Офтальмохирургия. 2021; : 12-20
Анализ результатов сквозной трансплантации роговицы в ретроспективном когортном исследовании
https://doi.org/10.25276/0235-4160-2021-4-12-20Аннотация
Цель. Оценить результаты сквозной кератопластики и выявить факторы риска развития болезни трансплантата (БТ). Материал и методы. В ретроспективном когортном исследовании были проанализированы данные 582 пациентов после трансплантации роговицы, выполненной за период с 2011 по 2019 г. по поводу кератоконуса (41%), а также бельм и дистрофий роговицы (59%), отягченных сопутствующей патологией – т.н. кератопластик высокого риска (КВР). Оценивали функциональные результаты и частоту развития болезни БТ. Применяли расчет t-критерия; метод кросс-табуляции; анализ выживаемости Каплана–Мейера; многофакторный анализ.
Результаты. В результате сквозной кератопластики острота зрения с коррекцией у пациентов с кератоконусом повысилась на 20%; у пациентов с КВР – на 8%. В общей группе выживаемость трансплантата составила 72%, при этом 8-летнее успешное приживление трансплантата у пациентов с кератоконусом составило 91%, с КВР – 60%. Выявлена значимая связь развития БТ с предоперационным диагнозом и рекератопластикой. Риск развития БТ был минимален у пациентов до 30 лет и максимален у пациентов в возрасте от 50 до 70 лет. Показатели выживаемости трансплантатов роговицы у мужчин были лучше, чем у женщин.
Заключение. Проведение сквозной кератопластики у пациентов с кератоконусом позволяет получить хороший функциональный результат при минимальном риске развития болезни БТ. При сквозной кератопластике у пациентов высокого риска результативность оперативных вмешательств существенно ниже (на ~30%).
Список литературы
1. Малюгин Б.Э., Измайлова С.Б., Айба Э.Э., Дроздов И.В., Паштаев А.Н. Сравнительный анализ клинико-функциональных результатов передней глубокой послойной и сквозной кератопластики по поводу кератоконуса. Офтальмохирургия. 2013;4: 44–49. 2013;(4): 44–49.
2. Труфанов С.В., Суббот А.М., Маложен С.А., Крахмалева Д.А., Саловарова Е.П. Реакция тканевой несовместимости после трансплантации роговицы. Офтальмология. 2017;15(3): 180–187. doi: 10.18008/1816-5095-2017-3-180-187
3. Тальдаев Р.Э., Андреева Д.И., Киясов А.П. Опыт применения консервированного трансплантата роговицы при сквозной кератопластике. Гены & Клетки. 2014;9(3): 136–139.
4. Gain P, Jullienne R, He Z, Aldossary M, Acquart S, Cognasse F, Thuret G. Global survey of corneal transplantation and eye banking. JAMA Ophthalmol. 2016;134(2): 167–173. doi: 10.1001/jamaophthalmol.2015.4776
5. Armitage WJ, Goodchild C, Griffin MD, Gunn DJ, Hjortdal J, Lohan P, Murphy C, Pleyer U, Ritter T, Tole DM, Vabres B High-risk Corneal transplantation: recent developments and future possibilities. Transplantation. 2019;103(12): 2468–2478. doi: 10.1097/TP.0000000000002938
6. Barraquer RI, Pareja-Aricò L, Gómez-Benlloch A, Michael R. Risk factors for graft failure after penetrating keratoplasty. Medicine. 2019;98(17): 5274. doi: 10.1097/ MD.0000000000015274
7. Stulting RD, Sugar A, Beck R, Belin M, Dontchev M, Feder RS, Gal RL, Holland EJ, Kollman C, Mannis MJ, Price F, Stark W, Verdier DD. Effect of donor and recipient factors on corneal graft rejection. Cornea. 2012(31): 1141–1147. doi: 10.1097/ICO.0b013e31823f77f5
