Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Department of Ophthalmology, Henan Provincial People's Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China.
Cornea. 2020 Aug;39(8):961-967. doi: 10.1097/ICO.0000000000002331.
To investigate the causes of graft failure and risk factors associated with total graft opacity after primary penetrating keratoplasty (PK) in children with Peters anomaly (PA).
In this retrospective study, patients with PA (younger than 5 years) who received primary PK in Beijing Tongren Hospital were reviewed. The follow-up period was a minimum of 6 months. A modified PA classification system was used, and all failed grafts were categorized into partial and total opacity groups. Patient demographics, PA classification, operation details, degree of graft opacity, and causes of graft failure were recorded.
Of the 165 eyes, 54 eyes (32.7%) demonstrated graft failure along with various degrees of graft opacity. Approximately half of the grafts applied failed within 6 months postoperatively. The partial and total opacity groups did not demonstrate any significant differences regarding diagnosis distribution. Irreversible immune rejection accounted for 61.1% of all graft failures; furthermore, it had a significantly higher proportion in the partial opacity group than in the total opacity group (71.0% and 47.8%, respectively; P = 0.058). The degree of graft opacity was significantly associated with patient age at surgery (P = 0.002), preoperative corneal vascularization (P = 0.009), and iris defects (P = 0.001). However, administration of intensive topical corticosteroids could reduce the risk of total opacity in the rejected grafts.
Irreversible immune rejection is the most common cause of graft failure after primary PK in pediatric patients with PA. The degree of graft opacity is closely related to patient age at surgery, preoperative corneal vascularization, and iris defects.
研究原发性穿透性角膜移植术（PK）后儿童彼得斯异常（PA）全植片混浊的原因及相关危险因素。
本回顾性研究纳入了在北京同仁医院接受原发性 PK 的 PA（年龄＜5 岁）患儿。随访时间至少 6 个月。采用改良的 PA 分类系统，所有失败的移植物分为部分混浊和完全混浊两组。记录患者的人口统计学资料、PA 分类、手术细节、植片混浊程度以及移植物失败的原因。
165 只眼中有 54 只（32.7%）发生了不同程度的植片混浊，术后 6 个月内约有一半的移植物失败。部分混浊组和完全混浊组在诊断分布方面无显著差异。不可逆免疫排斥反应占所有移植物失败的 61.1%，且在部分混浊组的比例明显高于完全混浊组（分别为 71.0%和 47.8%；P = 0.058）。植片混浊程度与手术时的患者年龄（P = 0.002）、术前角膜血管化（P = 0.009）和虹膜缺损（P = 0.001）显著相关。然而，强化局部皮质类固醇的应用可降低排斥性移植失败后全植片混浊的风险。
不可逆免疫排斥反应是儿童 PA 患者原发性 PK 后植片失败的最常见原因。植片混浊程度与手术时的患者年龄、术前角膜血管化和虹膜缺损密切相关。
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