美国角膜移植手术：2015 年至 2020 年的趋势和适应证。
Keratoplasty in the United States: Trends and Indications From 2015 to 2020.
机构信息
Johns Hopkins University School of Medicine, Baltimore, MD.
The Johns Hopkins Wilmer Eye Institute, Baltimore, MD; and.
出版信息
Cornea. 2023 Nov 1;42(11):1360-1364. doi: 10.1097/ICO.0000000000003180. Epub 2022 Nov 21.
PURPOSE
The aim of this study was to report trends in keratoplasty techniques and indications in the United States from 2015 to 2020.
METHODS
This retrospective review of annual reports from the Eye Bank Association of America assessed domestic corneal graft distribution and surgical indication data for various types of keratoplasty. Trends in procedure volume and indications from 2015 to 2020 were analyzed using the Cochran-Armitage test.
RESULTS
The total number of corneal transplants increased from 47,903 in 2015 to 49,143 in 2019, with a decline to 42,257 in 2020, most likely due to COVID-19. Penetrating keratoplasty (PK) volume decreased from 2015 to 2020 (19,160-15,402, 40% to 36.4%, P < 0.001), continuing a trend from the previous decade. Descemet membrane endothelial keratoplasty as a percentage of all keratoplasty procedures increased (9.8%-27.8%, P < 0.001), whereas Descemet stripping automated endothelial keratoplasty (47%-33.9%, P < 0.001) and anterior lamellar keratoplasty (ALK) decreased (2.3%-1.2%, P < 0.001).From 2017 to 2020, repeat corneal transplant was the most common specific indication for PK while ectasias/thinnings decreased in prevalence (15.6%-11.5%, P < 0.001). Ectasias/thinnings and endothelial dystrophy remained the leading indications for ALK and endothelial keratoplasty, respectively.
CONCLUSIONS
From 2015 to 2020, keratoplasty trends in the United States showed a continuation of the decrease in PK and increase in Descemet membrane endothelial keratoplasty observed in the previous decade. The most common domestic indications from 2017 to 2020 have been repeat corneal graft, endothelial dystrophy, and ectasias/thinnings for PK, EK, and ALK, respectively.
目的
本研究旨在报告美国 2015 年至 2020 年期间角膜移植技术和适应证的趋势。
方法
本回顾性研究对美国眼库协会的年度报告进行了评估，评估了各种类型角膜移植的国内角膜移植物分布和手术适应证数据。使用 Cochran-Armitage 检验分析 2015 年至 2020 年期间手术量和适应证的趋势。
结果
2015 年至 2019 年，角膜移植总数从 47903 例增加到 49143 例，2020 年下降到 42257 例，这很可能是由于 COVID-19 导致的。穿透性角膜移植术（PK）的数量从 2015 年到 2020 年下降（19160-15402，40%到 36.4%，P<0.001），延续了前十年的趋势。作为所有角膜移植术的百分比，Descemet 膜内皮角膜移植术增加（9.8%-27.8%，P<0.001），而 Descemet 剥离自动内皮角膜移植术（47%-33.9%，P<0.001）和前板层角膜移植术（ALK）减少（2.3%-1.2%，P<0.001）。2017 年至 2020 年，重复角膜移植是 PK 最常见的具体适应证，而扩张变薄的流行率降低（15.6%-11.5%，P<0.001）。扩张变薄和内皮营养不良仍然是 ALK 和内皮角膜移植的主要适应证。
结论
2015 年至 2020 年期间，美国角膜移植趋势显示，前十年观察到的 PK 减少和 Descemet 膜内皮角膜移植术增加的趋势仍在继续。2017 年至 2020 年期间，国内最常见的适应证分别为 PK 的重复角膜移植、内皮营养不良和扩张变薄，EK 的内皮病变和 ALK 的扩张变薄。
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