穿透性或后弹力层剥除自动角膜内皮移植术后移植物存活情况与青光眼治疗效果对比

Graft survival versus glaucoma treatment after penetrating or Descemet stripping automated endothelial keratoplasty.

作者信息

Ward Matthew S, Goins Kenneth M, Greiner Mark A, Kitzmann Anna S, Sutphin John E, Alward Wallace L M, Greenlee Emily C, Kwon Young H, Zimmerman M Bridget, Wagoner Michael D

机构信息

*Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA; †Department of Ophthalmology, Kansas University Medical Center, Kansas City, KS; and ‡Department of Biostatistics, School of Public Health, University of Iowa, Iowa City, IA.

出版信息

Cornea. 2014 Aug;33(8):785-9. doi: 10.1097/ICO.0000000000000170.

DOI:10.1097/ICO.0000000000000170

PMID:24915017

Abstract

PURPOSE

The aim of this study was to assess and compare the association of glaucoma therapy with graft survival after performing penetrating keratoplasty (PKP) and Descemet stripping automated endothelial keratoplasty (DSAEK).

METHODS

A retrospective chart review was performed of cases: primary PKP from January 1, 2003, to December 31, 2005, or primary DSAEK from January 1, 2006, to December 31, 2008. Eyes with a surgical indication of pseudophakic corneal edema were included in the statistical analysis. Eyes were stratified by glaucoma treatment into those with (1) no glaucoma treatment, (2) medical therapy only, or (3) surgical intervention. The main outcome measure was graft survival.

RESULTS

Fifty-seven PKP-operated and 156 DSAEK-operated eyes met the inclusion criteria. After PKP and DSAEK, respectively, the 5-year Kaplan-Meier graft survival was 94.7% and 93.8% in eyes with no glaucoma treatment (P > 0.99), 93.8% and 96.3% in eyes with medical therapy only (P > 0.99), and 56.8% and 50% in eyes with surgical intervention (P > 0.99). After both procedures were performed, graft survival was significantly worse in eyes with surgical intervention compared with that in eyes with no glaucoma treatment (P < 0.0001) or in eyes with medical therapy alone (P < 0.0001).

CONCLUSIONS

PKP and DSAEK have comparable graft survival in eyes without glaucoma management and in those with comparable glaucoma management.

摘要

目的

本研究旨在评估并比较穿透性角膜移植术（PKP）和Descemet膜剥除自动内皮角膜移植术（DSAEK）后青光眼治疗与植片存活之间的关联。

方法

对2003年1月1日至2005年12月31日的原发性PKP病例或2006年1月1日至2008年12月31日的原发性DSAEK病例进行回顾性病历审查。有人工晶状体性角膜水肿手术指征的眼睛纳入统计分析。根据青光眼治疗情况将眼睛分为：（1）未进行青光眼治疗；（2）仅药物治疗；（3）手术干预。主要观察指标为植片存活情况。

结果

57只接受PKP手术和156只接受DSAEK手术的眼睛符合纳入标准。PKP和DSAEK术后，未进行青光眼治疗的眼睛5年Kaplan-Meier植片存活率分别为94.7%和93.8%（P>0.99），仅药物治疗的眼睛分别为93.8%和96.3%（P>0.99），接受手术干预的眼睛分别为56.8%和50%（P>0.99）。两种手术术后，接受手术干预的眼睛植片存活率显著低于未进行青光眼治疗的眼睛（P<0.0001）或仅接受药物治疗的眼睛（P<0.0001）。