眼球穿通伤后角膜移植术的预后

Prognosis of keratoplasty after penetrating eye injury (Germ)

Background: The success of penetrating keratoplasty (PKP)-after penetrating e ye injuries is often worse than in keratoplasty with Fuchs’endothelial dystroph y. However, comparable investigations are rare. Therefore, we have retrospective ly analyzed the results and complication rates of PKPs in patients who experienc ed penetrating eye injuries. Patients and Methods: Between 1990 and 1997 forty- four patients who received a corneal transplant at Kiel University Eye Hospital after penetrating eye injury (study group S) were analyzed. 29 patients were re -examined (visual acuity testing, slit lamp microscopy, applanation tonometry, stereo testing, corneal TMS topography, keratometry, endothelial microscopy, per imetry, indirect retinoscopy, testing of the retinal visual acuity and probatory contact lens fitting). Postoperative follow-up ranged between 1 and 6 years (m edian 3 years). The results were compared to a group of corneal grafts performed in patients with Fuchs’endothelial dystrophy (K, n=18 patients, 25 eyes,median follow-up 2.8 years). Results: 38 males and 6 women had had a bilateral visual acuity of 0.8 or better before the accident, except for three cases. At the tim e of eye injury the patients’age ranged from 4 to 76 years. The eye trauma was caused by splinters of metal (45%), glass (20%), wood (16%) or stone (11%). In 73%of the cases the injury was confined to the anterior segment of the eye ( S1). The posterior part of the eye was involved in 27%(S2). BCVA of S before ke ratoplasty (KP) was 1/15 on average (K 0.2), at least one year after KP 0.25 (K 0.4); post KP S1 was better than S2 (P=0.0234), and K better than S (P=0.0009) . In group S 29 patients received a graft at random because of a central corneal scar, 14 patients received an HLA-typed graft with 2.3 mismatches on average. 9 3%of the grafts (41 patients) were clear at the last examination, 8 patients sh owed rejection episodes, half of them were reversible. 5 patients received a sec ond graft because of an irreversible rejection or endothelial decompensation. BC VA improved by at least one line in 84%in S (K 92%). BCVA was unchanged after KP in 6.8%(K 8%). In 9.1%of S BCVA after KP was worse (K 0%). 32 out of 44 p atients had a BCVA of 0.1 or better after the last check-up, 13 out of 44 patie nts presentedwith a BCVA of 0.5 or better (K 40%). 15 out of 29 patients separa tely tested showed stereopsis compared to 8 preoperatively in S. In 48%of the p atients studied stereovision could not be restored. 82%of the patients suffered from topographical irregular astigmatismin S, the superficial geometry of recip ient’s cornea seems relevant for astigmatism of the graft. Frequent postsurgica l complications consisted of secondary glaucoma (S 27%, K 4%), immunological r ejections (S 18%, K 0%), and amblyopia (S 14%, K 0%). Conclusion: Compared t o patients with Fuchs’dystrophy the results of grafting after eye injuries are significantly worse. This relates to BCVA, astigmatism, frequency of secondary g laucoma and graft rejection.