穿透性角膜移植术与板层角膜移植术治疗芥子气诱导的角膜炎。

Penetrating keratoplasty versus lamellar keratoplasty for mustard gas-induced keratitis.

机构信息

Ophthalmic Research Center, Ophthalmology Department, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

出版信息

Cornea. 2013 Apr;32(4):396-400. doi: 10.1097/ICO.0b013e3182609287.

DOI:10.1097/ICO.0b013e3182609287

PMID:23023404

Abstract

PURPOSE

To compare the outcomes of penetrating keratoplasty (PK) and lamellar keratoplasty (LK) in patients with mustard gas keratitis.

METHODS

A total of 78 eyes of 55 patients with mustard gas keratitis were included. Of these eyes, 27 (34.6%) underwent PK and 51 (63.4%) received LK. Keratolimbal allografts were performed in 11 and 30 eyes of the PK and LK groups, respectively. The study groups were compared in terms of best spectacle-corrected visual acuity, refractive error, and keratometry readings. The Kaplan-Meier survival curve and log-rank test were used to evaluate and compare the cumulative incidence of rejection-free graft survival and graft survival in PK and LK.

RESULTS

At the time of keratoplasty, the mean patient ages were 40.3 ± 4.5 years and 43.4 ± 8.3 years in the PK and LK groups, respectively (P = 0.08). The patients were followed-up for 53.2 ± 27.5 and 40.4 ± 29.6 months, respectively (P = 0.09). At the last follow-up, the 2 study groups were comparable with respect to best spectacle-corrected visual acuity (P = 0.87), refraction (P = 0.08), and keratometric astigmatism (P = 0.27). At the 33-month follow-up examination, the rejection-free graft survival rates were 33.6% in the PK group and 90% in the LK group, with mean durations of 34.6 and 84.8 months, respectively (P < 0.001). Moreover, the graft survival rates were 77.3% and 91.7%, with mean durations of 67.5 and 76.1 months, respectively (P = 0.03). Three eyes that had received LK underwent PK because of significant interface haziness.

CONCLUSIONS

LK is preferred to PK in the majority of mustard gas victims. However, PK should always be performed in certain conditions.

摘要

目的

比较穿透性角膜移植术（PK）和板层角膜移植术（LK）治疗芥子气角膜炎患者的疗效。

方法

共纳入 55 例芥子气角膜炎患者的 78 只眼，其中 27 只眼（34.6%）行 PK，51 只眼（63.4%）行 LK。PK 组和 LK 组分别有 11 只眼和 30 只眼接受同种异体角膜缘移植。比较两组最佳矫正视力、屈光不正和角膜曲率读数。采用 Kaplan-Meier 生存曲线和对数秩检验评估和比较 PK 和 LK 组无排斥反应的移植存活率和移植物存活率的累积发生率。

结果

在进行角膜移植时，PK 组和 LK 组患者的平均年龄分别为 40.3±4.5 岁和 43.4±8.3 岁（P=0.08）。患者分别随访 53.2±27.5 个月和 40.4±29.6 个月（P=0.09）。末次随访时，两组的最佳矫正视力（P=0.87）、屈光不正（P=0.08）和角膜散光（P=0.27）均无显著差异。在 33 个月的随访检查中，PK 组的无排斥反应的移植物存活率为 33.6%，LK 组为 90%，平均持续时间分别为 34.6 和 84.8 个月（P＜0.001）。此外，PK 组和 LK 组的移植物存活率分别为 77.3%和 91.7%，平均持续时间分别为 67.5 和 76.1 个月（P=0.03）。3 只 LK 眼因界面混浊显著而行 PK。