8. Mahabadi N, Czyz CN, Tariq M, Havens SJ. Corneal graft rejection. Treasure Island (FL). StatPearls Publishing; 2021.
9. Gal RL, Dontchev M, Beck RW, Mannis MJ, Holland EJ, Kollman C, Dunn SP, Heck EL, Lass JH, Montoya MM, Schultze RL, Stulting D, SugaA, Sugar J, Tennant B, Verdier DD. The effect of donor age on corneal transplantation outcome results of the cornea donor study. Ophthalmology. 2008;115(4): 620–626. doi: 10.1016/j.ophtha.2008.01.003
10. Sugar A, Tanner JP, Dontchev M, Tennant B, Schultze RL, Dunn SP, Lindquist TD, Gal RL, Beck RW, Kollman C, Mannis MJ, Holland EJ. Recipient risk factors forgraft failure in the cornea donor study. Ophthalmology. 2009. 116(6): 1023–1028. doi: 10.1016/j.ophtha.2008.12.050
11. Sugar A, Gal RL, Kollman C, Raghinaru D, Dontchev M, Croasdale CR, Feder RS, Holland EJ, Lass JH, Macy JI, Mannis MJ, Smith PW, Soukiasian SH, Beck RW. Factors associated with corneal graft survival in the cornea donor study. JAMA Ophthalmol. 2015;133(3): 246–254. doi: 10.1001/jamaophthalmol.2014.3923
12. Kayukawa K, Kitazawa K, Wakimasu K, Patel SV, Bush J, Sotozono C, Kinoshita S. Long-Term Maintenance of Corneal Endothelial Cell Density After Corneal Transplantation. Cornea. 2020:39(12): 1510–1515. doi: 10.1097/ICO.0000000000002386
13. Сахнов С.Н., Мясникова В.В., Марцинкевич А.О., Мелконян К.И., Русинова Т.В., Юцкевич Я.А. Прогностическая и профилактическая роль различных факторов в отторжении роговицы после кератопластики. Офтальмохирургия. 2021;(1): 82–87. doi: 10.25276/0235-4160-2021-1-82-87
14. Dunn SP, Gal RL, Kollman C, Raghinaru D, Dontchev M, Blanton CL, Holland EJ, Lass JH, Kenyon KR, Mannis MJ, Mian SI, Rapuano CJ, Stark WJ, Beck RW. Corneal graft rejection 10 years after penetrating keratoplasty in the cornea donor study. Cornea. 2014;33(10): 1003–1009. doi: 10.1097/ICO.0000000000000212.
15. Lass JH, Benetz BA, Patel SV, Szczotka-Flynn LB, O’Brien R, Ayala AR, Maguire MG, Daoud YJ, Greiner MA, Hannush SB, Lee WB, Mauger TF, Menegay HJ, Mifflin MD, Raizman MB, Rose-Nussbaumer J, Schultze RL, Schmidt GA, Sugar A, Terry MA, Verdier DD. Donor, recipient and operative factors associated with increased endothelial cell loss in the cornea preservation time study. JAMA Ophthalmol. 2019;137(2): 185–193. doi: 10.1001/jamaophthalmol.2018.5669
16. Zhu BB, Zhou J, Zheng J, Zhang Y, Wan T, Huang XD, Lin L, Jin XM. Corneal graft melting: a systematic review. Int J Ophthalmol. 2020;13(3): 493–502. doi: 10.18240/ ijo.2020.03.19
17. Плескова А.В., Катаргина Л.А., Мазанова Е.В. Сквозная кератопластика у детей: результаты хирургического лечения. Офтальмохирургия. 2018;(3): 26–32. doi: 10.25276/0235-4160-2018-3-26-32
18. Труфанов С.В., Суббот А.М., Маложен С.А., Крахмалева Д.А. Гипотеза иммунной привилегии роговицы и патофизиология отторжения кератотрансплантата. Вестник офтальмологии. 2016;132(5): 117–124. doi: 10.17116/oftalma20161325117-124
19. Williams KA, Keane MC, Coffey NE, Jones VJ, Mills RAD, Coster DJ. Flinders Unviersity; The Australian corneal graft registry 2018 report. South Australian Health and Medical Research Institute. Available from: https://dspace.flinders.edu.au/xmlui/handle/2328/37917 [Accessed 21rd October 2021]
20. Al-Sharif EM, Alkharashi M. Indications, surgical procedures and outcomes of keratoplasty at a Tertiary University-based hospital: a review of 10 years’ experience. International Ophthalmology. 2021;41(3): 957–972. doi: 10.1007/s10792-021-01731-2
21. Hopkinson CL, Romano V, Kaye RA, Steger B, Stewart RMK, Tsagkataki M, Jons MNA, Larkin DFP, Kaye SB. The influence of donor and recipient gender incompatibility on corneal transplant rejection and failure. Am J Transplant. 2017;17(1): 210–217. doi: 10.1111/ajt.13926
22. Zazzo AD, Kheirkhah A, Abud TB, Goyal S, and Dana R Management of Highrisk Corneal Transplantation. Surv Ophthalmol. 2017;62(6): 816–827. doi: 10.1016/j. survophthal.2016.12.010
Fyodorov Journal of Ophthalmic Surgery. 2021; : 12-20
Corneal graft survival analysis after penetrating keratoplasty in a retrospective cohort study
https://doi.org/10.25276/0235-4160-2021-4-12-20Abstract
Purpose. To assess the results of penetrating keratoplasty and identify the risk factors for the graft disease (GD) development. Material and methods. Data of 582 patients after corneal transplantation performed in the period since 2011 to 2019 for keratoconus (41%), as well for corneal leucorrhoea and dystrophies (59%), aggravated by concomitant pathology, the so-called high-risk keratoplasty (HRK) were analyzed in a retrospective cohort study. We estimated the functional results and incidence of GD. The calculation of the t-criterion; cross-tabulation method; Kaplan–Meier survival analysis and multivariate analysis were applied.
