Department of Ophthalmology and Visual Sciences, Medical School, University of Michigan, Ann Arbor, Michigan 48105, USA.
Am J Ophthalmol. 2013 Feb;155(2):213-219.e3. doi: 10.1016/j.ajo.2012.08.001. Epub 2012 Oct 27.
To estimate the probability of allograft rejection, graft failure, and recurrent keratoconus (KC) and to assess vision-specific quality of life 20 to 25 years after corneal transplantation for KC.
Retrospective case series.
Two hundred nineteen eyes of 184 subjects were identified from the Michigan Corneal Transplantation Patient Registry as receiving corneal transplantation for KC from 1980 through 1986. Current ophthalmic examinations and the 25-item National Eye Institute Visual Function Questionnaire were obtained. Kaplan-Meier analyses were used to estimate the time-related probability of allograft rejection, graft failure, and KC recurrence. Cox regression was used to identify predictive factors of these outcomes. The 25-item National Eye Institute Visual Function Questionnaire scores were summarized with descriptive statistics.
Follow-up was available up to 27 years after surgery (median, 10 years). Rejection occurred in 98 of 219 grafts. Most rejections occurred in the first 2 years (probability, 41%; standard error, 3%). KC recurrence was noted in 6 grafts 9 to 20 years after surgery, with a 20-year probability of 10% (standard error, 4%). Eighteen grafts failed, with a 20-year probability of 12% (standard error, 3%). Larger host trephine size, male donor gender, and nonwhite donor race were associated with increased rejection hazard. Worse astigmatism and nonwhite recipient race were associated with increased failure hazard. Twenty-eight subjects completed the 25-item National Eye Institute Visual Function Questionnaire at an average of 23 years after surgery (range, 18 to 26 years). Their mean composite score was 84.5 (standard deviation, 12.1).
Allograft rejection is frequent in the 2 years after corneal graft for KC. However, the 20-year probabilities of graft failure and recurrent KC are low. Given the relative youth of KC graft recipients, these statistics should enhance the information they receive.
评估同种异体排斥、移植物失功和复发性圆锥角膜（KC）的概率，并评估 KC 角膜移植术后 20 至 25 年时与视力相关的生活质量。
回顾性病例系列。
从密歇根角膜移植患者登记处确定了 184 名患者的 219 只眼，这些患者于 1980 年至 1986 年因 KC 接受角膜移植。获取当前的眼科检查和 25 项国家眼科研究所视觉功能问卷。使用 Kaplan-Meier 分析估计同种异体排斥、移植物失功和 KC 复发的时间相关概率。使用 Cox 回归来确定这些结果的预测因素。使用描述性统计总结 25 项国家眼科研究所视觉功能问卷得分。
随访时间最长达手术后 27 年（中位数，10 年）。219 个移植物中有 98 个发生排斥。大多数排斥发生在第 1 至 2 年内（概率为 41%，标准误差为 3%）。6 个移植物在手术后 9 至 20 年内出现 KC 复发，20 年的概率为 10%（标准误差为 4%）。18 个移植物失功，20 年的概率为 12%（标准误差为 3%）。较大的宿主环钻大小、男性供体性别和非白色供体种族与排斥危险增加相关。更差的散光和非白色受者种族与移植物失功危险增加相关。28 名受试者在手术后平均 23 年（范围为 18 至 26 年）完成了 25 项国家眼科研究所视觉功能问卷。他们的平均综合评分为 84.5（标准差为 12.1）。
KC 角膜移植后 2 年内同种异体排斥频繁。然而，移植物失功和复发性 KC 的 20 年概率较低。鉴于 KC 移植受者相对年轻，这些统计数据应增强他们所获得的信息。
