Lee Dae Seung, Heo Jang Won, Choi Hyuk Jin, Kim Mee Kum, Wee Won Ryang, Oh Joo Youn
Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
Clin Ophthalmol. 2014 Feb 25;8:449-54. doi: 10.2147/OPTH.S60008. eCollection 2014.
To evaluate the outcome of corneal allotransplantation in combined penetrating keratoplasty and vitreoretinal surgery using a temporary keratoprosthesis, and to determine the factors affecting corneal allograft survival.
We reviewed the medical charts of eleven patients who had undergone combined corneal allotransplantation and pars plana vitrectomy using an Eckardt temporary keratoprosthesis, for the treatment of corneal opacification and vitreoretinal disease. The survival rates of the corneal grafts were assessed, and patient demographics, the diagnosis of corneal and retinal disease, the preoperative ocular characteristics, and surgical methods were compared between the group with graft survival and that with graft failure.
The causes of corneal opacification were corneal laceration (four eyes), infectious keratitis (four eyes), atopic keratitis (one eye), rejected corneal graft (one eye), and uveitis-related bullous keratopathy (one eye). The preoperative diagnoses included endophthalmitis (six eyes), posterior uveitis (one eye), vitreous opacity or hemorrhage (two eyes), and rhegmatogenous retinal detachment (two eyes). The survival rate of the corneal allografts was 27.3% (3/11 eyes). The mean survival time was 391 days during the mean follow-up period of 687 days. The retinal surgery was successful in 81.8% (9/11 eyes) of cases. The presence of active inflammation in the cornea at the time of surgery was significantly correlated with graft rejection (P=0.004). Other factors, including age, the presence of glaucoma, type of corneal and retinal disease, or type of retinal surgery, such as silicone oil injection and gas tamponade, had no significant correlation with graft rejection.
Combined corneal allotransplantation and pars plana vitrectomy using a temporary keratoprosthesis allowed for successful surgical intervention in vitreoretinal disease. However, only 27.3% of corneal allografts survived, depending on the presence of active inflammation in the cornea.
评估使用临时性角膜假体在穿透性角膜移植术联合玻璃体视网膜手术中进行同种异体角膜移植的效果，并确定影响角膜移植存活的因素。
我们回顾了11例接受使用埃卡德临时性角膜假体进行同种异体角膜移植联合玻璃体切除术以治疗角膜混浊和玻璃体视网膜疾病患者的病历。评估角膜移植片的存活率，并比较移植存活组和移植失败组之间的患者人口统计学、角膜和视网膜疾病诊断、术前眼部特征及手术方法。
角膜混浊的原因包括角膜裂伤（4眼）、感染性角膜炎（4眼）、特应性角膜炎（1眼）、移植角膜排斥（1眼）以及葡萄膜炎相关性大泡性角膜病变（1眼）。术前诊断包括眼内炎（6眼）、后葡萄膜炎（1眼）、玻璃体混浊或出血（2眼）以及孔源性视网膜脱离（2眼）。同种异体角膜移植片的存活率为27.3%（3/11眼）。在平均687天的随访期内，平均存活时间为391天。视网膜手术在81.8%（9/11眼）的病例中成功。手术时角膜存在活动性炎症与移植排斥显著相关（P = 0.004）。其他因素，包括年龄、青光眼的存在、角膜和视网膜疾病类型或视网膜手术类型，如硅油注入和气液填充，与移植排斥无显著相关性。
使用临时性角膜假体进行同种异体角膜移植联合玻璃体切除术能够成功干预玻璃体视网膜疾病。然而，取决于角膜是否存在活动性炎症，只有27.3%的同种异体角膜移植片存活。
