Wu Xiaoxuan, Yu He, Yu Liang, Ji Lili, Liu Qiming, Song Jian, Dong He
Department of Ophthalmology, Affiliated Dalian Third People's Hospital of Dalian Medical University, Qianshan Road No.40, Dalian, 116033, Liaoning, China.
Int Ophthalmol. 2025 May 3;45(1):167. doi: 10.1007/s10792-025-03548-9.
The objectives of this study were to investigate the epidemiological characteristics and spectrum of corneal primary diseases among keratoplasty patients in the southern region of Liaoning Province and to study the changing trends in keratoplasty types and corneal graft materials.
The medical records of 537 patients who underwent keratoplasty at the Department of Ophthalmology of Dalian Third People's Hospital from 2017 to 2023 were retrospectively analyzed. Patient demographic (age and sex), primary corneal disease type, keratoplasty type and corneal graft material data were statistically analyzed.
A total of 537 patients who underwent keratoplasty during the 7 years study period were included. The average age of the patients was 56.35±15.93 years, ranging from 5 to 90 years. There were 348 male patients (64.8%) and 189 female patients (35.2%), with a ratio of 1.84:1. Among the primary corneal diseases, infectious keratitis was the most common (243, 45.25%), followed by corneal leukoma (73, 13.59%), corneal endothelial decompensation (48, 8.94%), traumatic corneal injury (36, 6.70%), corneal graft rejection (34, 6.33%), immune corneal ulcer (33, 6.15%), keratoconus (32, 5.96%), corneal dystrophy and degeneration (28, 5.21%), and corneal tumor (10, 1.86%). Among infectious keratitis cases, the detailed etiology was as follows: fungal keratitis (154, 63.37%), bacterial keratitis (54, 22.22%), viral keratitis (34, 13.99%), and Acanthamoeba keratitis (1, 0.41%). According to the classification of ker atoplasty types, the most common was PKP (265, 49.35%), followed by DALK (129, 24.02%), ALK (116, 21.60%), and EK (27, 5.03%). PKP is still the main surgical method for corneal transplantation, but the proportions of patients who undergo DALK, ALK, and EK are increasing. The corneal graft materials were classified as fresh human donor corneal grafts (297, 55.31%), dehydrated human donor corneal grafts (166, 30.91%), corneal stromal lenticules (4, 0.74%), and bioengineered corneal grafts (70, 13.04%).
Owing to factors such as economic development and industrial distribution, infectious keratitis is the primary cause of keratoplasty in the southern Liaoning region of China, followed by corneal leukoma and corneal endothelial decompensation. Fungal infection is the leading cause of infectious keratitis. The primary keratoplasty type has shifted from PKP to corneal composition transplantation. The range of materials utilized for corneal grafts has expanded significantly and now includes corneal stroma lenticules and bioengineered corneal grafts, in addition to human donor corneal grafts. The present study delineates the evolving surgical patterns and material innovations related to keratoplasty, providing insights for regional ophthalmic policy-making.
本研究旨在调查辽宁省南部地区角膜移植患者角膜原发性疾病的流行病学特征和疾病谱，并研究角膜移植类型和角膜移植材料的变化趋势。
回顾性分析2017年至2023年在大连第三人民医院眼科接受角膜移植的537例患者的病历。对患者的人口统计学信息（年龄和性别）、原发性角膜疾病类型、角膜移植类型和角膜移植材料数据进行统计分析。
在7年的研究期间，共纳入537例行角膜移植的患者。患者的平均年龄为56.35±15.93岁，年龄范围为5至90岁。男性患者348例（64.8%），女性患者189例（35.2%），男女比例为1.84:1。在原发性角膜疾病中，感染性角膜炎最为常见（243例，45.25%），其次是角膜白斑（73例，13.59%）、角膜内皮失代偿（48例，8.94%）、外伤性角膜损伤（36例，6.70%）、角膜移植排斥反应（34例，6.33%）、免疫性角膜溃疡（33例，6.15%）、圆锥角膜（32例，5.96%）、角膜营养不良和变性（28例，5.21%）以及角膜肿瘤（10例，1.86%）。在感染性角膜炎病例中，具体病因如下：真菌性角膜炎（154例，63.37%）、细菌性角膜炎（54例，22.22%）、病毒性角膜炎（34例，13.99%）和棘阿米巴角膜炎（1例，0.41%）。根据角膜移植类型分类，最常见的是穿透性角膜移植术（PKP，265例，49.35%），其次是深板层角膜移植术（DALK，129例，24.02%）、前板层角膜移植术（ALK，116例，21.60%）和上皮下角膜移植术（EK，27例，5.03%）。PKP仍然是角膜移植的主要手术方法，但接受DALK、ALK和EK手术的患者比例正在增加。角膜移植材料分类为新鲜人供体角膜移植（297例，55.31%）、脱水人供体角膜移植（166例，30.91%）、角膜基质透镜（4例，0.74%）和生物工程角膜移植（70例，13.04%）。
由于经济发展和产业分布等因素，感染性角膜炎是中国辽宁省南部地区角膜移植的主要原因，其次是角膜白斑和角膜内皮失代偿。真菌感染是感染性角膜炎的主要原因。原发性角膜移植类型已从PKP转变为角膜成分移植。角膜移植所用材料的范围已显著扩大，除人供体角膜移植外，现在还包括角膜基质透镜和生物工程角膜移植。本研究描述了角膜移植相关的手术模式演变和材料创新，为区域眼科政策制定提供了见解。
