Ferdinand Larry, Ngakeng Vanessa, Copeland Robert A
Department of Ophthalmology, Howard University Hospital, 2041 Georgia Ave., NW, Washington, DC 20060-0001, USA.
Saudi J Ophthalmol. 2011 Jul;25(3):285-9. doi: 10.1016/j.sjopt.2011.04.007. Epub 2011 Apr 30.
There is scarcity of data in the literature on cornel graft rejection rate in patients exclusively of African ancestry. The purpose of this study was to evaluate the rejection rate of corneal transplant surgery performed at Howard University Hospital on such patients over a 15 year period.
A retrospective evaluation was performed of the cornea graft rejection and corneal graft failure rate in 125 penetrating keratoplasties (PKPs) done by one corneal specialist at Howard University Hospital from January 1, 1990 to August 31, 2005.
Of the 125 patients, 62 were eliminated from the study because of re-grafted eyes, non-African descent, primary graft failures, follow-up less than 1 month and lack of availability of charts. This study, therefore, studied and recorded data from 63 penetrating keratoplasties of 63 eyes from 60 patients.
Episodes of graft rejection were documented in 23 eyes (36.5% of cases). Nine out of the 23 graft rejections manifested to secondary graft failure (39%). Overall, there were nine out of the 63 PKPs (14.3%) that resulted in secondary graft failure over the past 15 years. The major diagnostic categories were bullous keratopathy 24 (38%), keratoconus 10 (15.8%), Fuch's dystrophy 4 (6.3%), other 20 (31.7%). Of the cases with episodes of rejection and failure, 4.3% and none were attributable to keratoconus, 30.4% and 22.2% for bullous keratopathy, and 8.7% and 22.2% for Fuch's dystrophy, respectively. Also, best visual acuity was looked at in patients with rejection episodes. None of the patients had a pre-op visual acuity 20/40 or better; however, post-op PKP 2 (8.7%) of patients achieved 20/40 or better. Also, 4 (17.4%) of patients had a pre-op visual acuity between 20/50 and 20/150, but post-op PKP best visual acuity between 20/50 and 20/150 was increased to 9 (39.1%).
At 36% the prevalence of corneal graft rejection was one of the highest in the reported literature. But only 14% of those episodes resulted in graft failure which is one of the lowest in the published literature. This study demonstrates that patients of African ancestry may have a higher rejection rate which does not necessarily result in graft failure.
文献中关于纯非洲裔患者角膜移植排斥率的数据稀缺。本研究的目的是评估霍华德大学医院在15年期间对这类患者进行的角膜移植手术的排斥率。
对1990年1月1日至2005年8月31日期间一位角膜专科医生在霍华德大学医院进行的125例穿透性角膜移植术（PKP）的角膜移植排斥和角膜移植失败率进行回顾性评估。
在这125例患者中，62例因再次移植眼、非非洲裔、原发性移植失败、随访时间少于1个月以及缺乏病历而被排除在研究之外。因此，本研究对60例患者的63只眼的63例穿透性角膜移植术的数据进行了研究和记录。
23只眼（占病例的36.5%）记录有移植排斥事件。23例移植排斥中有9例导致继发性移植失败（占39%）。总体而言，在过去15年中，63例PKP中有9例（占14.3%）导致继发性移植失败。主要诊断类别为大疱性角膜病变24例（占38%）、圆锥角膜10例（占15.8%）、富克斯营养不良4例（占6.3%）、其他20例（占31.7%）。在有排斥和失败事件的病例中，圆锥角膜导致排斥和失败的比例分别为4.3%和0，大疱性角膜病变分别为30.4%和22.2%，富克斯营养不良分别为8.7%和22.2%。此外，还观察了有排斥事件患者的最佳视力。所有患者术前视力均未达到20/40或更好；然而，术后PKP患者中有2例（占8.7%）达到了20/40或更好。另外，4例（占17.4%）患者术前视力在20/50至20/150之间，但术后PKP最佳视力在20/50至20/150之间的患者增加到了9例（占39.1%）。
角膜移植排斥率为36%，是报道文献中最高的之一。但这些事件中只有14%导致移植失败，这是已发表文献中最低的之一。本研究表明，非洲裔患者可能有较高的排斥率，但不一定导致移植失败。
