穿透性角膜移植术后植片中心厚度的预后

作     者：Borderie V.M . Touzeau O. Bourcier T. 张少娟 

作者机构：Service V Ctr. Hosp. Natl. d'O. 28 ruede Charenton 75012 Paris FranceDr. 

出 版 物：《世界核心医学期刊文摘（眼科学分册）》 (Digest of the World Core Medical Journals:Ophthalmology)

年 卷 期：2005年第1卷第11期

页      面：50-50页

学科分类：1002[医学-临床医学] 100212[医学-眼科学] 10[医学] 

主　　题：植片 角膜移植 超声测厚仪 队列研究 观察性 相对风险 免疫反应 

摘      要：Objective: To analyze the outcome of graft central thickness after penetrating keratoplasty. Design: Retrospective observational cohort study. Participants: E ight hundred fifty-six consecutive penetrating keratoplasties (772 patients) pe rformed between 1992 and 2001 were analyzed and 772 were included (1 graft per p atient was included). Methods: Slit-lamp examination and ultrasound pachymetry. Main Outcome Measures: Slit-lamp findings, intraocular pressure, and graft cen tral thickness were recorded. Results: Patients were observed for an average of 55 months. The 36-and 60-month graft survival estimates were, respectively, 77 .2%and 71.0%. The average graft central thickness in successful transplants wa s 655 μm at 1 week, 558 μm at 1 month, 533 μm at 6 months, 538 μm at 12 mont hs, 558 μm at 24 months, 561 μm at 36 months, and 568 μm at 5 years. At each postoperative time point, the percentage of eyes with decreased, normal, and inc reased graft central thickness was significantly different according to slit-la mp findings. Of the patients with increased graft thickness, 46.2%had a simple outcome (normal intraocular pressure and normal slit-lamp findings), 28.6%expe rienced rejection, 15.8%experienced a graft nonimmunological event, and 9.4%ex perienced increased intraocular pressure. At each postoperative follow-up, subs equent graft survival was significantly lower in patients with increased graft t hickness as compared with patients with normal or decreased graft thickness. Whe n analyzing only patients with simple outcome, the relative risk of graft failur e was 3.3 if graft thickness was increased at 1 month (P 0.0001). Conclusions: In conclusion, graft central thickness assessed by ultrasound pachymetry is a u seful method for observing patients who have undergone penetrating keratoplasty. Evenwhen slit-lamp examination reveals no complications, patients with an incr ease in graft thickness above the upper limit of normal for the postoperative ti me poi