Farid Karimian, Kiana Hassanpour, Farbod Semnani, Sepehr Feizi, Mohammad Ali Javadi, Amir Faramarzi, Mohammadreza Jafarinasab
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引用次数: 0
Abstract
Purpose: To compare the graft survival rates and visual outcomes in patients with keratoconus (KCN) undergoing deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PKP) and identify possible risk factors.
Methods: This retrospective longitudinal study enrolled patients with KCN who underwent corneal transplantation at Labbafinejad Medical Center (Tehran, Iran) between 2006 and 2016. We utilized a one-to-one coarsened exact matching (CEM) approach. Matching considered the recipient's sex, donor age, and the presence and extent of corneal neovascularization in the recipient.
Results: A total of 213 patients with KCN who underwent PKP (49.8%; n = 106) or DALK (50.2%; n = 107) were enrolled. After CEM was performed, 67 patients in the PKP group were well-matched with 67 patients in the DALK group. There was no significant difference in terms of baseline characteristics between the two groups. Kaplan-Meier survival analysis showed that the percentage of patients free of graft rejection in a one- and three-year follow-up was 78.7% and 74.5% in the PKP group, and 95.3% and 95.3% in the DALK group, respectively. On univariate analysis, the strongest risk factor predictive of graft rejection was corneal vascularization in both the PKP and DALK groups, followed by recipient age only in the PKP group and dry eye disease only in the DALK group. In a multivariate Cox regression analysis, PKP was identified as an independent predictor of graft rejection, but not of graft failure. The DALK and PKP groups were comparable in terms of postoperative best-corrected visual acuity (BCVA; P = 0.48) and suture complications (P = 0.87).
Conclusion: In patients with KCN, DALK demonstrated comparable outcomes to PKP in terms of BCVA, but showed superiority in graft rejection-free survival. Corneal vascularization was the major recipient risk factor for graft rejection and failure.
目的：比较圆锥角膜（KCN）患者行深前板层角膜移植术（DALK）与穿透性角膜移植术（PKP）的移植存活率和视力结果，并确定可能的危险因素。方法：本回顾性纵向研究纳入了2006年至2016年在伊朗德黑兰Labbafinejad医疗中心接受角膜移植的KCN患者。我们使用了一对一的粗精确匹配（CEM）方法。匹配考虑了受者的性别、供者的年龄以及受者角膜新生血管的存在和程度。结果：共有213例KCN患者接受PKP （49.8%, n = 106）或DALK （50.2%, n = 107）。行CEM后，PKP组67例患者与DALK组67例患者匹配良好。两组在基线特征方面无显著差异。Kaplan-Meier生存分析显示，PKP组1年和3年随访中无移植排斥反应的患者比例分别为78.7%和74.5%，DALK组为95.3%和95.3%。在单因素分析中，PKP组和DALK组中预测移植排斥反应的最强危险因素是角膜血管化，其次是PKP组的受体年龄和DALK组的干眼症。在多变量Cox回归分析中，PKP被确定为移植物排斥反应的独立预测因子，但不是移植物衰竭的预测因子。DALK组和PKP组在术后最佳矫正视力（BCVA, P = 0.48）和缝合并发症（P = 0.87）方面具有可比性。结论：在KCN患者中，DALK在BCVA方面表现出与PKP相当的结果，但在移植物无排斥生存方面表现出优势。角膜血管化是移植排斥和失败的主要受体危险因素。
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