Descemet 膜内皮角膜移植术：青光眼合并眼中原发性青光眼的长期移植物存活率和失败的危险因素。
Descemet's stripping endothelial keratoplasty: long-term graft survival and risk factors for failure in eyes with preexisting glaucoma.
机构信息
Cornea Research Foundation of America, Indianapolis, Indiana, USA.
出版信息
Ophthalmology. 2012 Oct;119(10):1982-7. doi: 10.1016/j.ophtha.2012.04.031. Epub 2012 Jun 15.
PURPOSE
To evaluate long-term corneal graft survival and risk factors for graft failure after Descemet's stripping endothelial keratoplasty (DSEK) in eyes with preexisting glaucoma.
DESIGN
Retrospective case control study.
PARTICIPANTS
A total of 835 DSEK cases performed by a single surgeon between December 2003 and August 2007 were reviewed. Only the first treated eye of each patient with at least 1 year follow-up was included, resulting in 453 cases; 342 had no prior glaucoma (C), 65 had medically managed preexisting glaucoma (G), and 46 had prior glaucoma surgery (GS).
METHODS
Corneal graft failure was defined as persistent corneal edema resulting in irreversible loss of optical clarity. Corneal graft survival in the 3 groups was calculated using Kaplan-Meier survival analysis. Nine potential risk factors for graft failure were evaluated by Cox proportional hazards univariate and multivariate analysis. These methods took length of follow-up into consideration.
MAIN OUTCOME MEASURES
Corneal graft survival and risk factors influencing long-term corneal endothelial failure.
RESULTS
The 1-, 2-, 3-, 4-, and 5-year graft survival was 99%, 99%, 97%, 97%, and 96%, respectively, in group C; 100%, 98%, 98%, 96%, and 90%, respectively, in group G; and 96%, 91%, 84%, 69%, and 48%, respectively, in group GS (P < 0.001). In the GS group, the 5-year survival rate for eyes with a glaucoma drainage device (GDD) and those with trabeculectomy only was 25% and 59%, respectively. Indication for DSEK, surgically managed glaucoma, type and number of prior glaucoma surgeries, and occurrence of a rejection episode were the significant risk factors for graft survival in univariate analysis. Several factors were correlated; in a multivariate model, prior glaucoma surgery (P < 0.0001) and a prior rejection episode (0.0023) were the significant risk factors for corneal endothelial failure.
CONCLUSIONS
Patients with medically managed glaucoma had significantly better 5-year graft survival than those with surgically managed glaucoma. A prior glaucoma shunt or trabeculectomy significantly increased the risk of DSEK endothelial failure.
目的
评估在患有既往青光眼的患者中行去表皮角膜内皮移植术（DSEK）后的长期角膜移植物存活率和移植物失败的风险因素。
设计
回顾性病例对照研究。
参与者
共对 2003 年 12 月至 2007 年 8 月期间由一位外科医生进行的 835 例 DSEK 病例进行了回顾性分析。仅纳入每例患者中至少随访 1 年的第一只治疗眼，共 453 例；342 例患者无既往青光眼（C 组），65 例患者有经医学治疗的既往青光眼（G 组），46 例患者有既往青光眼手术史（GS 组）。
方法
角膜移植物失败定义为持续性角膜水肿导致光学清晰度不可逆转丧失。采用 Kaplan-Meier 生存分析法计算 3 组的角膜移植物存活率。采用 Cox 比例风险单因素和多因素分析评估 9 种可能影响移植物失败的风险因素。这些方法考虑了随访时间。
主要观察指标
角膜移植物存活率和影响长期角膜内皮失败的风险因素。
结果
C 组的 1 年、2 年、3 年、4 年和 5 年移植物存活率分别为 99%、99%、97%、97%和 96%；G 组分别为 100%、98%、98%、96%和 90%；GS 组分别为 96%、91%、84%、69%和 48%（P <0.001）。在 GS 组中，青光眼引流装置（GDD）和单纯小梁切除术的 5 年存活率分别为 25%和 59%。DSEK 适应证、手术治疗的青光眼、既往青光眼手术的类型和数量以及排斥反应的发生是单因素分析中影响移植物存活率的显著危险因素。一些因素相关；在多因素模型中，既往青光眼手术（P <0.0001）和既往排斥反应（0.0023）是角膜内皮失败的显著危险因素。
结论
经医学治疗的青光眼患者的 5 年移植物存活率明显优于手术治疗的青光眼患者。既往青光眼分流术或小梁切除术显著增加了 DSEK 内皮失败的风险。
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