Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
PLoS One. 2023 Aug 4;18(8):e0289601. doi: 10.1371/journal.pone.0289601. eCollection 2023.
Tectonic keratoplasties (TK) are used to treat corneal and scleral perforations and to prevent the loss of the eye. In this study, we retrospectively analyzed indications, surgical procedures, and outcomes of eccentric mini and corneo-scleral tectonic keratoplasties with respect to anatomical survival and clear graft survival rates to identify risk factors for graft failure.
This retrospective study includes 33 eccentric mini (graft diameter <6 mm) and/or corneo-scleral TK of 32 consecutive patients of a total of 41 TK carried out between 2005 and 2020 in the Eye Center, University of Freiburg, Germany, making up 0.7% of all keratoplasties performed during this period (n = 5557). Patient and graft specific data were extracted from medical files. Anatomical survival-defined as achieving integrity of the globe without further surgical interventions-and clear graft survival-defined as persisting graft clarity-were estimated using the Kaplan-Meier method. We also fitted Cox proportional hazard models to account for factors influencing anatomical and clear graft survival.
Median duration of anatomical success was 72.5 months (95% confidence interval (CI) 18.1-infinite (inf.)) and median duration of clear graft survival was 29.6 months (95% CI 12.5-Inf.). The 1-year survival rate for anatomical survival was 67.6% (95% CI 52.2% - 87.6%) and for clear graft survival 66.4% (95% CI 50.5%- 87.1%). No enucleation was necessary during this time-period. Non-inflammatory primary causes (n = 14) presented a trend towards better anatomical survival rates (median remained above 0.75 during follow-up) compared to inflammatory primary causes (n = 19, median 18.1 months (95% CI 2.8 - inf.)) and longer clear graft survival (median 29.6 months (95% CI 12.5 - inf.) versus 13.1 months (95% CI 3.2 - inf.)). Corneo-scleral grafts (n = 18) compared to corneal grafts (n = 15) showed a trend towards better anatomical survival (more than 50% of eyes did not fail during follow-up period (95% CI 21.9-Inf. months) versus 18.1 months (95% CI 2.4-Inf.)) and clear graft survival (median 29.6 months (95% CI 12.6-Inf.) versus 6.2 months (95% CI 2.8-Inf.)). Old age (n = 11, 75.2 - 90.1 years) compared to young age (n = 11, 6.2 - 60.2 years) was the only hazard ratio (hazard ratio 0.04 (95% CI 0.002-0.8)) that reached the level of significance (p = 0.03).
Eccentric TK is helpful in the successful treatment of a variety of severe eye diseases. Patients at young age, with pre-existing inflammatory conditions or corneal TK are at higher risk for anatomical failure as well as clear graft failure and therefore need to be monitored closely.
组织性角膜移植术（Tectonic Keratoplasty，TK）用于治疗角膜和巩膜穿孔，并防止眼球丧失。在本研究中，我们回顾性分析了偏心 mini 和角膜巩膜组织性角膜移植术的适应证、手术过程和结果，以确定与移植物失败相关的风险因素，包括解剖学存活率和清晰移植物存活率。
本回顾性研究包括 32 例患者共 33 例偏心 mini（移植直径 <6mm）和/或角膜巩膜组织性角膜移植术，这些患者来自德国弗莱堡大学眼科中心 2005 年至 2020 年间共进行的 41 例 TK 中的一部分（n=5557）。从病历中提取患者和移植物的具体数据。采用 Kaplan-Meier 方法估计解剖学存活率（定义为在没有进一步手术干预的情况下保持眼球完整性）和清晰移植物存活率（定义为持续保持移植物透明度）。我们还拟合了 Cox 比例风险模型，以考虑影响解剖学和清晰移植物存活率的因素。
解剖学成功的中位时间为 72.5 个月（95%置信区间（CI）18.1-无限期（inf.）），清晰移植物存活的中位时间为 29.6 个月（95%CI 12.5-inf.）。1 年解剖学存活率为 67.6%（95%CI 52.2%-87.6%），清晰移植物存活率为 66.4%（95%CI 50.5%-87.1%）。在此期间无需进行眼球摘除术。非炎症性原发性病因（n=14）的解剖学存活率呈上升趋势（中位值在随访期间一直高于 0.75），与炎症性原发性病因（n=19，中位值为 18.1 个月（95%CI 2.8-inf.））和更长的清晰移植物存活时间（中位值为 29.6 个月（95%CI 12.5-inf.））相比。与角膜移植（n=15）相比，角膜巩膜移植（n=18）的解剖学存活率和清晰移植物存活率均呈上升趋势（超过 50%的眼睛在随访期间未失败（95%CI 21.9-inf.个月），而不是 18.1 个月（95%CI 2.4-inf.））和清晰移植物存活率（中位值 29.6 个月（95%CI 12.6-inf.）），而不是 6.2 个月（95%CI 2.8-inf.））。与年轻患者（n=11，6.2-60.2 岁）相比，老年患者（n=11，75.2-90.1 岁）的风险比（危险比 0.04（95%CI 0.002-0.8））达到统计学意义（p=0.03）。
偏心 TK 有助于成功治疗各种严重眼病。年龄较小、存在先前炎症性疾病或角膜 TK 的患者发生解剖学失败和清晰移植物失败的风险较高，因此需要密切监测。
