山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (3): 134-140.doi: 10.6040/j.issn.1673-3770.0.2019.605

• 论著 • 上一篇    

角膜再移植原因与植片失活的危险因素分析

郝文培1,2, 翟华蕾2, 孙晓彤2, 张雅妮3, 朱艳辉4, 孔倩倩2, 程钧2, 张婷2   

  1. 山东省医学科学院)/山东省眼科研究所/山东省眼科学重点实验室-省部共建国家重点实验室培育基地/青岛眼科医院, 山东 青岛 266071;
    3. 青岛大学, 山东 青岛 266071;
    4. 张家口市宣化区眼科医院, 河北 张家口 075100
  • 发布日期:2020-06-29
  • 通讯作者: 翟华蕾. E-mail:zhaihualei0001@126.com
  • 基金资助:
    国家自然科学基金青年基金(81500703)

Etiology of repeat keratoplasty and risk factors for failure of corneal grafts

HAO Wenpei1,2, ZHAI Hualei2, SUN Xiaotong2, ZHANG Yani3, ZHU Yanhui4, KONG Qianqian2, CHENG Jun2, ZHANG Ting2   

  1. 1. School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan 250022, Shandong, China;
    2. Qingdao Eye Hospital, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong, China;
    3. Qingdao University, Qingdao 266071, Shandong, China;
    4. Xuanhua District Eye Hospital of Zhangjiakou, Zhangjiakou 075100, Hebei, China
  • Published:2020-06-29

PDF (PC)

168

摘要： 目的 分析再次角膜移植的原因及影响角膜植片存活的危险因素。 方法 收集2010年1月至2018年12月于青岛眼科医院行角膜移植患者2060例资料,回顾性分析再次角膜移植的原因、首次角膜移植的原发病、既往及再次角膜移植的手术方式及术后并发症等资料。 结果 其中228例为再次角膜移植术(11.07%)。204例患者(207眼)接受再次角膜移植,其中189眼接受1次再次角膜移植,15眼接受2次再次角膜移植,3眼接受3次再次角膜移植,男性137例,女性67例,接受再次移植时的年龄为11~81岁,平均(49.93±14.32)岁。再次角膜移植的主要原因为角膜植片溃疡(60例,26.32%)、角膜植片内皮功能失代偿(58例,25.44%)、原发病复发(41例,17.98%)及角膜移植片混浊(32例,14.04%)。再次角膜移植的原发病主要为化脓性角膜炎(69眼,33.33%)、单纯疱疹病毒性角膜炎(32眼,15.46%)、角膜烧伤(22眼,10.63%)与角膜营养不良和变性(21眼,10.14%)。202例再次角膜移植的术式为穿透性角膜移植术(88.60%),26例再次角膜移植的术式为板层角膜移植术(11.40%),内皮移植术0例。再次角膜移植术式与既往角膜移植术式之间存在相关性(连续性校正χ2=43.365,P<0.01),既往手术方式影响再次角膜移植的手术方式。Cox多因素回归分析感染性原发病(P=0.005)、角膜植片直径>8.75 mm(P=0.040)、继发青光眼(P=0.027)以及角膜植片免疫排斥(P=0.047)是穿透性角膜移植失败的危险因素;感染性原发病(P=0.011)、角膜植片直径>8.75 mm(P=0.016)是前板层角膜移植失败的危险因素。 结论 再次角膜移植的主要原因为角膜植片溃疡,其次为角膜植片内皮功能失代偿,再次为原发病复发。再次角膜移植的原发病以化脓性角膜炎最多见,其次为单纯疱疹病毒性角膜炎,再次为角膜烧伤。既往手术方式影响再次角膜移植的手术方式。感染性原发病、角膜植片直径>8.75 mm、继发青光眼及发生免疫排斥是影响穿透性角膜移植术后植片存活的危险因素。感染性原发病和角膜植片直径>8.75 mm是影响前板层角膜移植术后植片存活的危险因素。

