Cornea, Cataract & Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Cornea, Cataract & Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Am J Ophthalmol. 2018 May;189:166-175. doi: 10.1016/j.ajo.2018.03.011. Epub 2018 Mar 14.
To evaluate the functional and anatomic outcomes of repeat penetrating keratoplasty (PK) in optically failed therapeutic grafts.
Prospective interventional case series.
All cases admitted at the apex tertiary care center for repeat keratoplasty following optically failed therapeutic PK were enrolled over a period of 1 year. Repeat optical PK was performed in all eyes. Primary outcome measures were postoperative graft clarity and visual acuity. Secondary outcome measures were complications including graft rejection, infections, failure, and secondary glaucoma. Follow-up examinations were undertaken on day 1; on day 7; at 1, 3, 6, and 12 months; and yearly thereafter.
Thirty-two eyes underwent repeat PK with mean follow-up of 18.4 ± 8.9 months. Clear grafts were observed in 63.14% of cases 1 year after regraft, and graft survival further decreased to 50% at last follow-up. Visual acuity ≥ 20/200 was achieved in 43.8% of cases, and no case had a visual acuity of ≥ 20/40. Multivariate Cox regression analysis analyzed risk factors for regraft survival, and observed a hazard ratio of 3.56 with size of initial therapeutic graft ≥ 8.75 mm, and 10.99 with deep vascularization in 1 or more quadrants. Graft survival (P = .004), visual acuity (P = .039), and rejection rates (P = .036) were significantly better in cases with initial therapeutic graft size < 8.75 mm. Secondary glaucoma was present in 59.4% (19/32) after regrafts.
Regraft after therapeutic PK is associated with suboptimal visual outcomes and long-term graft survival. Large size of initial therapeutic graft and deep vascularization adversely affect graft survival.
评估光学失败治疗性穿透性角膜移植（PK）后重复穿透性角膜移植（PK）的功能和解剖学结果。
前瞻性干预性病例系列。
在光学治疗性 PK 失败后在尖端三级护理中心进行重复角膜移植的所有病例在 1 年内被纳入研究。所有眼睛均进行重复光学 PK。主要结局指标为术后移植片清晰度和视力。次要结局指标包括移植排斥反应、感染、失败和继发性青光眼等并发症。术后第 1 天、第 7 天、第 1、3、6 和 12 个月以及此后每年进行随访检查。
32 只眼睛接受了重复 PK，平均随访时间为 18.4 ± 8.9 个月。在移植后 1 年，63.14%的病例观察到透明移植物，而移植物存活率在最后一次随访时进一步降至 50%。43.8%的病例视力≥20/200，没有病例视力≥20/40。多变量 Cox 回归分析分析了影响移植物存活率的风险因素，观察到初始治疗性移植物大小≥8.75mm 的危险比为 3.56，1 个或多个象限存在深度血管化的危险比为 10.99。初始治疗性移植物大小<8.75mm 的病例移植物存活率（P=0.004）、视力（P=0.039）和排斥反应发生率（P=0.036）显著更好。在进行重复移植后，有 59.4%（19/32）的病例出现继发性青光眼。
治疗性 PK 后进行重复移植与术后视力结果不佳和长期移植物存活率相关。初始治疗性移植物的大小较大和深度血管化会对移植物存活率产生不利影响。
