Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China.
Research Center, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China.
Cornea. 2019 Nov;38(11):1370-1376. doi: 10.1097/ICO.0000000000002071.
To explore the transition of indications and surgical techniques of pediatric keratoplasty in Eastern China in the past 10 years.
Medical charts of 1026 pediatric patients (1059 eyes) who underwent keratoplasties at the Eye, Ear, Nose and Throat Hospital of Fudan University from 2008 to 2017 were retrospectively reviewed. The indications for keratoplasty and the surgical techniques were collected and analyzed.
A total of 634 infants (≤3 years) (661 eyes), 207 toddlers and older children (4-12 years) (211 eyes), and 185 adolescents (13-18 years) (187 eyes) were included. The median age at the time of surgery was 2 years. The surgical indications were composed of congenital abnormalities (74.6%), acquired nontraumatic diseases (16.5%), acquired traumatic diseases (3.6%), and regraft (5.3%). Only congenital abnormality had a significant growing trend during this decade (P = 0.023). Keratoconus (67.2%) exceeded infectious keratitis (14.9%) and was the most common acquired nontraumatic cause in our study. The annual number of pediatric keratoplasties increased significantly from 40 cases in 2008 to 190 cases in 2017 (P < 0.001). Although penetrating keratoplasty was performed in 414 eyes (39.1%), its application in the treatment of keratoconus decreased significantly during this decade (P = 0.04). By contrast, deep anterior lamellar keratoplasty showed an increasing trend because of its popularization in the treatment of keratoconus (P = 0.003).
Congenital abnormalities have replaced infectious keratitis and have been the leading indications of pediatric keratoplasty in the past 10 years. Although the using of penetrating keratoplasty was still the predominant procedure to treat pediatric corneal pathologies, the adoption of deep anterior lamellar keratoplasty showed a significant increasing trend during the past decade.
探讨过去 10 年中国东部地区儿童角膜移植手术适应证和手术技术的变化。
回顾性分析 2008 年至 2017 年复旦大学附属眼耳鼻喉科医院收治的 1026 例（1059 只眼）儿童患者的病历资料。收集并分析角膜移植的适应证和手术技术。
共纳入 634 例（≤3 岁）婴儿（661 只眼）、207 例幼儿和大龄儿童（4-12 岁）（211 只眼）和 185 例青少年（13-18 岁）（187 只眼）。手术时的中位年龄为 2 岁。手术适应证包括先天性异常（74.6%）、获得性非创伤性疾病（16.5%）、获得性创伤性疾病（3.6%）和再次移植（5.3%）。仅先天性异常在这 10 年中有显著增长趋势（P = 0.023）。圆锥角膜（67.2%）超过感染性角膜炎（14.9%），是本研究中最常见的获得性非创伤性病因。儿童角膜移植的年例数从 2008 年的 40 例显著增加到 2017 年的 190 例（P < 0.001）。虽然行穿透性角膜移植术 414 只眼（39.1%），但在这 10 年中，其在圆锥角膜治疗中的应用显著减少（P = 0.04）。相比之下，由于在圆锥角膜治疗中的普及，深板层角膜移植术的应用呈上升趋势（P = 0.003）。
先天性异常已取代感染性角膜炎，成为过去 10 年儿童角膜移植的主要适应证。虽然穿透性角膜移植术仍是治疗儿童角膜病变的主要方法，但深板层角膜移植术的应用在过去 10 年中呈显著上升趋势。
