Jules Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, University of California-Los Angeles, 100 Stein Plaza, Los Angeles, CA 90095-7004, USA.
Am J Ophthalmol. 2010 Aug;150(2):169-78. doi: 10.1016/j.ajo.2010.02.014.
To determine incidence and risk factors for graft failure following penetrating keratoplasty (PK) in eyes with Ahmed valves (AV).
Retrospective, observational cohort study.
Patients who underwent PK after AV implantation (both performed at our institution through 2004) were studied. Intervals to graft failure (defined as either dysfunction [stromal thickening with retention of clarity] or decompensation [central microcystic edema or loss of clarity]) were analyzed using Kaplan-Meier technique. Risk factors for graft failure were analyzed using Cox proportional hazard models.
Included were 77 eyes (77 patients; first procedure 1993). Following PK, 40 eyes (52%) required increased numbers of glaucoma medications; 10 eyes (13%) required additional glaucoma drainage device(s). Graft failure at 1, 2, and 3 years was 42.4% (95% confidence interval: 32.0%-54.6%), 57.1% (45.6%-69.1%), and 59.1% (47.5%-71.2%), respectively. Prior PK (HR 2.38, P = .006) and stromal vessels (HR 2.90, P = .0005) were associated with increased risk of graft failure. Use of glaucoma medications (HR 0.27, P = .009) and evidence of lower intraocular pressures (IOP) during follow-up (excluding hypotony; HR 0.92, P = .010) were associated with reduced risk of graft failure. Endothelial rejection episodes were observed in 13 eyes (17%); however, rejection was not a risk factor for graft failure (P = .98).
Long-term survival of corneal grafts is poor in eyes with AV. The majority of graft failures are associated with progressive loss of endothelial function, without observed immunologic rejection. Despite the presence of an AV, escalation in glaucoma therapy often follows PK; graft failure may be related to poor IOP control.
确定 Ahmed 阀（AV）植入术后穿透性角膜移植（PK）后移植物失败的发生率和相关因素。
回顾性观察性队列研究。
研究了在我们机构进行的 AV 植入（2004 年前）后接受 PK 的患者。使用 Kaplan-Meier 技术分析移植物失败（定义为功能障碍[基质增厚伴清晰度保留]或失代偿[中央微囊水肿或清晰度丧失]）的间隔时间。使用 Cox 比例风险模型分析移植物失败的风险因素。
共纳入 77 只眼（77 例患者；首次手术时间为 1993 年）。PK 后，40 只眼（52%）需要增加青光眼药物的使用次数；10 只眼（13%）需要额外的青光眼引流装置。1、2、3 年的移植物失败率分别为 42.4%（95%置信区间：32.0%-54.6%）、57.1%（45.6%-69.1%）和 59.1%（47.5%-71.2%）。先前的 PK（HR 2.38，P =.006）和基质血管（HR 2.90，P =.0005）与移植物失败的风险增加相关。青光眼药物的使用（HR 0.27，P =.009）和随访期间眼压（IOP）较低的证据（排除低眼压；HR 0.92，P =.010）与移植物失败风险降低相关。13 只眼（17%）观察到内皮排斥反应，但排斥反应不是移植物失败的危险因素（P =.98）。
AV 眼的角膜移植物长期存活率较差。大多数移植物失败与内皮功能逐渐丧失有关，而无免疫排斥反应。尽管存在 AV，但 PK 后青光眼治疗通常会升级；移植物失败可能与眼压控制不佳有关。
