PURPOSE:To identify risk factors for corneal graft rejection and rejection irreversibility. DESIGN:Retrospective cohort study. METHODS:setting: Institutional. patients: A total of 1438 consecutive eyes of 1438 patients who underwent corneal transplantation for optical indication at the Centre Hospitalier National d'Ophtalmologie des XV-XX, Paris, France, between December 1992 and December 2010 were studied. Surgical technique was penetrating keratoplasty (PK) in 1209 cases, anterior lamellar keratoplasty (ALK) in 165 cases, and Descemet stripping with endothelial keratoplasty in 64 cases. main outcome measures: Cumulative incidence of rejection episodes and rejection irreversibility rate. RESULTS:A total of 299 cases of rejection episodes were identified, of which 145 (48.5%) were irreversible after treatment. In multivariate analysis, the cumulative incidence of rejection episodes was influenced by recipient age (P = .00002), recipient rejection risk (P = .0003), lens status (P = .00003), and surgical group (P = .035). A higher incidence of rejection episodes was observed in young patients (<20 years) and patients aged from 41 to 50, high-risk recipients, aphakic eyes and eyes with anterior chamber intraocular lens, and eyes with PK (compared with eyes with ALK). Rejection episodes were more likely to be irreversible for high-risk recipients (P = .02), for eyes with preoperative hypertony (P = .009), and for eyes with poor visual acuity at presentation (P = .002). CONCLUSIONS:Recipient rejection risk and surgical group are the main risk factors for rejection as they both influence the incidence of rejection and the reversibility rate. Recipient age and lens status are predictive factors for the occurrence of rejection. Preoperative hypertony is a predictive factor for rejection irreversibility.

译文

目的:确定角膜移植排斥反应和排斥反应不可逆的危险因素。
设计:回顾性队列研究。
方法:设置:制度。患者:研究了1992年12月至2010年12月在法国巴黎国家眼科中心XV-XX中心进行角膜移植以进行光学指示的1438例患者的1438张连续眼睛。手术技术为穿透性角膜移植术(PK)1209例,前板层角膜移植术(ALK)165例,地塞米特剥离加内皮角膜移植术64例。主要结局指标:排斥反应发作的累积发生率和排斥反应不可逆率。
结果:共鉴定出299例排斥反应病例,其中145例(48.5%)在治疗后是不可逆的。在多变量分析中,排斥发作的累积发生率受受体年龄(P = .00002),受体排斥风险(P = .0003),晶状体状态(P = .00003)和手术组(P = .035)的影响。 。在年轻患者(<20岁)和41岁至50岁的患者,高风险接受者,无晶状体眼和前房人工晶状体眼以及PK眼(与ALK眼)相比,观察到排斥反应的发生率更高。 。高风险接受者(P = .02),术前高渗眼(P = .009)和呈现时视力差的眼睛(P = .002)的排斥反应更可能是不可逆的。
结论:接受排斥反应的风险和手术组是排斥反应的主要危险因素,因为它们都影响排斥反应的发生率和可逆性。接受者年龄和晶状体状态是排斥反应发生的预测因素。术前高渗是排斥反应不可逆的预测因素。

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