Patel Sanjay V, Hodge David O, Bourne William M
Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Am J Ophthalmol. 2005 Feb;139(2):311-9. doi: 10.1016/j.ajo.2004.09.045.
To determine changes in the central endothelium and thickness of grafted corneas and the cumulative probability of developing glaucoma, of graft rejection, and of graft failure 15 years after penetrating keratoplasty.
Longitudinal cohort study of 500 consecutive penetrating keratoplasties by one surgeon.
Regrafted eyes, fellow eyes of bilateral cases, and patients not granting research authorization were excluded, leaving 388 grafts for analysis. At intervals after surgery, we photographed the endothelium and measured corneal thickness using specular microscopy. The presence of glaucoma, graft rejection, and graft failure were recorded.
The 67 patients examined at 15 years represented 30% of the available clear grafts. Endothelial cell loss from preoperative donor levels was 71 +/- 12% (mean +/- standard deviation, n = 67), endothelial cell density was 872 +/- 348 cells/mm(2), and corneal thickness was 0.59 +/- 0.06 mm. Endothelial cell density was unchanged between 10 and 15 years, whereas corneal thickness increased (P = .001, n = 55). The mean annual rate of endothelial cell loss from 10 to 15 years after surgery was 0.2 +/- 5.7% (n = 54). The cumulative probability of developing glaucoma, graft rejection, or graft failure was 20%, 23%, and 28%, respectively, and 6 of the 8 graft failures after 10 years resulted from late endothelial failure.
From 10 to 15 years after penetrating keratoplasty, the annual rate of endothelial cell loss was similar to that of normal corneas, corneal thickness increased, and late endothelial failure was the major cause of graft failure.
确定穿透性角膜移植术后15年移植角膜中央内皮细胞和厚度的变化，以及发生青光眼、移植排斥反应和移植失败的累积概率。
对一位外科医生连续进行的500例穿透性角膜移植术进行纵向队列研究。
排除再次移植的眼睛、双侧病例的对侧眼睛以及未给予研究授权的患者，剩余388只移植眼用于分析。术后定期使用角膜内皮显微镜拍摄内皮细胞并测量角膜厚度。记录青光眼、移植排斥反应和移植失败的发生情况。
15年时检查的67例患者占可用透明移植眼的30%。与术前供体水平相比，内皮细胞损失率为71±12%（平均值±标准差，n = 67），内皮细胞密度为872±348个细胞/mm²，角膜厚度为0.59±0.06mm。10至15年间内皮细胞密度无变化，而角膜厚度增加（P = 0.001，n = 55）。术后10至15年内皮细胞损失的平均年率为0.2±5.7%（n = 54）。发生青光眼、移植排斥反应或移植失败的累积概率分别为20%、23%和28%，10年后8例移植失败中有6例是由于晚期内皮功能衰竭。
穿透性角膜移植术后10至15年，内皮细胞损失年率与正常角膜相似，角膜厚度增加，晚期内皮功能衰竭是移植失败的主要原因。