Results. As a result of penetrating keratoplasty, the BCVA (best corrected visual acuity) in patients with keratoconus increased by 20%; in patients with HRK – by 8%. In the general group the graft survival rate was 72%, while the 8-year successful graft engraftment in patients with keratoconus comprised 91%, with HRK – 60%. A significant relationship of the GD development with preoperative diagnosis and rekeratoplasty was determined. The risk of GD incidence was minimal in patients under 30 years of age and maximum in patients aged from 50 to 70 years. Survival rates for corneal transplants were better in men than in women.
Conclusion. Penetrating keratoplasty in patients with keratoconus provides a good functional result with a minimal risk of GD development. With penetrating keratoplasty in high-risk patients, the effectiveness of surgical interventions is significantly lower (by ~30%).
References
1. Malyugin B.E., Izmailova S.B., Aiba E.E., Drozdov I.V., Pashtaev A.N. Sravnitel'nyi analiz kliniko-funktsional'nykh rezul'tatov perednei glubokoi posloinoi i skvoznoi keratoplastiki po povodu keratokonusa. Oftal'mokhirurgiya. 2013;4: 44–49. 2013;(4): 44–49.
2. Trufanov S.V., Subbot A.M., Malozhen S.A., Krakhmaleva D.A., Salovarova E.P. Reaktsiya tkanevoi nesovmestimosti posle transplantatsii rogovitsy. Oftal'mologiya. 2017;15(3): 180–187. doi: 10.18008/1816-5095-2017-3-180-187
3. Tal'daev R.E., Andreeva D.I., Kiyasov A.P. Opyt primeneniya konservirovannogo transplantata rogovitsy pri skvoznoi keratoplastike. Geny & Kletki. 2014;9(3): 136–139.
4. Gain P, Jullienne R, He Z, Aldossary M, Acquart S, Cognasse F, Thuret G. Global survey of corneal transplantation and eye banking. JAMA Ophthalmol. 2016;134(2): 167–173. doi: 10.1001/jamaophthalmol.2015.4776
5. Armitage WJ, Goodchild C, Griffin MD, Gunn DJ, Hjortdal J, Lohan P, Murphy C, Pleyer U, Ritter T, Tole DM, Vabres B High-risk Corneal transplantation: recent developments and future possibilities. Transplantation. 2019;103(12): 2468–2478. doi: 10.1097/TP.0000000000002938
6. Barraquer RI, Pareja-Aricò L, Gómez-Benlloch A, Michael R. Risk factors for graft failure after penetrating keratoplasty. Medicine. 2019;98(17): 5274. doi: 10.1097/ MD.0000000000015274
7. Stulting RD, Sugar A, Beck R, Belin M, Dontchev M, Feder RS, Gal RL, Holland EJ, Kollman C, Mannis MJ, Price F, Stark W, Verdier DD. Effect of donor and recipient factors on corneal graft rejection. Cornea. 2012(31): 1141–1147. doi: 10.1097/ICO.0b013e31823f77f5
