胶原交联术是否降低圆锥角膜患者对角膜移植的需求？加拿大的经验。
Did Collagen Cross-Linking Reduce the Requirement for Corneal Transplantation in Keratoconus? The Canadian Experience.
机构信息
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver General Hospital Eye Care Center, Vancouver, BC, Canada.
出版信息
Cornea. 2019 Nov;38(11):1390-1394. doi: 10.1097/ICO.0000000000002085.
PURPOSE
To investigate the relationship between corneal collagen cross-linking (CXL) and the number of corneal transplants required for the treatment of keratoconus (KCN) in 2 major Canadian provinces.
METHODS
This is a retrospective review of all corneal transplantation performed in Ontario and British Columbia over an 18-year period (1998-2016). Data were collected at the Eye Bank of Canada-Ontario/British Columbia Divisions. The primary outcome was to determine the change in proportion and absolute number of corneal transplants required for treatment of KCN since the introduction of CXL in Canada in 2008.
RESULTS
A total of 31,943 grafts were included. Overall, the mean age of participants was 39.3 ± 2.2 years, with our cohort being composed of 28% of women and 72% of men. The results showed a significant decrease in the proportion of total transplants required for KCN between 1998 and 2016 [1998-2008 (pre-CXL), range: 14.77%-12.63%; 2009-2016 (post-CXL), range: 12.98%-5.50%, P < 0.001]. However, there was no change in the absolute number of grafts performed for KCN over this time (pre-CXL: 179 ± 26 grafts; post-CXL: 198 ± 27 grafts; P = 0.5), whereas the total number of grafts (pre-CXL: 1318 ± 183 grafts; post-CXL: 2181 ± 404; P < 0.001) and endothelial keratoplasties (pre-CXL: 59 ± 108; post-CXL: 966 ± 431 grafts; P < 0.001) increased significantly. In addition, there were no changes in penetrating keratoplasty/deep anterior lamellar keratoplasty (DALK) performed for indications other than KCN (pre-CXL: 1080 ± 157; post-CXL: 1017 ± 92; P > 0.5).
CONCLUSIONS
Although there has been a significant decrease in the proportion of corneal graft rates for KCN since the introduction of CXL as a factor of all transplants performed for all indications, this result is most likely because of an increase in endothelial keratoplasties rather than decreased transplants performed for definitive treatment.
目的
调查在加拿大两个主要省份中，角膜交联术（CXL）与治疗圆锥角膜（KCN）所需的角膜移植数量之间的关系。
方法
这是一项对 18 年来（1998-2016 年）安大略省和不列颠哥伦比亚省所有角膜移植手术的回顾性研究。数据由加拿大眼库安大略/不列颠哥伦比亚分部收集。主要结果是确定自 2008 年加拿大引入 CXL 以来，治疗 KCN 所需的角膜移植比例和绝对数量的变化。
结果
共纳入 31943 例移植物。总体而言，参与者的平均年龄为 39.3±2.2 岁，其中 28%为女性，72%为男性。结果表明，1998 年至 2016 年期间，KCN 所需的总移植比例显著下降[1998-2008 年（CXL 前），范围：14.77%-12.63%；2009-2016 年（CXL 后），范围：12.98%-5.50%，P<0.001]。然而，在此期间，KCN 的移植绝对数量没有变化（CXL 前：179±26 例；CXL 后：198±27 例；P=0.5），而移植总数（CXL 前：1318±183 例；CXL 后：2181±404 例；P<0.001）和内皮角膜移植术（CXL 前：59±108 例；CXL 后：966±431 例；P<0.001）显著增加。此外，除 KCN 以外的其他适应证行穿透性角膜移植术/深层前板层角膜移植术（DALK）的数量没有变化（CXL 前：1080±157 例；CXL 后：1017±92 例；P>0.5）。
结论
尽管自 CXL 作为所有适应证的所有移植的一个因素引入以来，KCN 的角膜移植率比例显著下降，但这一结果可能主要是由于内皮角膜移植术的增加，而不是用于明确治疗的移植数量减少。
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