Epstein R J, Seedor J A, Dreizen N G, Stulting R D, Waring G O, Wilson L A, Cavanagh H D
Department of Ophthalmology, Emory University, Atlanta.
Ophthalmology. 1987 Aug;94(8):935-44. doi: 10.1016/s0161-6420(87)33356-1.
To determine the relationship between corneal allograft rejection and failure, we studied patients who underwent penetrating keratoplasty for herpes simplex keratitis (n = 82) and keratoconus (n = 345), two frequent indications for keratoplasty in young patients, using survival analysis. For first grafts for herpes, the probability of survival was significantly less than it was for keratoconus (P less than 0.0001). For second grafts, this difference was less pronounced, and for three or more grafts, the difference in survival was not significant. The incidence of rejection episodes was similar in first grafts for herpes (16.6%) and keratoconus (18.5%) (P greater than 0.05). However, the incidence of rejection episodes in regrafts for herpes was significantly greater than in keratoconus (23.7 versus 17%, P less than 0.01). The incidence of failure after rejection episodes (first grafts and regrafts combined) was significantly greater in grafts for herpes (52.4 versus 16.2%, P less than 0.001). Because survival after multiple regrafts in both groups is poor, additional measures, such as tissue matching, may be necessary to improve the likelihood of success in these high-risk cases.
为了确定角膜移植排斥反应与移植失败之间的关系，我们采用生存分析方法，对因单纯疱疹性角膜炎（n = 82）和圆锥角膜（n = 345）接受穿透性角膜移植术的患者进行了研究，这两种疾病是年轻患者角膜移植术常见的适应症。对于初次因单纯疱疹进行的移植，其存活概率显著低于圆锥角膜移植（P小于0.0001）。对于二次移植，这种差异不太明显，而对于三次或更多次移植，存活差异不显著。初次因单纯疱疹进行的移植排斥反应发生率（16.6%）与圆锥角膜移植（18.5%）相似（P大于0.05）。然而，因单纯疱疹进行再次移植时的排斥反应发生率显著高于圆锥角膜移植（23.7%对17%，P小于0.01）。排斥反应发生后移植失败的发生率（初次移植和再次移植合并计算）在因单纯疱疹进行的移植中显著更高（52.4%对16.2%，P小于0.001）。由于两组多次再次移植后的存活率都很低，可能需要采取额外措施，如组织配型，以提高这些高风险病例成功的可能性。