关键词: 再次角膜移植, 病因, 植片存活, 危险因素

Abstract: Objective This study aimed to analyze the causes of repeat keratoplasty and the risk factors for failure of corneal grafts. Methods This retrospective consecutive clinical case series enrolled all cases at Qingdao Eye Hospital, Shandong Eye Institute, between January 2010 and December 2018. Causes of repeat keratoplasty, primary disease before first keratoplasty, surgical methods of the first and repeat keratoplasty, and postoperative complications were analyzed. Statistical analysis was performed using SPSS 22.0 software. Results A total of 2,060 corneal transplants was performed in our hospital, of which 228(11.07%)were repeat keratoplasties. From 2010 to 2018, repeat keratoplasties were performed in 207 eyes of 204(137 male and 67 female)patients-189 eyes with first repeat keratoplasties, 15 eyes with second repeat keratoplasties, and 3 eyes with third repeat keratoplasties. The patient age was 11 to 81(mean: 49.93±14.32)years. The main reasons for repeat keratoplasty were graft ulcers(60 cases, 26.32%), corneal graft endothelial decompensation(58 cases, 25.44%), recurrence of primary disease(41 cases, 17.98%), and graft opacity(32 cases, 14.04%). First keratoplasty was most commonly performed for purulent keratitis(69 eyes, 33.33%), followed by herpes simplex keratitis(32 eyes, 15.46%), corneal burns(22 eyes, 10.63%), and corneal dystrophy and degeneration(21 eyes, 10.14%). Penetrating keratoplasty was performed in 202 cases(88.60%)for repeat corneal transplantation, anterior lamellar keratoplasty was performed in 26 cases(11.40%), and endothelial transplantation was performed in 0 cases. There was a correlation between repeat keratoplasty and previous keratoplasty(continuous correction χ2=43.365, P<0.01). Previous surgery affects the operation of repeat keratoplasties. Infectious keratopathy(P=0.005), graft diameter >8.75 mm(P=0.040), postoperative secondary glaucoma(P=0.027), and corneal graft rejection(P=0.047)were risk factors for penetrating keratoplasty graft failure. In multivariate Cox regression analysis, infectious keratopathy(P=0.011)and graft diameter >8.75 mm(P=0.016)were risk factors for anterior lamellar keratoplasty graft failure. Conclusion The most common cause of repeat keratoplasty was corneal graft ulcer, followed by corneal graft endothelial decompensation, and recurrence of the primary disease. Infectious keratitis was the most common primary disease before the first keratoplasty, followed by herpes simplex keratitis and corneal burns. Previous surgery affects the operation of repeat keratoplasties. Infectious keratopathy, graft diameter >8.75 mm, postoperative secondary glaucoma, and corneal graft rejection were risk factors for penetrating keratoplasty graft failure, whereas infectious keratopathy and graft diameter >8.75 mm were risk factors for anterior lamellar keratoplasty graft failure.

Key words: Repeat keratoplasty, Etiology, Graft survival, Risk factors

中图分类号: 

