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

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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
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