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一家三级眼科医院的五年急诊角膜移植手术回顾。

Five years of emergency keratoplasty at a tertiary eye hospital.

机构信息

Department of Ophthalmology, Kulu Region State Hospital, Konya, Turkey.

Department of Ophthalmology, Ege University Faculty of Medicine, Bornova, 35100, Izmir, Turkey.

出版信息

Int Ophthalmol. 2024 Nov 11;44(1):426. doi: 10.1007/s10792-024-03333-0.

DOI:10.1007/s10792-024-03333-0
PMID:39527140
Abstract

PURPOSE

The aim of this study is to present the results of patients who underwent emergency keratoplasty for tectonic or therapeutic reasons.

METHODS

Medical records of 33 patients who underwent tectonic or therapeutic keratoplasty at Ege University Department of Ophthalmology between January 2019 and January 2024 were retrospectively evaluated. Demographic characteristics, ocular and systemic findings, indications of keratoplasty, size of grafts, need for re-keratoplasty, preoperative treatment modalities, need for additional surgical interventions, and prognosis of the patients were investigated.

RESULTS

During this period, 450 penetrating keratoplasty (PK) surgeries were performed and 34 (7.55%) were emergency PK (34 eyes of 33 patients). The mean age of the patients was 65.30 ± 15.40 (40-91). Female to male ratio was 18/15. 17 (50.00%) emergency PKs were performed for tectonic and 17 (50.00%) were performed for therapeutic purposes. Mean follow up time was 24.85 ± 26.62 (2-120) months. A total of 20 (58.82%) eyes required additional surgery, 9 (26.47%) of which required re-keratoplasty with different indications during follow-up. Graft rejection or failure developed in 17 (50.00%) of the eyes in an average of 12.05 (1-45) months. Evisceration was needed in 2 (5.88%) eyes.

CONCLUSION

Despite limited access to donor cornea and high complication rate, emergency keratoplasty is one of the most important options that retain ocular integrity in the treatment of corneal infections and non-traumatic corneal perforations unresponsive to conventional treatment.

摘要

目的

本研究旨在介绍因结构或治疗原因而行急诊角膜移植术患者的结果。

方法

回顾性分析 2019 年 1 月至 2024 年 1 月期间在伊兹密尔大学眼科系因结构或治疗原因而行角膜移植术的 33 例患者的病历。研究内容包括患者的人口统计学特征、眼部和全身情况、角膜移植术的适应证、移植物大小、再次行角膜移植术的需求、术前治疗方式、是否需要额外的手术干预以及患者的预后。

结果

在此期间共进行了 450 例穿透性角膜移植术(PK),其中 34 例(33 例患者的 34 只眼)为急诊 PK。患者的平均年龄为 65.30±15.40 岁(40-91 岁)。男女比例为 18/15,其中 17 例(50.00%)因结构原因而行急诊 PK,17 例(50.00%)因治疗原因而行急诊 PK。平均随访时间为 24.85±26.62 个月(2-120 个月)。共有 20 只眼(58.82%)需要接受额外的手术,其中 9 只眼(26.47%)在随访期间因不同的适应证再次行角膜移植术。在平均 12.05 个月(1-45 个月)内,有 17 只眼(50.00%)发生了移植物排斥或失败。2 只眼(5.88%)需要进行眼内容剜除术。

结论

尽管供体角膜有限且并发症发生率较高,但在治疗角膜感染和非外伤性角膜穿孔且常规治疗无效的情况下,急诊角膜移植术仍是保留眼球完整性的重要选择之一。

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本文引用的文献

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Fungal Keratitis and Corneal Perforation as a Rare Complication of Corneal Collagen Cross-Linking Treatment.真菌性角膜炎伴角膜穿孔:角膜胶原交联治疗罕见并发症。
Cornea. 2023 Sep 1;42(9):1179-1182. doi: 10.1097/ICO.0000000000003270. Epub 2023 Mar 3.
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Therapeutic and tectonic keratoplasty with simple cryopreserved remnants of donor corneas: an 11 year retrospective case series.单纯冷冻保存供体角膜残片的治疗性和结构性角膜移植术:一项 11 年回顾性病例系列研究。
Sci Rep. 2022 May 5;12(1):7331. doi: 10.1038/s41598-022-10994-3.
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Tectonic Deep Anterior Lamellar Keratoplasty to Treat Corneal Perforation and Descemetocele from Microbial Keratitis.
构造性深层前板层角膜移植术治疗微生物性角膜炎所致角膜穿孔和后弹力层膨出
Clin Ophthalmol. 2021 Aug 24;15:3549-3555. doi: 10.2147/OPTH.S324390. eCollection 2021.
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Tectonic keratoplasty using small incision lenticule extraction-extracted intrastromal lenticule for corneal lesions.使用小切口透镜切除术取出的基质内透镜进行角膜病变的结构性角膜移植术。
J Int Med Res. 2020 Jan;48(1):300060519897668. doi: 10.1177/0300060519897668.
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Outcomes of therapeutic penetrating keratoplasty in 198 eyes with fungal keratitis.198 只真菌性角膜炎眼行治疗性穿透性角膜移植术的结果。
Indian J Ophthalmol. 2019 Oct;67(10):1599-1605. doi: 10.4103/ijo.IJO_1952_18.
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Glaucoma after penetrating keratoplasty.穿透性角膜移植术后青光眼
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Emergency corneal grafting in the UK: a 6-year analysis of the UK Transplant Registry.英国的急诊角膜移植:英国移植登记处的6年分析
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