Figueiredo Gustavo Souto Maior, Jones Mark Neville Arthur, Krishna Yamini, Figueiredo Francisco Carlos D'Amorim, Larkin Daniel Frank P, Kaye Stephen Bruce
Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.
National Health Service Blood and Transplant, Statistics and Clinical Studies, Bristol, United Kingdom.
Am J Ophthalmol. 2015 Sep;160(3):416-21. doi: 10.1016/j.ajo.2015.06.012. Epub 2015 Jun 24.
To investigate the incidence and outcome of cornea transplant rejection following endothelial keratoplasty (EK) and penetrating keratoplasty (PK) for Fuchs endothelial dystrophy (FED) and pseudophakic bullous keratopathy (PBK).
Multicenter cohort study.
Patients registered on the United Kingdom Transplant Registry (UKTR) who had an EK or PK for FED or PBK between April 1, 2005 and March 31, 2011 were included. Data were collected from UKTR forms at 1 and 2 years. Postoperative steroid use varies between surgeons and cannot be captured in this reporting system. Rejection events were identified as those recorded as endothelial rejection.
A total of 3486 corneal transplants were undertaken: 1973 for FED, 1513 for PBK. For FED, 2-year rejection-free survival was 93% (95% confidence interval [CI] 90%-94%) for PK and 94% (95% CI 92%-96%) for EK (P = .3). In transplants that had a rejection episode, 50% of PKs (17) and 60% of EKs (15) subsequently failed. For PBK, 2-year rejection-free survival for PK was 88% (95% CI 86%-90%) and 90% (95% CI 86%-92%) for EK (P = .6). In transplants that had a rejection episode, 85% of PKs (41) and 76% of EKs (22) subsequently failed. Inflammation (ie, conjunctival injection, presence of keratic precipitates and intraocular signs) at the time of surgery for patients with FED was significant for developing rejection: 3.5 times greater compared with those with no inflammation (P = .02).
There is no significant difference in rejection-free survival between EK and PK for FED or PBK. The presence of inflammation is an important risk factor, and attention to its control before and following surgery is important.
探讨采用内皮角膜移植术（EK）和穿透性角膜移植术（PK）治疗Fuchs内皮营养不良（FED）和假晶状体大泡性角膜病变（PBK）后角膜移植排斥反应的发生率及转归。
多中心队列研究。
纳入2005年4月1日至2011年3月31日期间在英国移植登记处（UKTR）登记的因FED或PBK接受EK或PK的患者。在术后1年和2年从UKTR表格中收集数据。不同外科医生术后使用类固醇的情况不同，本报告系统无法记录。排斥事件被确定为记录为内皮排斥的事件。
共进行了3486例角膜移植：1973例用于FED，1513例用于PBK。对于FED，PK的2年无排斥生存率为93%（95%置信区间[CI]90%-94%），EK为94%（95%CI 92%-96%）（P = 0.3）。在发生排斥反应的移植中，50%的PK（17例）和60%的EK（15例）随后失败。对于PBK，PK的2年无排斥生存率为88%（95%CI 86%-90%），EK为90%（95%CI 86%-92%）（P = 0.6）。在发生排斥反应的移植中，85%的PK（41例）和76%的EK（22例）随后失败。FED患者手术时的炎症（即结膜充血、角膜后沉着物和眼内体征）对发生排斥反应有显著影响：与无炎症者相比，发生排斥反应的几率高3.5倍（P = 0.02）。
对于FED或PBK，EK和PK的无排斥生存率无显著差异。炎症的存在是一个重要的危险因素，术前和术后注意控制炎症很重要。
