.: ORİJİNAL ARAŞTIRMA
Penetran Keratoplasti Yapılan Hastalarda Rejeksiyon Risk Faktörlerinin ve Tedavi Sonuçlarının Değerlendirilmesi
Evaluation of Risk Factors and Treatment Results in Patients with Penetrating Keratoplasty
Turkiye Klinikleri J Ophthalmol. 2019;28(3):154-60
doi: 10.5336/ophthal.2018-63388
Makale Dili: TR
Tam Metin
ÖZET
Amaç: Penetran keratoplasti (PK) yapılan hastalarda rejeksiyon risk faktörlerinin ve tedavi sonuçlarının değerlendirilmesidir. Gereç ve Yöntemler: Ocak 2013-Ağustos 2018 tarihleri arasında PK yapılan hastalar retrospektif olarak incelendi. Greft rejeksiyonu gelişenler çalışmaya dâhil edildi. Hastalar rejeksiyon risk faktörleri, tedavi yöntemleri, görme keskinlikleri, takip süresi, klinik bulgular ve rejeksiyona olan yanıt açısından değerlendirildi. Bulgular: Penetran keratoplasti uygulanan 305 hastadan, akut greft rejeksiyonu gerçekleşen 22 hastanın 22 gözü çalışmaya dâhil edildi. PK sonrası gelişen akut greft rejeksiyon süresi ortalama 12,22±10,95 ay idi. Korneal vaskülarizasyon, önceden keratoplasti geçirmiş olmak, ön sineşi, glokom varlığı, çoklu cerrahi, sütür problemleri, enfeksiyon, kimyasal yanık ve herpetik keratit varlığı rejeksiyon risk faktörlerini oluşturmakta idi. Tedavi verilen hastaların 11 (%50)'inde rejeksiyon gerilemişken, 11 (%50)'inde gerileme izlenmedi. Akut greft rejeksiyonu sırasında ortalama en iyi görme keskinliği 2,45±0,74 logMAR iken, tedavi sonrası üçüncü ayda görme keskinliği 1,88±1,09 logMAR idi. Sonuç: Korneal vaskülarizasyon, ön sineşi, glokom varlığı ve çoklu cerrahi geçirmiş olmak en önemli risk faktörlerini oluşturmuştur.
Anahtar Kelimeler: Greft reddi; korneal vaskülarizasyon; penetran keratoplasti; rejeksiyon risk faktörleri; rejeksiyon tedavisi
Amaç: Penetran keratoplasti (PK) yapılan hastalarda rejeksiyon risk faktörlerinin ve tedavi sonuçlarının değerlendirilmesidir. Gereç ve Yöntemler: Ocak 2013-Ağustos 2018 tarihleri arasında PK yapılan hastalar retrospektif olarak incelendi. Greft rejeksiyonu gelişenler çalışmaya dâhil edildi. Hastalar rejeksiyon risk faktörleri, tedavi yöntemleri, görme keskinlikleri, takip süresi, klinik bulgular ve rejeksiyona olan yanıt açısından değerlendirildi. Bulgular: Penetran keratoplasti uygulanan 305 hastadan, akut greft rejeksiyonu gerçekleşen 22 hastanın 22 gözü çalışmaya dâhil edildi. PK sonrası gelişen akut greft rejeksiyon süresi ortalama 12,22±10,95 ay idi. Korneal vaskülarizasyon, önceden keratoplasti geçirmiş olmak, ön sineşi, glokom varlığı, çoklu cerrahi, sütür problemleri, enfeksiyon, kimyasal yanık ve herpetik keratit varlığı rejeksiyon risk faktörlerini oluşturmakta idi. Tedavi verilen hastaların 11 (%50)'inde rejeksiyon gerilemişken, 11 (%50)'inde gerileme izlenmedi. Akut greft rejeksiyonu sırasında ortalama en iyi görme keskinliği 2,45±0,74 logMAR iken, tedavi sonrası üçüncü ayda görme keskinliği 1,88±1,09 logMAR idi. Sonuç: Korneal vaskülarizasyon, ön sineşi, glokom varlığı ve çoklu cerrahi geçirmiş olmak en önemli risk faktörlerini oluşturmuştur.
Anahtar Kelimeler: Greft reddi; korneal vaskülarizasyon; penetran keratoplasti; rejeksiyon risk faktörleri; rejeksiyon tedavisi
ABSTRACT
Objective: To evaluate the risk factors and treatment outcomes of rejection in patients undergoing penetrating keratoplasty (PK). Material and Methods: The patients who underwent PK between January 2013-August 2018 were retrospectively analyzed. Patients with graft rejection were included in the study. The cases were evaluated in terms of risk factors for rejection, treatment modalities, visual acuity, duration of follow-up, clinical findings, and response to rejection. Results: Twenty-two eyes of 22 patients who underwent acute graft rejection from 305 patients undergoing penetrating keratoplasty were included in the study. The mean duration of acute graft rejection after PC was 12.22±10.95 months. Corneal vascularization, pre-keratoplasty, anterior synechia, the presence of glaucoma, multiple surgery, suture problems, infection, the presence of chemical burns and herpetic keratitis were the risk factors for rejection. In 22 patients, rejection was observed in 11 (50%), and 11 (50%) did not. The mean best visual acuity during acute graft rejection was 2.45±0.74 logMAR and the mean visual acuity was 1.88±1.09 logMAR at the third month after the treatment. Conclusion: Corneal vascularization, anterior synechiae, presence of glaucoma and multiple surgery have been the most important risk factors.
