RESUMEN
OBJECTIVE: To determine the long-term corneal graft survival in patients of General Hospital Dr. Miguel Silva. MATERIALS AND METHODS: This was a retrospective cohort study. Records from patients who underwent corneal transplant surgery at General Hospital Dr. Miguel Silva were analyzed. The percentages of graft failure were obtained. Kaplan-Meier survival analysis was performed to evaluate the long-term cumulative probability of graft non-rejection in all patients according to diagnosis. RESULTS: Overall, 71.9% (CI 95%: 64.8-78.9) of the patients did not have any graft rejections, and 12.5% (CI 95%: 7-18) required a regraft and were considered graft failures. Patients with posttraumatic leucoma had a cumulative probability of non-rejection of 100%. Subjects with keratoconus had a 65% likelihood of non-rejection after 40 months of follow-up. The likelihood of non-rejection was greater than 80% at 100 months of follow-up in pseudophakic bullous keratopathy patients and 60% at 20 months of follow-up in inactive herpetic leucoma patients. CONCLUSIONS: Posttraumatic leucoma patients had the greatest cumulative survival probability compared with postherpetic leucoma patients and other patient groups.
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Trasplante de Córnea , Adulto , Estudios de Cohortes , Trasplante de Córnea/mortalidad , Femenino , Humanos , Masculino , Estudios Retrospectivos , Centros de Atención Secundaria , Análisis de SupervivenciaRESUMEN
BACKGROUND: Our aims were to examine graft survival and visual outcome after full-thickness corneal transplantation. METHODS: Records of 18,686 penetrating corneal grafts, 14,622 with archival follow-up from 1 to 22 years, were examined within a national database. Kaplan-Meier survival analysis indicated variables of interest for Cox proportional hazards regression analysis. A model clustered by patient to control intereye or intergraft dependence was constructed to identify variables best predicting penetrating corneal graft failure. Visual acuity in the grafted eye was measured by Snellen acuity. RESULTS: Probability of corneal graft survival was 0.87, 0.73, 0.60, and 0.46 at 1, 5, 10, and 15 years, respectively. Reasons for graft failure included irreversible rejection (34%), corneal endothelial cell failure including cases of glaucoma (24%), and infection (14%). Variables predicting graft failure in multivariate analysis included transplant center, location and volume of surgeon's case-load, graft era, indication for graft, number of previous ipsilateral grafts, lens status, corneal neovascularization at transplantation, a history of ocular inflammation or raised intraocular pressure, graft diameter, and postoperative events including graft neovascularization and rejection. Best-corrected Snellen acuity of 6/12 or better was achieved by 45%, and of less than 6/60 by 26%, of grafted eyes at last follow-up. CONCLUSIONS: The short-term survival of penetrating corneal transplants is excellent, but the eventual attrition rate appears inexorable and many factors that influence graft survival significantly are not amenable to change. Most penetrating grafts are performed for visual improvement, and excellent acuity will be achieved by approximately half of all grafts.
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Trasplante de Córnea/fisiología , Distribución por Edad , Australia , Trasplante de Córnea/efectos adversos , Trasplante de Córnea/mortalidad , Bases de Datos Factuales , Oftalmopatías/clasificación , Oftalmopatías/etiología , Femenino , Supervivencia de Injerto/fisiología , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Análisis de Supervivencia , Insuficiencia del Tratamiento , Resultado del Tratamiento , Agudeza VisualRESUMEN
BACKGROUND: In a large patient cohort, we investigated long-term corneal graft outcome, risk factors for graft failure, and whether corneal graft survival had improved over time. METHODS: Records of 10,952 full-thickness corneal grafts with associated archival follow-up were examined within a prospectively-maintained, national database of 13,831 records, with follow-up extending for up to 18 years. Kaplan-Meier survival analysis was used to indicate variables of interest for Cox proportional hazards regression analysis. A model clustered by individual patient to control for inter-eye or inter-graft dependence was constructed to identify variables best predicting penetrating corneal graft failure. RESULTS: Probability of corneal graft survival was 0.86 at 1 year, 0.73 at 5 years, 0.62 at 10 years, and 0.55 at 15 years. Graft survival did not improve over a 15-year timeframe. Variables predicting graft failure in multivariate analysis included transplant centre, donor age, preoperative diagnosis, number of previous ipsilateral grafts, lens status, history of corneal neovascularisation, ocular inflammation or raised intraocular pressure in the grafted eye, requirement for anterior vitrectomy, graft size, early suture removal, postoperative events including graft neovascularisation, rise in intraocular pressure, and rejection episodes, type of treatment for raised intraocular pressure, and arrangements for recipient follow-up. A further 11 variables showing a significant influence on graft survival in univariate analysis were not included in the final Cox model. CONCLUSION: The long-term results of corneal transplantation are no better than for other forms of transplantation and have shown no measurable improvement over the past 15 years.