  • R779.65
[1] Tan DTH, Dart JKG, Holland EJ, et al. Corneal transplantation[J]. The Lancet, 2012, 379(9827): 1749-1761.doi:10.1016/S0140-6736(12)60437-1.
[2] Moffatt SL, Cartwright VA, Stumpf TH. Centennial review of corneal transplantation[J]. Clinical Experimental Ophthalmology, 2005, 33(6): 642-657. doi:10.1111/j.1442-9071.2005.01134.x.
[3] Patel NP, Kim T, Rapuano CJ, et al. Indications for and outcomes of repeat penetrating keratoplasty, 1989-1995[J]. Ophthalmology, 2000, 107(4): 719-724. doi:10.1016/s0161-6420(00)00003-8.
[4] Al-Mezaine H, Wagoner MD, King Khaled Eye Specialist Hospital Cornea Transplant Study Group. Repeat penetrating keratoplasty: indications, graft survival, and visual outcome[J]. Br J Ophthalmol, 2006, 90(3): 324-327. doi:10.1136/bjo.2005.079624.
[5] 高华, 曲利军, 张菊, 等. 再次穿透性角膜移植原因临床分析[J]. 中华移植杂志(电子版), 2009, 3(3): 195-199. doi:10.3969/j.issn.1674-3903.2009.03.006. GAO Hua, QU Lijun, ZHANG Ju, et al. Etiology for repeat penetrating keratoplasty[J]. Chinese Journal of Transplanation(Electronic Edition), 2009, 3(3): 195-199. doi:10.3969/j.issn.1674-3903.2009.03.006.
[6] 陈丽, 陆佳骏, 盛敏杰, 等. 角膜保存方法现状及进展[J]. 国际眼科杂志, 2017, 17(6): 1060-1062. doi:10.3980/j.issn.1672-5123.2017.6.12. CHEN Li, LU Jiajun, SHENG Minjie, et al. Current status and progress of corneal preservation methods[J]. International Eye Science, 2017, 17(6): 1060-1062. doi:10.3980/j.issn.1672-5123.2017.6.12.
[7] Kitazawa K, Wakimasu K, Kayukawa K, et al. Moderately long-term safety and efficacy of repeat penetrating keratoplasty[J]. Cornea, 2018, 37(10): 1255-1259. doi:10.1097/ICO.0000000000001694.
[8] Srujana D, Kaur M, Urkude J, et al. Long-term functional and anatomic outcomes of repeat graft after optically failed therapeutic keratoplasty[J]. Am J Ophthalmol, 2018, 189: 166-175. doi:10.1016/j.ajo.2018.03.011.
[9] Park CY, Lee JK, Gore PK, et al. Keratoplasty in the United States: a 10-year review from 2005 through 2014[J]. Ophthalmology, 2015, 122(12): 2432-2442. doi:10.1016/j.ophtha.2015.08.017.
[10] Zhang AQ, Rubenstein D, Price AJ, et al. Evolving surgical techniques of and indications for corneal transplantation in Ontario: 2000-2012[J]. Canadian Journal of Ophthalmology, 2013, 48(3): 153-159.doi:10.1016/j.jcjo.2012.12.008.
[11] Keenan TDL, Jones MNA, Rushton S, et al. Trends in the indications for corneal graft surgery in the United Kingdom: 1999 through 2009[J]. Archives of ophthalmology, 2012, 130(5): 621-628. doi:10.1001/archophthalmol.2011.2585.
[12] 孙晓彤, 翟华蕾, 白曜, 等. 青岛某医院穿透性角膜移植手术原因[J]. 中华眼视光学与视觉科学杂志, 2019, 21(5): 375-381. doi:10.3760/cma.j.issn.1674-845X.2019.05.010. SUN Xiaotong, ZHAI Hualei, BAI Yao, et al. Analysis of causes for penetrating keratoplasty in a hospital in Qingdao[J]. Chinese Journal of Optometry Ophthalmology and Visual Science, 2019, 21(5): 375-381. doi:10.3760/cma.j.issn.1674-845X.2019.05.010.
[13] Muller LJ, Marfurt CF, Kruse FE, et al. Corneal nerves: structure, contents and function[J]. Exp Eye Res, 2003, 76(5): 521-542. doi:10.1016/S0014-4835(03)00050-2.