Keywords: Graft rejection; corneal vascularization; penetrating keratoplasty; rejection risk factors; rejection treatment
Objective: To evaluate the risk factors and treatment outcomes of rejection in patients undergoing penetrating keratoplasty (PK). Material and Methods: The patients who underwent PK between January 2013-August 2018 were retrospectively analyzed. Patients with graft rejection were included in the study. The cases were evaluated in terms of risk factors for rejection, treatment modalities, visual acuity, duration of follow-up, clinical findings, and response to rejection. Results: Twenty-two eyes of 22 patients who underwent acute graft rejection from 305 patients undergoing penetrating keratoplasty were included in the study. The mean duration of acute graft rejection after PC was 12.22±10.95 months. Corneal vascularization, pre-keratoplasty, anterior synechia, the presence of glaucoma, multiple surgery, suture problems, infection, the presence of chemical burns and herpetic keratitis were the risk factors for rejection. In 22 patients, rejection was observed in 11 (50%), and 11 (50%) did not. The mean best visual acuity during acute graft rejection was 2.45±0.74 logMAR and the mean visual acuity was 1.88±1.09 logMAR at the third month after the treatment. Conclusion: Corneal vascularization, anterior synechiae, presence of glaucoma and multiple surgery have been the most important risk factors.
Keywords: Graft rejection; corneal vascularization; penetrating keratoplasty; rejection risk factors; rejection treatment
REFERANSLAR:
- Rahman I, Huang MC, Carley F, Hillarby MC, Vasileiadis GT, Tullo A. The influence of donor and recipient factors in allograft rejection of the human cornea. Eye (Lond). 2010;24(2):334-9. [Crossref] [PubMed]
- Patel NP, Kim T, Rapuano CJ, Cohen EJ, Laibson PR. Indications for and outcomes of repeat penetrating keratoplasty, 1989-1995. Ophthalmology, 2000;107(4): 719-24. [Crossref]
- Al-Mezaine H, Wagoner MD; King Khaled Eye Specialist Hospital Cornea Transplant Study. Repeat penetrating keratoplasty: indications, graft survival, and visual outcome. Br J Ophthalmol. 2006;90(3): 324-7. [Crossref] [PubMed] [PMC]
- Bourne WM. One-year observation of transplanted human corneal endothelium. Ophthalmology. 1980;87(7):673-9. [Crossref]
- Patel SV, Hodge DO, Bourne WM. Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty. Am J Ophthalmol. 2005;139(2):311-9. [Crossref] [PubMed]
- Wilson SE, Kaufman HE. Graft failure after penetrating keratoplasty. Surv Ophthalmol. 1990;34(5):325-6. [Crossref]
- Vail A, Gore SM, Bradley BA, Easty DL, Rogers CA, Armitage WJ. Conclusions of the corneal transplant follow up study. Collaborating Surgeons. Br J Ophthalmol. 1997;81(8): 631-6. [Crossref] [PubMed] [PMC]
- Maguire MG, Stark WJ, Gottsch JD, Stulting RD, Sugar A, Fink NE, et al. Risk factors for corneal graft failure and rejection in the collaborative corneal transplantation studies. Collaborative Corneal Transplantation Studies Research Group. Ophthalmology. 1994;101 (9):1536-47. [Crossref]
- Hori J. Mechanisms of immune privilege in the anterior segment of the eye: what we learn from corneal transplantation. J Ocul Biol Dis Infor. 2008;1(2-4):94-100. [Crossref] [PubMed] [PMC]
- Stulting RD, Sugar A, Beck R, Belin M, Dontchev M, Feder RS, et al. Effect of donor and recipient factors on corneal graft rejection. Cornea. 2012;31(10):1141-7. [Crossref] [PubMed] [PMC]
- Kharod-Dholakia B, Randleman JB, Bromley JG, Stulting RD. Prevention and treatment of corneal graft rejection: current practice patterns of the Cornea Society (2011). Cornea. 2015;34(6):609-14. [Crossref] [PubMed]
- Bachmann B, Taylor RS, Cursiefen C. Corneal neovascularization as a risk factor for graft failure and rejection after keratoplasty: an evidence-based meta-analysis. Ophthalmology. 2010;117(7):1300-5.e7. [Crossref] [PubMed]
- Bock F, Onderka J, Dietrich T, Bachmann B, Kruse FE, Paschke M, et al. Bevacizumab as a potent inhibitor of inflammatory corneal angiogenesis and lymphangiogenesis. Invest Ophthalmol Vis Sci. 2007;48(6):2545-52. [Crossref] [PubMed]
- Bock F, König Y, Kruse F, Baier M, Cursiefen C. Bevacizumab (Avastin) eye drops inhibit corneal neovascularization. Graefes Arch Clin Exp Ophthalmol. 2008;246(2):281-4. [Crossref] [PubMed]
- Kim SW, Ha BJ, Kim EK, Tchah H, Kim TI. The effect of topical bevacizumab on corneal neovascularization. Ophthalmology. 2008;115 (6):e33-8. [Crossref] [PubMed]
- Sellami D, Abid S, Bouaouaja G, Ben Amor S, Kammoun B, Masmoudi M, et al. Epidemiology and risk factors for corneal graft rejection. Transplant Proc. 2007;39(8):2609-11. [Crossref] [PubMed]
- Yamamoto S, Shimmura-Tomita M, Satake Y, Shimazaki-Den S, Shimmura S, Shimazaki J. [Factors affecting outcomes of repeated penetrating keratoplasty]. Nippon Ganka Gakkai Zasshi. 2015;119(9):625-31.
