Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2020, Vol. 34 ›› Issue (3): 134-140.doi: 10.6040/j.issn.1673-3770.0.2019.605

Previous Articles    

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)

193

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

CLC Number: 

  • 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] ZHANG Lijun, XU Ran, LUO Jifang, LIU Guoqi, HE Qian, LI Wei, JIANG Zhenhua. Factors affecting flap neurosis and other postoperative flap-related complications after free-flap reconstruction of head and neck tumors [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(4): 86-90.
[2] LIU Shanshan, HAN Shujing, WANG Xiaoxu, LI Yanhong, NI Xin, ZHANG Jie. Hearing loss in children after bacterial meningitis: a systematic review and meta-analysis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 48-54.
[3] To describe characteristics and risk factors associated with central serous chorioretinopathy(CSC)in a hospital-based outpatient sample population. MethodsIn this hospital-based cross-sectional study, CSC patients were recruited from the Beijing Friendship Hospital from 01/2019 to 12/2019. All participants underwent a standardized interview. Logistic regression models were used to assess the risk factors associated with CSC. ResultsA total of 23,878 outpatients were recorded during the period 01/2019-12/2019. Of these, 45 patients(0.19%)were diagnosed with CSC, divided in 37 male patients(82.22%)and 8 female patients(17.78%). The patients′ age ranged from 21 to 65(42.3±10.1)years. Three patients(6.67%)presented a bilateral involvement. Of all the patients, 39 were included in the present analysis. Control patients were matched for age and sex at a ratio of 1:1. The presence of CSC was associated with exposure to steroids(OR=5.04, 95% CI:1.11-22.89), sleep time(going to sleep after 12 pm)(OR=4.16, 95% CI:1.33-13.04)),and shift-work(OR=5.74, 95% CI:1.47-22.45).ConclusionsOur data showed that CSC prevalence in the analyzed outpatients was 0.19%. Exposure to steroids, sleep time, and shift-work were factors related with CSC in the observed population.. Prevalence and risk factors of central serous chorioretinopathy in a hospital-based population YANG Xiufen, YOU Ran, MA Xiumei, WANG Kang, WANG Yanling Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, ChinaAbstract:Objective〓 [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(4): 75-79.
[4] This study was conducted to explore the preoperative risk factors for postoperative adhesion in patients with chronic rhinosinusitis(CRS)undergoing functional endoscopic sinus surgery(FESS), and to construct a risk score model to evaluate their predictive effect. MethodsA retrospective study was conducted on 323 patients with CRS who underwent FESS at our hospital between January 2015 and June 2018. The risk factors for postoperative adhesion were screened using a multivariate logistic regression analysis. The risk score was assigned according to the odds ratio(OR)value, and a receiver operating characteristic(ROC)curve was drawn to evaluate the predictive effect. ResultsPostoperative adhesion occurred in 35 patients(10.8%). The logistic regression results showed that concha bullosa, primary FESS, operative experience less than 10 years, and a history of middle turbinate resection were independent risk factors for postoperative adhesion in FESS. The OR values were 1.12(95% CI: 1.06-1.18), 3.87(95% CI: 2.23-5.51), 3.19(95% CI: 2.07-4.31), and 2.24(95% CI:1.95-2.53), respectively. The risk score model assigned 1 point for vesicular middle turbinate, 4 points for first time FESS, 3 points for operative experience less than 10 years, and 2 points for middle turbinate resection. The ROC curve analysis showed that the area under the curve(AUC)was 0.784(95% CI: 0.672-0.896, P<0.05). When 4 points were selected as the cut-off point, the Jordan index was the largest, with a sensitivity of 75.1% and a specificity of 73.6%. ConclusionThe incidence of postoperative adhesion in 323 patients with CRS who underwent FESS was 10.8%. The risk score model has certain reference value for predicting high-risk postoperative adhesion.. Potential risk factors and evaluation of a predictive risk score model for postoperative adhesion in functional endoscopic sinus surgeryCHEN Dong1, YU Hong2, LI Yang1, HUANG Qiang1, FANG Min1 1. Department of Otolaryngology, Jiangyou Peoples Hospital, Jiangyou 621700, Sichuan, China; 2. Department of Pathology, Jiangyou Peoples Hospital, Jiangyou 621700, Sichuan, ChinaAbstract:Objective〓 [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(4): 87-91.
[5] Haijin YI,Shiming YANG. Value the diagnosis and treatment of ear trauma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 1-3.
[6] Hui XIE. Understanding vertigo from a Chinese medicine perspective [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(5): 11-17.
[7] Yupeng SHEN,Qi SONG,Xiaoming LI. Etiology, molecular mechanisms, and treatment strategies of precancerous laryngeal lesions [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 25-30.
[8] ZHAO Junying, WANG Jianming. Correlation between unilateral sudden deafness and imaging features of vertebrobasilar artery [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 47-51.
[9] HUANG He, OUYANG Hui. Risk factors and prognosis of esophageal cancer with hypopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 82-86.
[10] Yongyao LANG,Yun YANG,Qing LIU,Lindi XU,Ziping LIN. Analysis of influencing factors and observation of therapeutic effects in patients with laryngopharyngeal reflux disease [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(3): 119-123.
[11] JIANG Xiuying, LI Yuanbin. Clinical analysis of posterior intraocular lens dislocation [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 105-110.
[12] WANG Yue, LIU Qian, WANG Haibo. Prospect and progress of spontaneous cerebrospinal fluid otorrhea [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 130-135.
[13] SUN Ziwen, CUI Hongwei, SUN Xiling, CHEN Chen, ZHANG Lu, HU Zhulin. SUN Ziwen1, CUI Hongwei2, SUN XilingEtiology, pathogenesis, and management of dry eye [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 159-166.
[14] Chuangli HAO,Wenjing GU. Recognizing the etiology of chronic cough in children of different ages [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(1): 20-24.
[15] CUI Le, GUAN Kai, LI Lisha, LI Junda, WANG Zixi, XU Yingyang, WANG Lianglu, YIN Jia. Analysis of prevalence and related risk factors of bee venom in bee research population [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(1): 63-66.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(2): 116 -118 .
[2] ZHOU Zi-ning,JIN Guo-wei . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(5): 462 -465 .
[3] ZHOU Bin,LI Bin . Endoscopic sinus surgery for 75 patients with chronic sinusitis and nasal polyps[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 24 -26 .
[4] XU Sainan,YANG Lei . Apoptosis of epithelial cells in nasal polyps promoted by erythromycin[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 27 -29 .
[5] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 94 -95 .
[6] LIU Lian-he . Treatment of deep neck abscess in 37 cases[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(2): 180 -181 .
[7] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 200 -203 .
[8] QIAO Yi,NI Guan-sen,CHEN Wen-wen . Effect of H-UPPP and nasal operations on obstructive sleep apnea syndrome in 38 cases
[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 206 -208 .
[9] WANG Xiao-feng,LIN Chang,CHENG Jin-mei . Expression of ABAD in inner ears and its clinical significance in different age mice[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 207 -211 .
[10] FAN Qi-jun,HUANG Zhi-wu,MEI Ling,XIAO Bo-kui . Expression of the heat shock protein 27 in rat cochlea induced by sodium salicylate injection by the FQ-PCR technique[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 212 -214 .
Website Copyright: Editorial Office of Journal of Otolaryngology and Ophthalmology of Shandong University
Address: No.27 Shanda South Road, Jinan, Shandong, China. Post code: 250100 Tel: +86-0531-88366912 Email: ebhxb@sdu.edu.cn Supported by Beijing Magtech Co.Ltd