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Trasplante de Córnea , Trasplante de Córnea/métodos , Trasplante de Córnea/mortalidad , Supervivencia de Injerto , Humanos , Análisis Multivariante , Sistema de RegistrosRESUMEN
BACKGROUND: Studies in corneal transplant rejection remain important because acute immunologic rejection continues to be the leading cause of human corneal transplant failure. As the permeability of vessels and the neovascularization induce cells infiltration into the graft, we considered the possibility that vascular endothelial growth factor (VEGF), a potent permeability-increasing factor and angiogenesis-mediating factor, could participate in the immune response. METHODS: As the established corneal transplant model for rejection, the corneal transplant between Lewis and Fisher rats has been reported. First, we evaluated VEGF production in the graft by immunohistochemical method in the animal model. Next, we tried to neutralize the effect of VEGF by topical administration of anti-VEGF antibody. We administered anti-VEGF antibody as eye drops for 10 days just after the transplantation of the established animal corneal transplant model. RESULTS: VEGF was strongly produced from the infiltrative cells into the graft. Anti-VEGF antibody significantly suppressed the acute rejection compared with saline or rabbit IgG. CONCLUSIONS: The inhibition of VEGF by topically applied neutralizing antibody is a new potential therapeutic strategy for the treatment of corneal transplantation.
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Trasplante de Córnea/inmunología , Factores de Crecimiento Endotelial/inmunología , Linfocinas/inmunología , Administración Tópica , Animales , Anticuerpos/administración & dosificación , Neovascularización de la Córnea/patología , Neovascularización de la Córnea/fisiopatología , Trasplante de Córnea/mortalidad , Rechazo de Injerto/prevención & control , Ratas , Ratas Endogámicas F344 , Ratas Endogámicas Lew , Tasa de Supervivencia , Factor A de Crecimiento Endotelial Vascular , Factores de Crecimiento Endotelial VascularRESUMEN
The results of tissue typing on 115 recipient/donor pairs prior to corneal grafting were analyzed with the proportional hazard regression model for the incidence of the first rejection episode and for graft failure from rejection. Like other investigators, we found that a previously failed corneal graft and the degree of recipient corneal vascularization were significant risk factor for graft rejection. ABO blood group matching had no effect. The absence of mismatches in both the HLA-A and HLA-DR loci decreased the incidence of rejection. However, no difference was observed for the presence of one versus two mismatches. Regression results for the HLA-A and DR loci were not significant. Surprisingly, matching for one or both HLA-B alleles resulted in a significantly higher incidence of graft rejection episodes (P < 0.005) and of graft failure (P < 0.052). This adverse matching effect for the B locus was proportional to the number of mismatches.
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Trasplante de Córnea/inmunología , Rechazo de Injerto/epidemiología , Supervivencia de Injerto , Antígenos HLA-B/inmunología , Prueba de Histocompatibilidad , Sistema del Grupo Sanguíneo ABO , Trasplante de Córnea/métodos , Trasplante de Córnea/mortalidad , Estudios de Seguimiento , Antígenos HLA-A/inmunología , Antígenos HLA-DR/inmunología , Humanos , Modelos de Riesgos Proporcionales , Reoperación , Factores de Riesgo , Tasa de Supervivencia , Insuficiencia del TratamientoRESUMEN
OBJECTIVES: To determine if melanomas have occurred in the recipients of corneas from donor eyes with primary choroidal melanomas and to determine the success of corneal grafting with tissue taken from eyes with primary choroidal melanomas. DESIGN: Retrospective cohort comparison and follow-up patient questionnaire. SETTING: A tertiary medical center in Rochester, Minn. PATIENTS: In patients who received corneal transplants, we reviewed 47 consecutive corneas transplanted from donor eyes enucleated for choroidal melanomas and compared them with 47 corneal grafts from donor eyes without melanomas matched for recipient age (+/- 10 years), date of operation (+/- 12 months), corneal storage time (+/- 24 hours), and operation type. RESULTS: No melanomas occurred in either group over a mean follow-up of 5.4 years (range, 0.4 to 15 years). There was no significant difference between the two groups in corneal thickness and endothelial cell loss at 2 months and 1 year after transplantation and in the probability of a rejection episode. CONCLUSIONS: There is no evidence of tumor transmission by transplantation of corneas from donor eyes with primary choroidal melanomas. Corneas transplanted from donor eyes with primary choroidal melanomas have similar outcomes to corneas transplanted from donor eyes without melanomas.