Anshu Arundhati, Li Lim, Htoon Hla Myint, de Benito-Llopis Laura, Shuang Lang Stephanie, Singh Mehta Jodhbir, Tiang Hwee Tan Donald
Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore.
Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Eye Academic Clinical Program, Singhealth DUKE - National University of Singapore Academic Medical Centre, Singapore.
Am J Ophthalmol. 2021 Apr;224:254-266. doi: 10.1016/j.ajo.2020.10.014. Epub 2020 Oct 28.
To review the long-term outcomes of optical, therapeutic and tectonic forms of penetrating keratoplasty over a 20-year period in Asian eyes.
Prospective cohort study involving the Singapore Corneal Transplant Study (SCTS).
All penetrating keratoplasties (PK) performed at the Singapore National Eye Centre (SNEC) from January 1991 to December 2010 were analyzed using records from the computerized database of the SCTS. This database includes preoperative, intraoperative, and postoperative patient data and donor cornea data. Only primary grafts were included. Patient demographics, donor cornea source, indications for grafting, complications, graft survival rate, and causes of graft failure were analyzed.
A total of 1,206 primary PKs were performed. The mean age of the patients was 55 years (range: <1-101 years). The overall corneal graft survival rates at 1, 5, 10, 15, and 20 years were 91%, 66.8%, 55.4%, 52%, and 44%, respectively. For optical grafts, pseudophakic bullous keratopathy, postinfectious corneal scarring and thinning and keratoconus were the most common diagnoses. Graft survival for optical grafts was significantly better than therapeutic and tectonic grafts at all time points. Multivariate analysis suggested that a younger donor cornea age and higher donor endothelial cell count are associated with better long-term graft survival for optical grafts. Irreversible allograft rejection and late endothelial failure accounted for more than 60% of graft failures.
Graft survival decreased over time from 91% at 1 year to 44% at 20 years' follow-up. Allograft rejection and late endothelial failure accounted for more than 60% of graft failures.
回顾20年间亚洲人眼中穿透性角膜移植术的光学性、治疗性和结构性术式的长期效果。
涉及新加坡角膜移植研究（SCTS）的前瞻性队列研究。
利用SCTS计算机化数据库中的记录，分析1991年1月至2010年12月在新加坡国立眼科中心（SNEC）进行的所有穿透性角膜移植术（PK）。该数据库包括术前、术中和术后患者数据以及供体角膜数据。仅纳入初次移植。分析患者人口统计学特征、供体角膜来源、移植指征、并发症、移植存活率及移植失败原因。
共进行了1206例初次PK。患者平均年龄为55岁（范围：<1 - 101岁）。1年、5年、10年、15年和20年时的总体角膜移植存活率分别为91%、66.8%、55.4%、52%和44%。对于光学性移植，人工晶状体性大泡性角膜病变、感染后角膜瘢痕形成与变薄以及圆锥角膜是最常见的诊断。在所有时间点，光学性移植的存活率均显著优于治疗性和结构性移植。多因素分析表明，供体角膜年龄较小和供体内皮细胞计数较高与光学性移植更好的长期存活率相关。不可逆的同种异体移植排斥和晚期内皮功能衰竭占移植失败的60%以上。
随访期间，移植存活率随时间下降，从1年时的91%降至20年时的44%。同种异体移植排斥和晚期内皮功能衰竭占移植失败的60%以上。
