目的:报告适应症,外科技术,和重复角膜移植术的结果,并评估中国人群移植失败的危险因素。
方法:回顾性分析了2011年至2020年间在中国南方一家主要眼科医院接受至少两次角膜移植术的216例患者(243例)的病历。分析了重复角膜移植的适应症和手术程序。使用Kaplan-Meier生存分析来确定重复角膜移植术后的移植物存活率。多变量生存模型用于评估危险因素。
结果:从2011年到2020年,反复角膜移植术持续增加(P=0.002)。最常见的主要适应症是感染性角膜炎(38.7%),重复角膜移植术的最常见原因是移植物排斥(30.04%)。移植技术包括穿透性角膜移植术(PK)165例(67.9%),深板层角膜移植术(DALK)52例(21.40%),内皮角膜移植术(EK)26例(10.7%)。PK的中位生存期为5.3、6.8和6.4年,DALK,还有EK,分别。5年生存率为53.5%,66.6%,PK为69.8%,DALK,还有EK,分别。PK的LogMAR视力中位数为1.4,0.75表示DALK,在随访结束时,EK为1.2。多因素分析显示,移植排斥反应是角膜移植术失败的危险因素(P=0.002)。
结论:DALK和EK在治疗移植物衰竭方面可能比PK提供更好的结果。预防和治疗术后移植排斥反应可能是提高移植存活率的关键。这些发现将有助于处理失败的角膜移植物。
OBJECTIVE: To report the indications, surgical techniques, and outcomes of repeat keratoplasty and evaluate the risk factors for graft failure in the Chinese population.
METHODS: The medical records of 216 patients (243 cases) who underwent at least two keratoplasties at a leading eye hospital in southern
China between 2011 and 2020 were retrospectively reviewed. Indications and surgical procedures for repeat corneal transplantation were analyzed. Kaplan-Meier survival analysis was used to determine the graft survival rate after repeat keratoplasty. A multivariable survival model was used to assess the risk factors.
RESULTS: Repeated keratoplasties increased continuously from 2011 to 2020 (P = 0.002). The most common primary indication was infectious keratitis (38.7%), and the most common reason for repeat keratoplasty was graft rejection (30.04%). Regraft techniques included penetrating keratoplasty (PK) in 165 cases (67.9%), deep lamellar keratoplasty (DALK) in 52 cases (21.40%), and endothelial keratoplasty (EK) in 26 cases (10.7%). Median survival was 5.3, 6.8, and 6.4 years for PK, DALK, and EK, respectively. The 5-year survival rate was 53.5%, 66.6%, and 69.8% for PK, DALK, and EK, respectively. The median LogMAR visual acuity was 1.4 for PK, 0.75 for DALK, and 1.2 for EK at the end of the follow-up. Multivariate analysis revealed that graft rejection is a risk factor for repeat keratoplasty failure (P = 0.002).
CONCLUSIONS: DALK and EK may provide better outcomes than PK in treating graft failure. Preventing and treating postoperative graft rejection may be key to improving regraft survival. These findings will aid in the management of failed corneal grafts.