富克斯内皮营养不良患者角膜移植中尼龙缝线与涤纶缝线的并发症发生率及术后散光比较。

Bartels Marjolijn C, van Rooij Jeroen, Geerards Annette J M, Mulder Paul G H, Remeijer Lies

Department of Ophthalmology, Erasmus MC, Rotterdam, The Netherlands.

Cornea. 2006 Jun;25(5):533-9. doi: 10.1097/01.ico.0000214218.60249.e5.

PURPOSE

The purpose of this study is to evaluate corneal astigmatism and suture-related complications for transplants sutured with nylon and transplants sutured with Mersilene in primary corneal transplants for Fuchs endothelial dystrophy.

METHODS

A retrospective, observational, and comparative study between transplants sutured with either nylon 10-0 or 11-0 (n = 108) or Mersilene 11-0 (n = 58) was done. One hundred sixty-six eyes of 140 patients who received a primary penetrating keratoplasty for Fuchs endothelial dystrophy between 1995 and 2001 at the Rotterdam Eye Hospital in Netherlands were included.

RESULTS

Overall, transplant survival did not differ between groups (log-rank test; P = 0.24). During the first 2 years after transplantation, significantly lower astigmatism was seen in transplants sutured with nylon (P = 0.03). Transplants sutured with Mersilene had a significantly higher risk of surgical intervention to correct astigmatism or wound dehiscence after transplantation (hazard ratio, 2.83; 95% confidence interval, 1.34-6.01). Time to first infiltrate, metaplasia (marked scarring along the sutures), or cheesewiring was significantly less in the Mersilene group (P < 0.01). There was a tendency toward a higher risk of complications associated with loose or broken sutures in the nylon group (hazard ratio, 2.00; 95% confidence interval, 0.57-6.98), which was more pronounced after 2 years.

CONCLUSIONS

During the first years after corneal transplant surgery, Mersilene sutures are associated with a higher risk of complications and more interventions to correct suture-related problems. However, after 2 years, the grafts seem to be able to retain Mersilene sutures with less risk of suture-related complications as compared with grafts with retained nylon sutures. These favorable long-term effects of Mersilene sutures may outweigh its short-term disadvantage in patients with Fuchs endothelial dystrophy.

目的

本研究旨在评估在针对富克斯内皮营养不良的初次角膜移植中，使用尼龙缝线缝合的移植片和使用涤纶编织缝线缝合的移植片的角膜散光及与缝线相关的并发症。

方法

对使用10-0或11-0尼龙缝线（n = 108）或11-0涤纶编织缝线（n = 58）缝合的移植片进行了一项回顾性、观察性和对比性研究。纳入了1995年至2001年期间在荷兰鹿特丹眼科医院接受针对富克斯内皮营养不良的初次穿透性角膜移植术的140例患者的166只眼。

结果

总体而言，各组间移植片存活率无差异（对数秩检验；P = 0.24）。在移植后的头2年，使用尼龙缝线缝合的移植片散光明显更低（P = 0.03）。使用涤纶编织缝线缝合的移植片在移植后进行手术干预以矫正散光或伤口裂开的风险显著更高（风险比，2.83；95%置信区间，1.34 - 6.01）。涤纶编织缝线组首次出现浸润、化生（缝线周围明显瘢痕形成）或缝线松解的时间显著更短（P < 0.01）。尼龙组中与缝线松动或断裂相关的并发症风险有升高趋势（风险比，2.00；95%置信区间，0.57 - 6.98），在2年后更为明显。