St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom.
Ophthalmology. 2013 Apr;120(4):682-6. doi: 10.1016/j.ophtha.2012.09.050. Epub 2013 Jan 3.
To investigate mortality and graft survival in patients undergoing penetrating keratoplasty (PKP) for rheumatoid arthritis-associated corneal ulceration (RACU), Fuchs' endothelial dystrophy (FED), and pseudophakic bullous keratopathy (PBK).
Case-control study.
Patients listed on the UK Transplant Registry who had undergone a PKP for RACU, FED, or PBK between January 4, 1999, and January 4, 2006. Comparative standardized mortality ratios (SMRs) and causes of death were obtained from the Office for National Statistics.
Outcome data were collected from the UK Ocular Tissue National Transplant database and supplementary questionnaires at transplantation and at 1, 2, and 5 years. Institutional review board approval for the National Health Service Blood and Transplant to undertake the study was obtained.
Mortality and graft survival.
A total of 3665 patients were included: RACU (117), PBK (1701), and FED (1847). Five-year survival of patients with RACU was 42% (95% confidence interval [CI], 26-56) compared with 76% (95% CI, 72-78) for FED and 55% for PBK (95% CI, 50-60; P < 0.01). The SMRs for female and male patients with RACU were 43.5 (95% CI, 19.5-63.3) and 12.2 (95% CI, 7.1-19.5), respectively, in comparison with 1.84 and 1.45 for patients with RA, respectively (P < 0.01). There were no significant differences in the causes of death among patients with RACU, FED, or PBK (P > 0.9), with infection the most common cause. The 5-year graft survival rate was 48% (95% CI, 32-62) for RACU, 59% (95% CI, 56-62) for PBK, and 84% (95% CI, 82-86) for FED (P < 0.01).
Mortality and ocular morbidity were significantly increased in patients with RACU. Accelerated immunosenescence should be considered in the differential diagnosis of patients presenting with RACU, and a multidisciplinary approach to management is required.
调查类风湿关节炎相关性角膜溃疡（RACU）、Fuchs 角膜内皮营养不良（FED）和白内障术后发性大泡性角膜病变（PBK）患者行穿透性角膜移植术（PKP）后的死亡率和移植物存活率。
病例对照研究。
1999 年 1 月 4 日至 2006 年 1 月 4 日期间在英国移植登记处接受 RACU、FED 或 PBK 行 PKP 的患者。通过国家统计局获得标准化死亡率比（SMR）和死亡原因。
从英国眼组织国家移植数据库和移植时以及 1、2 和 5 年的补充问卷中收集结局数据。国家卫生服务血液和移植机构获得了对国民健康服务进行这项研究的批准。
死亡率和移植物存活率。
共纳入 3665 例患者：RACU（117 例）、PBK（1701 例）和 FED（1847 例）。RACU 患者的 5 年存活率为 42%（95%置信区间[CI]，26%-56%），而 FED 为 76%（95% CI，72%-78%），PBK 为 55%（95% CI，50%-60%；P<0.01）。RACU 女性和男性患者的 SMR 分别为 43.5（95% CI，19.5-63.3）和 12.2（95% CI，7.1-19.5），而类风湿关节炎患者分别为 1.84 和 1.45（P<0.01）。RACU、FED 或 PBK 患者的死因无显著差异（P>0.9），感染是最常见的原因。RACU 的 5 年移植物存活率为 48%（95% CI，32%-62%），PBK 为 59%（95% CI，56%-62%），FED 为 84%（95% CI，82%-86%）（P<0.01）。
RACU 患者的死亡率和眼部发病率显著增加。在诊断 RACU 患者时应考虑加速免疫衰老，并需要多学科方法进行管理。