[14] Darwish T, Brahma A, Efron N, et al. Subbasal nerve regeneration after penetrating keratoplasty[J]. Cornea, 2007, 26(8): 935-940. doi:10.1097/ICO.0b013e318-0de493f.
[15] Galletti JG, Guzmán M, Giordano MN. Mucosal immune tolerance at the ocular surface in health and disease[J]. Immunology, 2017,150(4):397-407. doi: 10.1111/imm.12716.
[16] 阳雪, 李莹. 干眼对角膜内皮细胞的影响及相关因素分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 72-76. doi:10.6040/j.issn.1673-3770.0.2018.151. YANG Xue, LI Ying. Impact of dry eye on corneal endothelial cell density and morphology[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(4): 72-76. doi:10.6040/j.issn.1673-3770.0.2018.151.
[17] 宫华青, 高华, 谢立信, 等. 穿透性角膜移植术后慢性失功移植片的超微结构观察[J]. 中华眼科杂志, 2007(4): 307-312. doi:10.3760/j.issn:0412-4081.2007.04.005. GONG Huaqing, GAO Hua, XIE Lixin, et al. Ultrastructure changes in chronic corneal ailograft dysfunction after penetrating keratoplasty[J]. Chinese Journal of Ophthalmology, 2007(4): 307-312. doi:10.3760/j.issn:0412-4081.2007.04.005.
[18] Shinomiya K, Ueta M, Sotozono C, et al. Immunohistochemical analysis of inflammatory limbal conjunctiva adjacent to Mooren's ulcer[J]. Br J Ophthalmol, 2013, 97(3): 362-366. doi:10.1136/bjophthalmol-2012-302631.
[19] Alhassan MB, Rabiu M, Agbabiaka IO. Interventions for Mooren's ulcer[J]. Cochrane Database Syst Rev,2014,22(1):CD006131. doi: 10.1002/14651858.
[20] Chen J, Xie H, Wang Z, et al. Mooren's ulcer in China: a study of clinical characteristics and treatment[J]. Br J Ophthalmol, 2000, 84(11): 1244-1249. doi:10.1136/bjo.84.11.1244.
[21] Huang T, Wang YJ, Ji JP, et al. Lamellar keratoplasty for treatment of peripheral corneal perforation[J]. Chinese Journal of Ophthalmology, 2008, 44(2): 104-110.
[22] Liu JC, Shi WY, Li SX, et al. Modified lamellar keratoplasty and immunosuppressive therapy guided by in vivo confocal microscopy for perforated Mooren's ulcer[J]. Br J Ophthalmol, 2015, 99(6): 778-783. doi:10.1136/bjophthalmol-2014-306012.
[23] Bersudsky V, Blum-Hareuveni T, Rehany U, et al. The profile of repeated corneal transplantation[J]. Ophthalmology, 2001, 108(3): 461-469. doi:10.1016/s0161-6420(00)00544-3.
[24] Ramamurthy S, Reddy JC, Vaddavalli PK, et al. Outcomes of repeat keratoplasty for failed therapeutic keratoplasty[J]. Am J Ophthalmol, 2016, 162: 83-88.e2. doi:10.1016/j.ajo.2015.11.004.
[25] Skeens HM, Holland EJ. Large-diameter penetrating keratoplasty: indications and outcomes[J]. Cornea, 2010, 29(3): 296-301. doi:10.1097/ICO.0b013e3181b6489e.
[26] Ramamurthy S, Reddy JC, Vaddavalli PK, et al. Outcomes of repeat keratoplasty for failed therapeutic keratoplasty[J]. Am J Ophthalmol, 2016, 162: 83-88.e2. doi:10.1016/j.ajo.2015.11.004.
[27] Claesson M, Armitage WJ. Ten-year follow-up of graft survival and visual outcome after penetrating keratoplasty in Sweden[J]. Cornea, 2009, 28(10): 1124-1129. doi:10.1097/ICO.0b013e3181a2a7a6.
[28] Anshu A, Lim LS, Htoon HM, et al. Postoperative risk factors influencing corneal graft survival in the Singapore Corneal Transplant Study[J]. Am J Ophthalmol, 2011, 151(3): 442-448.e1. doi:10.1016/j.ajo.2010.09.002.
