Pramanik Sudeep, Musch David C, Sutphin John E, Farjo Ayad A
Cornea, External Diseases and Refractive Surgery Services, Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Ophthalmology. 2006 Sep;113(9):1633-8. doi: 10.1016/j.ophtha.2006.02.058. Epub 2006 Jul 7.
To report graft survival results for initial penetrating keratoplasty (PK) performed more than 20 years ago for keratoconus. Secondary outcome measures included recurrent keratoconus, best spectacle-corrected visual acuity (BSCVA), and rates of glaucoma.
Retrospective, consecutive, noncomparative case series.
All patients with clinical and histopathological keratoconus who underwent initial PK at the University of Iowa Hospitals and Clinics from 1970 to 1983. Patients with pellucid marginal degeneration were excluded.
At baseline, age, preoperative BSCVA, keratometric astigmatism, and host/donor graft sizes for each eye were recorded. Visual acuity and intraocular pressure were followed until the eyes reached 1 of 4 end points: graft failure, recurrent keratoconus, loss to follow-up, or death. Kaplan-Meier survival analysis was performed to estimate the long-term probability of graft failure and recurrent keratoconus.
Among the 112 eyes of 84 patients who met entry criteria, there was a mean age at transplant of 33.7 years and preoperative BSCVA of 20/193. With a mean follow-up of 13.8 years (range, 0.5-30.4), 7 eyes (6.3%) experienced graft failure. Recurrent keratoconus was confirmed clinically or histologically in 6 eyes (5.4%), with a mean time to recurrence of 17.9 years (range, 11-27). Kaplan-Meier analysis estimated a graft survival rate of 85.4% and a rate of recurrent keratoconus of 11.7% at 25 years after initial transplantation. Six eyes (5.4%) developed open-angle glaucoma, and 2 eyes required trabeculectomy. At the last follow-up visit, 82 eyes (73.2%) had BSCVA of 20/40 or better.
Penetrating keratoplasty offers good long-term visual rehabilitation for keratoconus. Relative to other indications for PK, there is a low rate of graft failure. Late recurrence of disease occurs with increasing frequency over time. Given the younger age at which keratoconus patients undergo corneal transplantation, these long-term findings should be incorporated into preoperative counseling.
报告20多年前因圆锥角膜行初次穿透性角膜移植术（PK）的植片存活结果。次要观察指标包括复发性圆锥角膜、最佳矫正视力（BSCVA）和青光眼发病率。
回顾性、连续性、非对照病例系列研究。
1970年至1983年在爱荷华大学医院及诊所接受初次PK的所有临床及组织病理学诊断为圆锥角膜的患者。排除透明边缘变性患者。
记录基线时每只眼的年龄、术前BSCVA、角膜散光以及植片的宿主/供体大小。随访视力和眼压，直至眼睛达到以下4个终点之一：植片失败、复发性圆锥角膜、失访或死亡。采用Kaplan-Meier生存分析评估植片失败和复发性圆锥角膜的长期概率。
符合纳入标准的84例患者的112只眼中，移植时平均年龄为33.7岁，术前BSCVA为20/193。平均随访13.8年（范围0.5 - 30.4年），7只眼（6.3%）发生植片失败。6只眼（占5.4%）经临床或组织学确诊为复发性圆锥角膜，复发平均时间为17.9年（范围11 - 27年）。Kaplan-Meier分析估计初次移植后25年植片存活率为85.4%，复发性圆锥角膜发生率为11.7%。6只眼（占5.4%）发生开角型青光眼，2只眼需要行小梁切除术。在最后一次随访时，82只眼（73.2%）的BSCVA为20/40或更好。
穿透性角膜移植术为圆锥角膜提供了良好的长期视力康复效果。相对于PK的其他适应证，植片失败率较低。随着时间推移，疾病的晚期复发频率增加。鉴于圆锥角膜患者接受角膜移植时年龄较轻，这些长期研究结果应纳入术前咨询。
Zotero 插件