- Sherwood MB, Grierson I, Millar L, Hitchings RA. Long-term morphologic effects of antiglaucoma drugs on the conjunctiva and Tenon's capsule in glaucomatous patients. Ophthalmology. 1989;96(3):327-35. [Crossref]
- Baudouin C, Pisella PJ, Fillacier K, Goldschild M, Becquet F, De Saint Jean M, et al. Ocular surface inflammatory changes induced by topical antiglaucoma drugs: human and animal studies. Ophthalmology. 1999;106(3):556-63. [Crossref]
- Baudouin C. Side effects of antiglaucomatous drugs on the ocular surface. Curr Opin Ophthalmol. 1996;7(2):80-6. [Crossref] [PubMed]
- Price MO, Thompson RW Jr, Price FW Jr. Risk factors for various causes of failure in initial corneal grafts. Arch Ophthalmol. 2003;121 (8):1087-92. [Crossref] [PubMed]
- Olson RJ. Complications associated with running 11-0 nylon suture in penetrating keratoplasty. Ophthalmic Surg. 1982;13(7):558-61.
- Shimazaki J, Shimmura S, Tsubota K. Intraoperative versus postoperative suture adjustment after penetrating keratoplasty. Cornea. 1998;17(6):590-4. [Crossref] [PubMed]
- Dana MR, Goren MB, Gomes JA, Laibson PR, Rapuano CJ, Cohen EJ. Suture erosion after penetrating keratoplasty. Cornea. 1995;14(3): 243-8. [Crossref] [PubMed]
- van Rooij J, Rijneveld WJ, Remeijer L, Völker-Dieben HJ, Eggink CA, Geerards AJ, et al. Effect of oral acyclovir after penetrating keratoplasty for herpetic keratitis: a placebo-controlled multicenter trial. Ophthalmology. 2003;110(10):1916-9. [Crossref]
- Kuffova L, Knickelbein JE, Yu T, Medina C, Amescua G, Rowe AM, et al. High-risk corneal graft rejection in the setting of previous corneal herpes simplex virus (HSV)-1 infection. Invest Ophthalmol Vis Sci. 2016;57(4):1578-87. [Crossref] [PubMed] [PMC]
- Garcia DD, Farjo Q, Musch DC, Sugar A. Effect of prophylactic oral acyclovir after penetrating keratoplasty for herpes simplex keratitis. Cornea. 2007;26(8):930-4. [Crossref] [PubMed]
- van Rooij J, Rijneveld WJ, Remeijer L, Völker-Dieben HJ, Eggink CA, Geerards AJ, et al. Effect of oral acyclovir after penetrating keratoplasty for herpetic keratitis: a placebo-controlled multicenter trial. Ophthalmology. 2003;110(10):1916-9. [Crossref]
- Tambasco FP, Cohen EJ, Nguyen LH, Rapuano CJ, Laibson PR. Oral acyclovir after penetrating keratoplasty for herpes simplex keratitis. Arch Ophthalmol. 1999;117(4):445-9. [Crossref] [PubMed]
- Barker NH, Henderson TR, Ross CA, Coster DJ, Williams KA. Current Australian practice in the prevention and management of corneal allograft rejection. Clin Exp Ophthalmol. 2000;28(5):357-60. [Crossref] [PubMed]
- Perera C, Jhanji V, Lamoureux E, Pollock G, Favilla I, Vajpayee RB. Clinical presentation, risk factors and treatment outcomes of first allograft rejection after penetrating keratoplasty in early and late postoperative period. Eye (Lond). 2012;26(5):711-7. [Crossref] [PubMed] [PMC]
- Pleyer U, Steuhl KP, Weidle EG, Lisch W, Thiel HJ. Corneal graft rejection: incidence, manifestation, and interaction of clinical subtypes. Transplant Proc. 1992;24(5):2034-7.
- Alldredge OC, Krachmer JH. Clinical types of corneal transplant rejection. Their manifestations, frequency, preoperative correlates, and treatment. Arch Ophthalmol. 1981;99(4):599-604. [Crossref] [PubMed]
- Ing JJ, Ing HH, Nelson LR, Hodge DO, Bourne WM. Ten-year postoperative results of penetrating keratoplasty. Ophthalmology. 1998;105(10):1855-65. [Crossref]
.: İşlem Listesi