[29] Tandon A, Espandar L, Cupp D, et al. Surgical management for postkeratoplasty glaucoma: a meta-analysis[J]. J Glaucoma, 2014, 23(7): 424-429. doi:10.1097/IJG.0b013e31827a0712.
[30] Kusakabe A, Okumura N, Wakimasu K, et al. Effect of trabeculotomy on corneal endothelial cell loss in cases of after penetrating-keratoplasty Glaucoma[J]. Cornea, 2017, 36(3): 317-321. doi:10.1097/ICO.0000000000-001088.
[1] 王兴鑫,杨欣雨,郑晓军,丁麟,盛亚文,毕晓云,杨继国. 穴位贴敷疗法治疗小儿腺样体肥大1例[J]. 山东大学耳鼻喉眼学报, 2022, 36(5): 122-124.
[2] 张礼俊, 胥然, 罗继芳, 刘国旗, 何千, 李玮, 蒋振华. 头颈肿瘤游离皮瓣修复术后皮瓣坏死及皮瓣相关并发症影响因素分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 86-90.
[3] 刘珊珊, 韩书婧, 王晓旭, 李艳红, 倪鑫, 张杰. 儿童细菌性脑膜炎后听力损害危险因素的系统评价与Meta分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 48-54.
[4] 杨秀芬,尤冉,马秀梅,王康,王艳玲. 以医院为基础的中心性浆液性脉络膜视网膜病变流行病学调查及危险因素的研究[J]. 山东大学耳鼻喉眼学报, 2020, 34(4): 75-79.
[5] 陈东,余红,李洋,黄强,方敏. 功能性鼻内窥镜鼻窦手术粘连的潜在危险因素及其预测价值[J]. 山东大学耳鼻喉眼学报, 2020, 34(4): 87-91.
[6] 伊海金,杨仕明. 重视耳部外伤诊疗工作[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 1-3.
[7] 谢慧. 眩晕的中医认识[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 11-17.
[8] 邓巧媚, 张玥琦, 王巍, 徐开旭, 温超, 刘强, 陈太生, 林鹏. 良性阵发性位置性眩晕与合并疾病的关联性分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 22-25.
[9] 申宇鹏,宋琦,李晓明. 喉癌前病变的病因、分子机制和处理策略[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 25-30.
[10] 赵俊英,王建明. 单侧突发性聋与椎基底动脉影像学特征的相关性研究[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 47-51.
[11] 黄河,欧阳晖. 下咽癌共病食管癌的高危因素及预后分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 82-86.
[12] 郎永耀,杨云,刘晴,徐林弟,林子萍. 咽喉反流性疾病的影响因素及治疗效果分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 119-123.
[13] 姜秀颖,李元彬. 后房型人工晶体脱位的临床分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 105-110.
[14] 王玥,刘芊,王海波. 自发性脑脊液耳漏的研究进展[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 130-135.
[15] 孙子雯,崔洪玮,孙喜灵,陈晨,张璐,胡竹林. 干眼病的病因、发病机制及治疗进展[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 159-166.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 邓基波,孙奉乾,许安廷 . 大前庭导水管综合征[J]. 山东大学耳鼻喉眼学报, 2006, 20(2): 116 -118 .
[2] 周子宁,金国威 . 喉气管狭窄的预防和治疗进展[J]. 山东大学耳鼻喉眼学报, 2006, 20(5): 462 -465 .
[3] 周斌,李滨 . 鼻内窥镜下鼻窦鼻息肉手术75例疗效观察[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 24 -26 .
[4] 徐赛男,杨雷 . 红霉素促进鼻息肉上皮细胞凋亡的实验研究[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 27 -29 .
[5] 张玉光,韩旭光,张华,王旭,徐湘辉 . 改良穿透性角膜移植术治疗真菌性角膜炎[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 94 -95 .
[6] 刘联合 . 颈深部脓肿37例[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 180 -181 .
[7] 谢治年 ,姬长友 . RNA干扰及其在喉鳞癌研究中的应用[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 200 -203 .
[8] 乔 艺,倪关森,陈文文 . 改良悬雍垂腭咽成形术联合鼻腔手术治疗阻塞性睡眠呼吸暂停综合征38例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 206 -208 .
[9] 汪晓锋,林 昶,程金妹 . 不同龄小鼠内耳中ABAD的表达及临床意义[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 207 -211 .
[10] 凡启军,黄治物,梅 玲,肖伯奎 . 荧光定量PCR测定水杨酸钠作用后大鼠耳蜗基因的表达[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 212 -214 .
网站版权所有 © 2018 《山东大学耳鼻喉眼学报》编辑部　
地址：山东省济南市山大南路27号（250100）电话：+86-0531-88366912 E-mail: ebhxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发