使用γ射线辐照角膜透镜进行角膜移植的长期临床结果。
Long-term clinical outcomes of keratoplasty using gamma-irradiated corneal lenticules.
作者信息
Mathews Priya M, Fogla Rajesh, Samayoa Erik, VanCourt Shanna, Akpek Esen K
机构信息
Cornea and External Diseases, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Cornea Clinic, Apollo Hospitals, Hyderabad, India.
出版信息
BMJ Open Ophthalmol. 2019 Nov 10;4(1):e000396. doi: 10.1136/bmjophth-2019-000396. eCollection 2019.
OBJECTIVE
To report long-term clinical outcomes of gamma-irradiated corneal lenticules in partial and full-thickness keratoplasty.
METHODS AND ANALYSIS
This multicentre, retrospective case series includes 23 patients who underwent surgery at three centres (India, Guatemala, and USA) between May 2009 and March 2018. The main outcome measures were epithelialization and retention for therapeutic keratoplasty and best spectacle-corrected visual acuity (BSCVA) for optical keratoplasty.
RESULTS
Patients were categorised according to primary aetiology requiring corneal transplantation: non-inflammatory conditions, infectious keratitis and sterile keratolysis. Nine patients with non-inflammatory conditions underwent anterior lamellar keratoplasty (n=7) and Boston type 1 keratoprosthesis (n=2). All nine grafts remained intact and epithelialized during follow-up (median 24 months). In the seven patients who underwent anterior keratoplasty, the graft stayed optically clear during follow-up (median 12 months), with BSCVA between 20/20 and 20/40 in all but one patient who developed cataract. Nine patients with severe infectious keratitis had emergency patch grafting. Six of those grafts epithelialized and remained intact over a median of 30 months, providing tectonic support until optical keratoplasty with fresh tissue could be performed. Three grafts had recurrent infectious keratitis 1-3 months postoperatively, two of which underwent tectonic keratoplasty with fresh tissue which also eventually became infected during follow-up. In five additional patients with sterile keratolysis who underwent lamellar patch graft, two grafts remained intact during follow-up (median 36 months). Two patients had recurrent corneal melt within 1 month, and both had subsequent corneal surgery with fresh tissue which also failed. There were no donor-related complications.
CONCLUSION
Gamma-irradiated sterile corneal stromal lenticules can be considered as a viable alternative to fresh tissue in various clinical settings.
目的
报告经伽马射线照射的角膜透镜在部分和全层角膜移植术中的长期临床结果。
方法与分析
本多中心回顾性病例系列研究纳入了2009年5月至2018年3月期间在三个中心（印度、危地马拉和美国）接受手术的23例患者。主要结局指标为治疗性角膜移植的上皮化和植片留存情况，以及光学性角膜移植的最佳矫正视力（BSCVA）。
结果
根据需要进行角膜移植的主要病因对患者进行分类：非炎症性疾病、感染性角膜炎和无菌性角膜溶解。9例患有非炎症性疾病的患者接受了前板层角膜移植术（n = 7）和波士顿1型人工角膜植入术（n = 2）。在随访期间（中位时间24个月），所有9例植片均保持完整且上皮化。在接受前角膜移植术的7例患者中，随访期间植片保持光学透明（中位时间12个月），除1例发生白内障的患者外，所有患者的BSCVA在20/20至20/40之间。9例患有严重感染性角膜炎的患者接受了急诊补片移植。其中6例植片上皮化并在中位时间30个月内保持完整，为后续进行新鲜组织光学性角膜移植提供了结构支持。3例植片在术后1 - 3个月发生复发性感染性角膜炎，其中2例接受了新鲜组织的结构性角膜移植，但最终在随访期间也发生了感染。另外5例患有无菌性角膜溶解的患者接受了板层补片移植，2例植片在随访期间（中位时间36个月）保持完整。2例患者在1个月内发生复发性角膜融解，随后均接受了新鲜组织的角膜手术，但均失败。未发生与供体相关的并发症。
结论
在各种临床情况下，经伽马射线照射的无菌角膜基质透镜可被视为新鲜组织的可行替代物。
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