risk factors for initial graft failure. Data were collected retrospectively from August 1, 1982, through December 31, 1986, and prospectively from January 1, 1987, through August 31, 1996. Patients were examined preoperatively, at 1, 3, 6, 9, 12, 18, and 24 months posttransplantation, and annually thereafter. Potential risk factors were evaluated individually by Kaplan-Meier survival analysis. Cox proportional hazards regression modeling was then used to investigate the impact of each independent variable, adjusted for the confounding influence of the other independent variables.
The use of topical glaucoma medications was a significant risk factor for corneal graft failure by 3 major causes: rejection, endothelial decompensation without a documented immunologic reaction, and ocular surface disease. Deep stromal vascularization was an independent risk factor for rejection failure. Diabetes mellitus, peripheral anterior synechiae, recipient race, and small trephination size were significant risk factors for endothelial failure.
Independent risk factors differentially impact specific causes of corneal graft failure.
确定初次角膜移植失败特定原因的危险因素。
本研究分析了在一个大型单一转诊中心连续进行的3992例穿透性角膜移植术的纵向非对照病例系列中的角膜移植存活率。再次移植（n = 352）被排除在初次移植失败危险因素分析之外。数据收集时间为回顾性1982年8月1日至1986年12月31日，前瞻性1987年1月1日至1996年8月31日。术前、术后1、3、6、9、12、18和24个月以及此后每年对患者进行检查。通过Kaplan-Meier生存分析单独评估潜在危险因素。然后使用Cox比例风险回归模型研究每个自变量的影响，并针对其他自变量的混杂影响进行调整。
局部使用青光眼药物是角膜移植因3种主要原因失败的显著危险因素：排斥反应、无免疫反应记录的内皮失代偿和眼表疾病。深层基质血管化是排斥反应失败的独立危险因素。糖尿病、周边前粘连、受者种族和小植片大小是内皮失代偿的显著危险因素。
独立危险因素对角膜移植失败的特定原因有不同影响。
