Department of Ophthalmology, St Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.
Moran Eye Center, University of Utah, Salt Lake City, UT.
Cornea. 2013 Dec;32(12):1591-1598. doi: 10.1097/ICO.0b013e31829ebb0d.
To examine the effects of presurgical corticosteroid treatment for normal-risk penetrating keratoplasty (NRPK), high-risk penetrating keratoplasty (HRPK), and high-risk penetrating keratoplasty plus lensectomy.
We used 3 corneal transplantation models (NRPK, HRPK, and high-risk penetrating keratoplasty plus lensectomy). For each model, we tried to compare the effect of corticosteroid treatment according to different timetables as follows: The first trial began with a corticosteroid injection given 2 weeks before the PK and continued until 4 weeks after the PK (group 1). The second trial started with a corticosteroid injection given on the day of the PK and continued for 4 weeks after the PK (group 2). The third trial started with a corticosteroid injection administered on the day of the PK and continued for 8 weeks after the PK (group 3). After harvesting and immunostaining of corneas, graft survival, neovascularization (NV), and lymphangiogenesis (LY) were compared among the groups. A P value <0.05 was considered as being statistically significant.
With respect to graft survival, group 1 had improved graft survival compared with that of group 3 in the HRPK model (P = 0.025). In all the 3 PK models, groups 2 and 3 demonstrated a similar graft survival (P > 0.05). With respect to NV and LY, in NRPK, group 1 showed less NV than did group 2 (P < 0.001) and group 3 (P = 0.016). In HRPK, group 1 also demonstrated less NV and LY than did group 3 (P = 0.045 and 0.044, respectively).
The initiation time point of the corticosteroid treatment is important for graft survival. Corticosteroid pretreatment is an effective means to increase graft survival for HRPK and to decrease NV and LY for both NRPK and HRPK.
研究术前皮质类固醇治疗普通风险穿透性角膜移植术(NRPK)、高风险穿透性角膜移植术(HRPK)和高风险穿透性角膜移植术联合晶状体切除术的效果。
我们使用了 3 种角膜移植模型(NRPK、HRPK 和高风险穿透性角膜移植术联合晶状体切除术)。对于每个模型,我们试图根据不同的时间表比较皮质类固醇治疗的效果,如下所示:第一次试验从 PK 前 2 周开始给予皮质类固醇注射,并持续到 PK 后 4 周(组 1)。第二次试验从 PK 当天开始给予皮质类固醇注射,并持续 4 周(组 2)。第三次试验从 PK 当天开始给予皮质类固醇注射,并持续 8 周(组 3)。采集和免疫染色角膜后,比较各组移植物存活率、新生血管形成(NV)和淋巴管生成(LY)。P 值<0.05 被认为具有统计学意义。
在 HRPK 模型中,与组 3 相比,组 1 的移植物存活率提高(P = 0.025)。在所有 3 种 PK 模型中,组 2 和组 3 的移植物存活率相似(P>0.05)。在 NRPK 中,与组 2 和组 3 相比,组 1 显示出较少的 NV(P<0.001 和 P = 0.016)。在 HRPK 中,与组 3 相比,组 1 也显示出较少的 NV 和 LY(P = 0.045 和 0.044)。
皮质类固醇治疗的起始时间点对移植物存活率很重要。皮质类固醇预处理是增加 HRPK 移植物存活率的有效手段,并减少 NRPK 和 HRPK 的 NV 和 LY。