重复穿透性角膜移植术：适应证、植片存活情况及视觉效果。
Repeat penetrating keratoplasty: indications, graft survival, and visual outcome.
作者信息
Al-Mezaine H, Wagoner M D
机构信息
King Khaled Eye Specialist Hospital, PO Box 7191, Riyadh 11462, Kingdom of Saudi Arabia.
出版信息
Br J Ophthalmol. 2006 Mar;90(3):324-7. doi: 10.1136/bjo.2005.079624.
AIM
To determine graft survival and visual outcome after repeat penetrating keratoplasty (PKP).
METHODS
Retrospective review of the medical records patients who underwent repeat PKP at the King Khaled Eye Specialist Hospital (KKESH) between 1 January 1991 and 31 December 2002.
RESULTS
243 repeat PKP performed in 210 eyes of 208 patients, who had also had initial PKP at KKESH, were included in the study. The mean follow up was 43 months (range 1-170). At the most recent examination, 114 (54.3%) grafts were clear. The overall survival rate was 98% at 1 year, 83% at 2 years, and 49% at 5 years. The best graft survival was in eyes with an original diagnosis of keratoconus (93.8%) and the worst was in eyes with Fuchs' dystrophy (23.1%). Overall, 29.6% of eyes achieved a final visual acuity greater than 20/200, while only 4.8% were 20/40 or better. The best visual prognosis was in eyes with an original diagnosis of stromal dystrophy and keratoconus.
CONCLUSION
Although the prognosis for repeat PKP is poorer than that of initial PKP, reasonable outcomes can be obtained with repeat PKP with careful case selection.
目的
确定重复穿透性角膜移植术（PKP）后的植片存活率和视力结果。
方法
回顾性分析1991年1月1日至2002年12月31日在沙特国王哈立德眼科专科医院（KKESH）接受重复PKP的患者的病历。
结果
本研究纳入了208例患者的210只眼，这些患者在KKESH也接受过初次PKP，共进行了243次重复PKP。平均随访时间为43个月（范围1 - 170个月）。在最近一次检查时，114只（54.3%）植片透明。1年时总体存活率为98%，2年时为83%，5年时为49%。原诊断为圆锥角膜的眼植片存活率最佳（93.8%），而原诊断为富克斯营养不良的眼最差（23.1%）。总体而言，29.6%的眼最终视力大于20/200，而只有4.8%的眼视力达到20/40或更好。原诊断为基质营养不良和圆锥角膜的眼视力预后最佳。
结论
尽管重复PKP的预后比初次PKP差，但通过仔细选择病例，重复PKP仍可获得合理的结果。
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