Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Bioscience Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
Int Ophthalmol. 2024 Feb 29;44(1):120. doi: 10.1007/s10792-024-03008-w.
This study reports the mechanisms, complications and graft survival following sight-threatening traumatic globe rupture in patients having previously undergone corneal transplantation in the same eye.
A retrospective, observational, single-center consecutive cohort study at the Royal Victoria Infirmary, Newcastle upon Tyne, UK over a 20-year period. Medical records and Newcastle Corneal Transplantation Service electronic database (eNCTS) review was undertaken of all consecutive patients who underwent corneal transplantation with a history of traumatic globe rupture. Main outcome measures include mechanism of injury, final best-corrected distance visual acuity (BCDVA), graft survival and complications.
A total of 921 keratoplasties were undertaken between 1997 and 2017 with 24 (3.0%) patients identified with a history of traumatic globe rupture. A bimodal relationship of age and mechanism of trauma was observed. The mean age (SD) of individuals reporting cause as a fall was 71.5 (14.8) years, and 45.3 (20.8) years (P < 0.05) amongst individuals reporting accidental trauma or assault. The pre- and post-trauma mean (SD) LogMAR BCDVA was 0.6 (0.9) and 1.7 (1.0), respectively (P = 0.001). The overall graft-failure rate was 60.9% (11 grafts) during a mean (SD) follow-up period of 3.5 (4.1) years. Globe rupture with lens damage was associated with poorer final BCDVA (P < 0.05).
This study represents the first published series from England for this type of patient cohort. Overall visual outcomes were poor with a bimodal relationship of age and mechanism of trauma. Worse prognostic factors included lens and posterior segment complications. Re-grafting in these select group of patients may prove valuable.
本研究报告了在同一眼先前接受过角膜移植的患者中，因威胁视力的外伤性眼球破裂而导致的机制、并发症和移植物存活率。
这是一项在英国纽卡斯尔皇家维多利亚医院进行的回顾性、观察性、单中心连续队列研究，时间跨度为 20 年。对所有接受过角膜移植并有外伤性眼球破裂史的连续患者的病历和纽卡斯尔角膜移植服务电子数据库（eNCTS）进行了回顾。主要观察指标包括损伤机制、最终最佳矫正距离视力（BCVA）、移植物存活率和并发症。
在 1997 年至 2017 年间共进行了 921 例角膜移植，其中有 24 例（3.0%）患者有外伤性眼球破裂史。观察到年龄和创伤机制的双峰关系。报告因跌倒而导致创伤的患者的平均（SD）年龄为 71.5（14.8）岁，报告因意外创伤或袭击而导致创伤的患者的平均（SD）年龄为 45.3（20.8）岁（P＜0.05）。外伤前和外伤后的平均（SD）LogMAR BCVA 分别为 0.6（0.9）和 1.7（1.0）（P=0.001）。在平均（SD）3.5（4.1）年的随访期间，总体移植物失效率为 60.9%（11 个移植物）。伴有晶状体损伤的眼球破裂与最终 BCVA 较差相关（P＜0.05）。
本研究代表了英格兰对此类患者队列的首次报道。总体视觉预后较差，年龄和创伤机制呈双峰关系。预后较差的危险因素包括晶状体和后节并发症。在这些选择的患者群体中进行再次移植可能具有价值。
