Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, China.
State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, 372 Jingsi Road, Jinan, 250021, China.
BMC Ophthalmol. 2024 Sep 11;24(1):402. doi: 10.1186/s12886-024-03669-2.
This study aims to evaluate the clinical outcomes and efficacy of a modified tectonic corneoscleral graft (TCG) in patients suffering from devastating corneoscleral infections.
Thirty-eight eyes from 38 patients who underwent the modified TCG were included in this study. The outcomes measured were recurrence rates, best-corrected visual acuity (BCVA), ocular surface stability, postoperative complications, and graft survival.
Among the 38 patients, 23 had fungal infections, 9 had bacterial infections and 6 had Pythium insidiosum infections. At the final follow-up, with an average duration of 25.1 ± 8.6 months, the rate of monocular blindness decreased from 100 to 58%. Significant improvements in LogMAR BCVA were observed from preoperative to postoperative measurements (P < 0.001). Thirty-two eyes (84.2%) maintained a stable ocular surface. The survival rate of ocular surface stability was 84.2%±5.9% at one year and 57.7%±9.7% at three years post-surgery. Twenty eyes (52.6%) retained a clear graft, with a survival rate for graft clarity was 81.6%±6.3% at one year and 36.0%±10.8% at three years post-surgery. The incidence of immune rejection was 36.8%. Corneal epithelial defects were observed in ten patients, and choroidal detachment occurred in four patients. No cases of elevated intraocular pressure were detected.
The modified TCG is effective in eradicating infections, preserving the eyeball, and maintaining useful vision in cases of devastating corneoscleral infections. Regular use of tacrolimus, timely administration of glucocorticoids, and good patient compliance can help mitigate postoperative challenges.
本研究旨在评估改良组织性板层角巩膜移植术（TCG）在严重角巩膜感染患者中的临床疗效。
本研究纳入了 38 例（38 只眼）接受改良 TCG 的患者。观察指标包括复发率、最佳矫正视力（BCVA）、眼表稳定性、术后并发症和移植物存活率。
38 例患者中，真菌感染者 23 例，细菌感染者 9 例，棘阿米巴感染者 6 例。末次随访时（平均随访时间 25.1±8.6 个月），单眼失明率从 100%降至 58%。术后 LogMAR BCVA 较术前明显改善（P<0.001）。32 只眼（84.2%）眼表稳定。术后 1 年和 3 年时眼表稳定的存活率分别为 84.2%±5.9%和 57.7%±9.7%。20 只眼（52.6%）保持了透明的移植物，术后 1 年和 3 年时移植物透明度的存活率分别为 81.6%±6.3%和 36.0%±10.8%。免疫排斥反应发生率为 36.8%。10 例患者出现角膜上皮缺损，4 例患者出现脉络膜脱离。未发现眼压升高的病例。
改良 TCG 可有效消除感染，保存眼球，维持严重角巩膜感染患者的有用视力。定期使用他克莫司、及时给予糖皮质激素和良好的患者依从性有助于减轻术后挑战。
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