8. Mahabadi N, Czyz CN, Tariq M, Havens SJ. Corneal graft rejection. Treasure Island (FL). StatPearls Publishing; 2021.
9. Gal RL, Dontchev M, Beck RW, Mannis MJ, Holland EJ, Kollman C, Dunn SP, Heck EL, Lass JH, Montoya MM, Schultze RL, Stulting D, SugaA, Sugar J, Tennant B, Verdier DD. The effect of donor age on corneal transplantation outcome results of the cornea donor study. Ophthalmology. 2008;115(4): 620–626. doi: 10.1016/j.ophtha.2008.01.003
10. Sugar A, Tanner JP, Dontchev M, Tennant B, Schultze RL, Dunn SP, Lindquist TD, Gal RL, Beck RW, Kollman C, Mannis MJ, Holland EJ. Recipient risk factors forgraft failure in the cornea donor study. Ophthalmology. 2009. 116(6): 1023–1028. doi: 10.1016/j.ophtha.2008.12.050
11. Sugar A, Gal RL, Kollman C, Raghinaru D, Dontchev M, Croasdale CR, Feder RS, Holland EJ, Lass JH, Macy JI, Mannis MJ, Smith PW, Soukiasian SH, Beck RW. Factors associated with corneal graft survival in the cornea donor study. JAMA Ophthalmol. 2015;133(3): 246–254. doi: 10.1001/jamaophthalmol.2014.3923
12. Kayukawa K, Kitazawa K, Wakimasu K, Patel SV, Bush J, Sotozono C, Kinoshita S. Long-Term Maintenance of Corneal Endothelial Cell Density After Corneal Transplantation. Cornea. 2020:39(12): 1510–1515. doi: 10.1097/ICO.0000000000002386
13. Sakhnov S.N., Myasnikova V.V., Martsinkevich A.O., Melkonyan K.I., Rusinova T.V., Yutskevich Ya.A. Prognosticheskaya i profilakticheskaya rol' razlichnykh faktorov v ottorzhenii rogovitsy posle keratoplastiki. Oftal'mokhirurgiya. 2021;(1): 82–87. doi: 10.25276/0235-4160-2021-1-82-87
14. Dunn SP, Gal RL, Kollman C, Raghinaru D, Dontchev M, Blanton CL, Holland EJ, Lass JH, Kenyon KR, Mannis MJ, Mian SI, Rapuano CJ, Stark WJ, Beck RW. Corneal graft rejection 10 years after penetrating keratoplasty in the cornea donor study. Cornea. 2014;33(10): 1003–1009. doi: 10.1097/ICO.0000000000000212.
15. Lass JH, Benetz BA, Patel SV, Szczotka-Flynn LB, O’Brien R, Ayala AR, Maguire MG, Daoud YJ, Greiner MA, Hannush SB, Lee WB, Mauger TF, Menegay HJ, Mifflin MD, Raizman MB, Rose-Nussbaumer J, Schultze RL, Schmidt GA, Sugar A, Terry MA, Verdier DD. Donor, recipient and operative factors associated with increased endothelial cell loss in the cornea preservation time study. JAMA Ophthalmol. 2019;137(2): 185–193. doi: 10.1001/jamaophthalmol.2018.5669
16. Zhu BB, Zhou J, Zheng J, Zhang Y, Wan T, Huang XD, Lin L, Jin XM. Corneal graft melting: a systematic review. Int J Ophthalmol. 2020;13(3): 493–502. doi: 10.18240/ ijo.2020.03.19
17. Pleskova A.V., Katargina L.A., Mazanova E.V. Skvoznaya keratoplastika u detei: rezul'taty khirurgicheskogo lecheniya. Oftal'mokhirurgiya. 2018;(3): 26–32. doi: 10.25276/0235-4160-2018-3-26-32
18. Trufanov S.V., Subbot A.M., Malozhen S.A., Krakhmaleva D.A. Gipoteza immunnoi privilegii rogovitsy i patofiziologiya ottorzheniya keratotransplantata. Vestnik oftal'mologii. 2016;132(5): 117–124. doi: 10.17116/oftalma20161325117-124
19. Williams KA, Keane MC, Coffey NE, Jones VJ, Mills RAD, Coster DJ. Flinders Unviersity; The Australian corneal graft registry 2018 report. South Australian Health and Medical Research Institute. Available from: https://dspace.flinders.edu.au/xmlui/handle/2328/37917 [Accessed 21rd October 2021]
20. Al-Sharif EM, Alkharashi M. Indications, surgical procedures and outcomes of keratoplasty at a Tertiary University-based hospital: a review of 10 years’ experience. International Ophthalmology. 2021;41(3): 957–972. doi: 10.1007/s10792-021-01731-2
21. Hopkinson CL, Romano V, Kaye RA, Steger B, Stewart RMK, Tsagkataki M, Jons MNA, Larkin DFP, Kaye SB. The influence of donor and recipient gender incompatibility on corneal transplant rejection and failure. Am J Transplant. 2017;17(1): 210–217. doi: 10.1111/ajt.13926
22. Zazzo AD, Kheirkhah A, Abud TB, Goyal S, and Dana R Management of Highrisk Corneal Transplantation. Surv Ophthalmol. 2017;62(6): 816–827. doi: 10.1016/j. survophthal.2016.12.010
