Price F W, Whitson W E, Johns S, Gonzales J S
Corneal Consultants of Indiana, Indianapolis, USA.
J Refract Surg. 1996 Jan-Feb;12(1):134-43; discussion 143-7. doi: 10.3928/1081-597X-19960101-24.
Penetrating keratoplasty is one of the most common and successful ophthalmic procedures. However, controversy and uncertainty still call to question the significance of certain risk factors for graft failure.
A consecutive series of 1819 penetrating keratoplasties at a single center was studied to determine donor and recipient risk factors for graft failure. Mean follow up was 2.3 years (range, 1 to 96 months) with 139 (7.7%) eyes lost to follow up.
Previous graft failure was the most significant risk factor for secondary failure (P = .0013). The risk of failure significantly decreased with increased postoperative time. Significant patient risk factors for secondary failures in initial grafts included race (P = .01), age (P = .004), iris color (P = .02), use of preoperative glaucoma medications (P = .0008), deep stromal vascularization (P = .002), and host horizontal diameter (P = 0.007). Significant risk factors for failures associated with immunologic allograft reactions in initial grafts included horizontal corneal diameter (P = .002), donor size (P = .05), differences between horizontal corneal diameter, and both donor size (P = .02) and recipient trephination size (P = .01). However, deep stromal vascularization was only marginally significant (P = .09). A history of preoperative glaucoma medication usage was not a significant risk factor.
The relationship of the recipient's horizontal corneal diameter to immunologic graft rejection is a new risk factor that surgeons can directly control and thereby help avoid graft failure.
穿透性角膜移植术是最常见且成功的眼科手术之一。然而，争议和不确定性仍对某些移植失败风险因素的重要性提出质疑。
对单一中心连续进行的1819例穿透性角膜移植术进行研究，以确定移植失败的供体和受体风险因素。平均随访时间为2.3年（范围1至96个月），139只眼（7.7%）失访。
既往移植失败是二次失败的最显著风险因素（P = 0.0013）。失败风险随术后时间延长而显著降低。初次移植二次失败的显著患者风险因素包括种族（P = 0.01）、年龄（P = 0.004）、虹膜颜色（P = 0.02）、术前使用青光眼药物（P = 0.0008）、深层基质血管化（P = 0.002）和宿主角膜水平直径（P = 0.007）。初次移植中与免疫同种异体移植反应相关的失败显著风险因素包括角膜水平直径（P = 0.002）、供体大小（P = 0.05）、角膜水平直径与供体大小（P = 0.02）以及受体环钻大小（P = 0.01）之间的差异。然而，深层基质血管化仅具有边缘显著性（P = 0.09）。术前使用青光眼药物史不是显著风险因素。
受体角膜水平直径与免疫性移植排斥反应的关系是一种新的风险因素，外科医生可以直接控制，从而有助于避免移植失败。
