Choi Jin A, Lee Min A, Kim Man-Soo
Department of Ophthalmology, St. Vincent's Hospital, College of Medicine, the Catholic University of Korea, #93 Jungbudae-ro, Paldal-gu, Suwon-si, Kyunggi-do 442-723, Korea.
Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, #505 Banpo-dong, Seocho-ku, Seoul 137-701, Korea.
Int J Ophthalmol. 2014 Jun 18;7(3):517-21. doi: 10.3980/j.issn.2222-3959.2014.03.24. eCollection 2014.
To investigate the long-term results of penetrating keratoplasty (PK) in patients with keratoconus (KC) and to evaluate factors that might influence the final visual outcome.
We retrospectively reviewed the data of all patients with clinical KC who had undergone PK by a single corneal surgeon in a single center from May 1980 to December 2005. The age of the patients, preoperative best-corrected visual acuity (BCVA), corneal thickness, death to preservation time, and preservation to transplantation time were recorded. Additionally, postoperative complications such as graft rejection, development of glaucoma and specular microscopy were checked during the follow-up.
Sixty-nine eyes from 69 patients were finally included. The follow-up period was 8.64±6.13y. Graft rejection occurred in 4 eyes of 69 cases (5.8%), and the time to graft rejection was 2.1±1.3y. A Kaplan-Meier survival analysis showed that the estimated cumulative probability of graft rejection at 6, 13, and 17y after PK were 95.6%, 90.0%, and 78.8%, respectively. When we evaluated factors that might influence final BCVA in eyes, no disparity donor-host trephine size (same graft size) as well as higher spherical equivalent, and average K-value were associated with higher final BCVA. (P=0.006, 0.051, 0.092, and 0.021 in eyes with follow-up <8y; P=0.068, 0.065, and 0.030 in eyes with follow-up ≥8y, respectively).
The long-term results of PK in patients with KC were favorable with a high percentage of good BCVA. Less myopic change and low average K-reading, as well as a surgical technique using the same size donor-recipient button may provide better visual outcomes particularly in patients with KC.
研究圆锥角膜（KC）患者穿透性角膜移植术（PK）的长期效果，并评估可能影响最终视力结果的因素。
我们回顾性分析了1980年5月至2005年12月在单一中心由同一位角膜外科医生为临床诊断为KC的所有患者行PK手术的数据。记录患者的年龄、术前最佳矫正视力（BCVA）、角膜厚度、死亡至保存时间以及保存至移植时间。此外，在随访期间检查术后并发症，如移植排斥反应、青光眼的发生情况以及角膜内皮显微镜检查结果。
最终纳入69例患者的69只眼。随访时间为8.64±6.13年。69例中有4只眼发生移植排斥反应（5.8%），发生移植排斥反应的时间为2.1±1.3年。Kaplan-Meier生存分析显示，PK术后6年、13年和17年移植排斥反应的估计累积概率分别为95.6%、90.0%和78.8%。当评估可能影响眼最终BCVA的因素时，供体-受体环钻大小无差异（相同移植片大小）以及更高的等效球镜度和平均角膜曲率值与更高的最终BCVA相关。（随访时间<8年的眼中，P=0.006、0.051、0.092和0.021；随访时间≥8年的眼中，P分别为0.068、0.065和0.030）。
KC患者PK的长期效果良好，BCVA良好的比例较高。近视变化较小、平均角膜曲率读数较低以及使用相同大小供体-受体植片的手术技术可能会提供更好的视力结果，尤其是在KC患者中。
