穿透性角膜移植后糖皮质激素眼液对植片慢性失功的影响(英文)

Effects of topical corticosteroid treatment on chronic corneal allograft dysfunction after penetrating keratoplasty

背景:穿透性角膜移植后即使没有发生免疫排斥反应,植片内皮细胞密度也会以超生理的速度进行性下降,即发生植片内皮细胞慢性失功。目的:评价穿透性角膜移植后局部糖皮质激素眼液对植片内皮细胞慢性失功的影响。设计、时间及地点:临床对比分析,于2004-05/2009-05在同济大学附属同济医院眼科内实施。对象:穿透性角膜移植患者54例(54只眼)。方法:对穿透性角膜移植病例术后以妥布霉素地塞米松眼液治疗:6次/d,1个月;4次/d,2个月;2次/d,1个月,之后分为停药组和长期组。长期组以2次/d,再持续治疗直到术后12个月,停药组停止以任何激素或免疫抑制药物眼局部或全身治疗。主要观察指标:对患者内皮细胞密度进行随访,随访时间(3.12±0.28)年。结果:停药组和长期组在穿透性角膜移植后36个月内植片内皮细胞密度均有显著降低,内皮细胞密度在各随访时间点与前次随访结果相比均显著下降(P均<0.01),停药组内皮细胞密度由术前的(2438±211)个/mm2降低到术后的(1424±124)个/mm2;长期组由术前的(2791±229)个/mm2降低到术后的(1614±114)个/mm2。停药组和长期组在术前和术后各时间点组间比较时,差异有显著性意义(P<0.01),但2条曲线的变化趋势基本一致,即穿透性角膜移植后糖皮质激素眼液治疗并不能对内皮细胞密度的减少造成影响(P>0.05)。结论:局部糖皮质激素眼液治疗不能缓解植片内皮细胞慢性失功的进展速度。

BACKGROUND：Corneal graft endothelial cell density may decline spontaneously at a super-physiological speed after penetrating keratoplasty （PKP）,even if no corneal rejection happens,and this is chronic corneal allograft dysfunction （CCAD）.OBJECTIVE：To investigate the effects of topical corticosteroid treatment on chronic corneal allograft dysfunction after PKP.DESIGN,TIME AND SETTING：A controlled clinical analysis was performed at the Department of Ophthalmology,Tongji Hospital,Tongji University from May 2004 to May 2009.PARTICIPANTS：A total of 54 patients （eyes） who underwent PKP were included in this study.METHODS：Tobramycin-dexamethasone eyedrops was applied 6 times per day as an initial dosage and tapered during 4 months.Thereafter,drug withdrawal group and long term group were randomly divided.Treatments were ceased in the drug withdrawal group but were continued in the long-term group with a dosage of twice per day till 12 months after surgery.MAIN OUTCOME MEASURES：Corneal graft endothelial cell density was followed up.The mean follow up period was 3.12±0.28 years.RESULTS：The corneal graft endothelial cell density of drug withdrawal and long term groups was dramatically declined within 36 months after PKP.At every time point,the endothelial cell density was significantly decreased compared to the last follow up （all P〈0.01）.The endothelial cell density was decreased from （2 428 ±211） cells/mm^2 and （2 791 ±229） cells/mm^2 to （1 424 ± 124） cells/mm^2 and （1 614 ±114） cells/mm^2 in the drug withdrawal and long-term groups,respectively.There was significant difference in endothelial cell density between the two groups no matter prior to surgery or at each time points after surgery,but the declination trends of two groups were basically the same,indicating that graft loss of endothelial cell density was not impacted by topical corticosteroid treatment after PKP （P 〉 0.05）.CONCLUSION：Chronic corneal allograft dysfunction after PKP is independent of topical corticosteroid treatment.