Majander Anna, Kivelä Tero T, Krootila Kari
Paediatric Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Ophthalmic Pathology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Acta Ophthalmol. 2016 Sep;94(6):618-24. doi: 10.1111/aos.13040. Epub 2016 Apr 7.
To report the indications and the outcomes of keratoplasties in children over four decades.
A retrospective cohort study of patients aged 16 years or younger who underwent keratoplasty in the Helsinki University Eye Hospital during 1968-2011. Diagnosis, preoperative status, age at the time of surgery, surgical technique, complications and follow-up time were registered. Main outcome measures were visual acuity and graft survival as assessed by Kaplan-Meier analysis. The independent role of risk factors on outcomes was evaluated by Cox multivariate regression analysis.
Forty-eight keratoplasties, 42 penetrating and six lamellar, were performed in 44 eyes of 39 children at the age of 4.5 months to 16 years (median, 12 years). Five patients had bilateral grafts, and five grafts were regrafts. The indication for keratoplasty was injury for 13 grafts, non-traumatic acquired corneal opacities for 11, keratoconus for eight, corneal dystrophy for seven, congenital corneal opacities for six and aniridia for three grafts. The cumulative proportion of clear grafts was 46% at 5 years postoperatively, and the median follow-up time of clear grafts was 5.1 years (range, 0.4-29 years) for 41 penetrating allografts (PKP). Simultaneous intraocular surgery at the time of grafting [hazard ratio (HR) 9.7], corneal vascularization (HR 8.1) and regrafting (HR 5.4) were the main independent risk factors for graft failure in this PKP cohort. The cumulative proportion of clear grafts was 84% at 5 years in the absence of any of these risk factors. PKP for keratoconus and corneal dystrophy yielded clear grafts in 83% of the eyes, and a visual acuity ≥0.3 (Snellen) in 75% of the eyes. Seventeen of the 20 graft failures were due to rejection.
Favourable graft survival was obtained in primary keratoplasties for non-vascularized corneal opacities performed without any other simultaneous intraocular surgery. Visual outcome was favourable in keratoconus and corneal dystrophies and poor in most eyes with injury.
报告四十多年来儿童角膜移植的适应证及结果。
对1968年至2011年期间在赫尔辛基大学眼科医院接受角膜移植手术的16岁及以下患者进行回顾性队列研究。记录诊断、术前状况、手术时年龄、手术技术、并发症及随访时间。主要观察指标为通过Kaplan-Meier分析评估的视力和植片存活率。通过Cox多变量回归分析评估危险因素对结果的独立作用。
39名年龄在4.5个月至16岁（中位数12岁）的儿童的44只眼睛接受了48次角膜移植手术，其中穿透性角膜移植42次，板层角膜移植6次。5例患者接受了双侧植片，5次为再次移植。角膜移植的适应证为：外伤13例，非创伤性获得性角膜混浊11例，圆锥角膜8例，角膜营养不良7例，先天性角膜混浊6例，无虹膜3例。术后5年透明植片的累积比例为46%，41例穿透性同种异体角膜移植（PKP）透明植片的中位随访时间为5.1年（范围0.4 - 29年）。移植时同时进行眼内手术[风险比（HR）9.7]、角膜血管化（HR 8.1）和再次移植（HR 5.4）是该PKP队列中植片失败的主要独立危险因素。在没有这些危险因素的情况下，术后5年透明植片的累积比例为84%。圆锥角膜和角膜营养不良的PKP手术中，83%的眼睛获得透明植片，75%的眼睛视力≥0.3（Snellen）。20例植片失败中有17例是由于排斥反应。
对于无其他眼内手术同时进行的非血管化角膜混浊的初次角膜移植，可获得良好的植片存活率。圆锥角膜和角膜营养不良的视力预后良好，大多数外伤眼预后较差。
