PDF(Pubmed)
Abstract：
The purpose of this study is to evaluate loose suture-related inflammation and activation of conjunctiva-associated lymphoid tissue (CALT) in patients after keratoplasty. The patients who were treated with keratoplasty at the First Affiliated Hospital of Harbin Medical University between 2015 and 2022 were recruited into the study. We evaluated the time and location of loose suture development in patients after keratoplasty. In addition, in vivo confocal microscopy was used to evaluate the activation of CALT and the accumulation of inflammatory cells around loose sutures. Meso Scale Discovery assay detection kits were used to evaluate the inflammatory cytokines in the tears of patients before and after the loose suture was removed. In this study, we collected the information from 212 cases (212 eyes) who had PK (126 eyes) and DALK-treated (86 eyes) for corneal transplantation, including 124 males and 88 females, aged 14-84 years old. The average age was 50.65 ± 16.81 years old. Corneal sutures were more prone to loose at 3 months and 6 months after keratoplasty, and the frequent sites were at 5 and 6 o\'clock. An increased number of inflammatory cells could be observed around the loose sutures than normal sutures (P < 0.001). In CALT, the density of diffuse lymphocytes (P < 0.001), follicles (P < 0.001), and parafollicular lymphocytes (P < 0.001) were higher and the central reflection of the follicles (P < 0.001) was stronger when suture loosening happened. The levels of inflammatory cytokines such as IL-1β (P = 0.003), IL-8 (P = 0.012), and TNF-α (P < 0.001) were higher in the tears of the patients with loose sutures. The activation of CALT was partly settled after removing the loose sutures. In conclusion, loose sutures after corneal transplantation can lead to increased infiltration of inflammatory cells, activation of CALT, and increased secretion of inflammatory cytokines in the tears of patients. Regular follow-up to identify and solve the problem in time can avoid suture-related complications.
摘要：
这项研究的目的是评估角膜移植术后患者的松缝相关炎症和结膜相关淋巴组织（CALT）的激活。2015年至2022年在哈尔滨医科大学附属第一医院接受角膜移植术的患者被纳入研究。我们评估了角膜移植术后患者松动缝线发育的时间和位置。此外,体内共聚焦显微镜用于评估CALT的激活和松散缝线周围炎症细胞的积累。使用MesoScaleDiscovery测定检测试剂盒评估患者在去除松缝前后泪液中的炎性细胞因子。在这项研究中,我们收集了212例（212只眼）接受PK（126只眼）和DALK治疗（86只眼）进行角膜移植的信息，包括124名男性和88名女性，14-84岁。平均年龄50.65±16.81岁。角膜缝线在角膜移植术后3个月和6个月更容易松动，频繁的地点是5点和6点。与正常缝合线相比，在松弛缝合线周围观察到炎症细胞数量增加（P<0.001）。在CALT,弥漫淋巴细胞密度（P<0.001），卵泡（P<0.001），当缝线松动时，滤泡旁淋巴细胞（P<0.001）更高，滤泡的中央反射（P<0.001）更强。IL-1β等炎性细胞因子水平(P=0.003),IL-8(P=0.012),在有松动缝线的患者的泪液中TNF-α较高（P<0.001）。CALT的活化在去除松散的缝合线后部分沉降。总之,角膜移植后的松散缝线可导致炎症细胞浸润增加，ALT的激活，患者泪液中炎性细胞因子的分泌增加。定期随访发现并及时解决问题,可避免缝合相关并发症。
