Rao Kavita V, Fernandes Merle, Gangopadhyay Nibaran, Vemuganti Geeta K, Krishnaiah Sannapaneni, Sangwan Virender S
Cornea and Anterior Segment Service, L.V. Prasad Eye Institute, Hyderabad, India.
Cornea. 2008 Aug;27(7):749-53. doi: 10.1097/ICO.0b013e31816fe9a7.
To determine the results of corneal graft survival after penetrating keratoplasty for Peters anomaly.
Retrospective review of records of children 12 years of age or younger who underwent penetrating keratoplasty for Peters anomaly between March 1988 and December 2003. The data were analyzed regarding graft survival. The survival probabilities were estimated by using the Kaplan-Meier method. The main outcome measure was graft clarity.
Forty corneal transplants were performed in 32 children with Peters anomaly whose mean age at keratoplasty was 8.6 +/- 3.9 months (range, 2.5-22 months). The mean follow-up period was 1.9 +/- 2.9 years (range, 1 month to 15 years). Seventeen (42.5%) of the 40 grafts retained full clarity. Survival analysis showed a 52% probability of the graft remaining clear at the end of 6 months, which dropped to 22% at 2 years. The predicted mean survival time of grafts was 20.1 months (95% confidence interval, 4.9-36.3). Allograft rejection was the most frequently identified cause of graft failure, accounting for 15 (65%) of the 23 failed grafts, with 93.3% of episodes occurring in the first year. Poor graft survival correlated with age younger than 6 months (P = 0.04).
The overall probability of maintaining a clear corneal transplant in Peters anomaly is 22% at 2 years and may be adversely affected by younger age at surgery. Because most episodes of rejection occurred in the first year, follow-up is recommended during this period.
确定彼得斯异常行穿透性角膜移植术后角膜植片存活的结果。
回顾性分析1988年3月至2003年12月期间12岁及以下因彼得斯异常接受穿透性角膜移植术的儿童病历。对植片存活情况进行数据分析。采用Kaplan-Meier法估计存活概率。主要观察指标为植片清晰度。
32例患有彼得斯异常的儿童接受了40次角膜移植，角膜移植时的平均年龄为8.6±3.9个月（范围2.5 - 22个月）。平均随访时间为1.9±2.9年（范围1个月至15年）。40片植片中17片（42.5%）保持完全清晰。生存分析显示，6个月末植片保持清晰的概率为52%，2年时降至22%。预测植片的平均存活时间为20.1个月（95%置信区间，4.9 - 36.3）。同种异体移植排斥是最常见的植片失败原因，23片失败植片中15片（65%）是由其导致，93.3%的排斥事件发生在第一年。植片存活率低与手术时年龄小于6个月相关（P = 0.04）。
彼得斯异常患者角膜移植术后2年保持植片清晰的总体概率为22%，手术时年龄较小可能会对其产生不利影响。由于大多数排斥事件发生在第一年，建议在此期间进行随访。
