| Objective:To summarize the clinical data related to patients who underwent corneal transplantation for complex corneal lesions and had regular postoperative follow-up observations from 2015-2016 at the First Affiliated Hospital of Dali University,and to review the medium-and long-term outcomes of 63 corneal transplantation cases over 5years.Methods: This is a retrospective study of 63 corneal transplantation patients.Baseline information and clinical information were included.Baseline information included:name,gender,age,ethnicity,occupation,and economic level.Clinical information included: etiology,preoperative general and ocular status,surgical procedure:penetrating keratoplasty(PK)/ anterior lamellar keratoplasty(ALK),postoperative visual acuity,implant survival,corneal graft rejection,and ocular surface analysis.reactions,ocular surface analysis.t-test and chi square-test were used to evaluate the differences among the variables,Kaplan Meier survival analysis was used to evaluate the graft survival rate,and univariate analysis was used to determine the potential risk factors.Results: 1.In this group,25(39.6%)of the corneal transplantation patients with middle income or above,and 38(60.4%)patients with lower middle income or low income.2.63 eyes were transplanted for various corneal diseases in this group,46 males(46eyes)and 17 females(17 eyes);aged 16-85 years,with a mean age of 57±2.5(54.5-59.5)years.There was no significant difference in age(P=0.72)and gender(P=1.70)between the PK and ALK groups.3.In this group,the most common preoperative diagnosis was corneal leukoplakia caused by various reasons in 27 eyes(42.8%),followed by infectious keratitis in 19eyes(30.1%),including bacterial corneal ulcer in 6 eyes,viral corneal ulcer in 6 eyes,fungal corneal ulcer in 7 eyes;previous trauma inducement in 32 eyes(50.8%);farmers were the most common occupation,33 people(52.4%);age distribution of patients was different The age of the middle-aged group(45-59 years old)was 23(36.5%).4.In this group,38 eyes(60.3%)had improved vision after corneal transplantation.52 eyes were blind preoperatively and 27 eyes recovered after surgery,with the recovery rate of 51.9%.Visual acuity results: 52 eyes(82.5%)had preoperative visual acuity<0.05,10 eyes(15.9%)had 0.05-0.3 and 1 eye(1.6%)had >0.3;25 eyes(39.7%)had postoperative visual acuity <0.05,27 eyes(42.8%)had 0.05-0.3 and 11 eyes(17.5%)had >0.3.The distribution of best corrected visual acuity before operation was significantly different from that after surgery(P < 0.001).5.The 5-year graft survival rate was 58%(n = 37)and 41.3%(n = 26)were confirmed as graft failure.Univariate analysis showed that preoperative primary disease,gender,age,operation mode and graft size were risk factors for graft survival rate(all P < 0.05),while nationality and preoperative ocular symptoms were not risk factors for graft survival rate(both P > 0.05).6.In this group,immune rejection(16 eyes,61.5%)was the main cause of transplantation failure.7.The results of ocular surface analysis showed that OSDI score was 22.4 ± 17.6 in 37 eyes with graft survival,5(13.5%)were normal(< 13),13(35.1%)were mild(13-22),15(40.5%)were moderate(22-32),and 4(10.9%)were severe(> 33).Noninvasive tear height: 0.17 ± 0.42 mm in operative eyes,0.24 ± 0.28 mm in healthy eyes,P = 0.03;noninvasive tear breakup time: Nikbut-f: 5.49 ± 2.0 seconds in operative eyes,9.524 ±3.53 seconds in healthy eyes,P < 0.01;Nikbut-ave: 6.97 ± 2.98 seconds in operative eyes,12.82 ± 1.95 seconds in healthy eyes,P < 0.01;eye redness analysis: 1.90 ± 0.53 minutes in affected eyes,1.98 ± 0.50 minutes in healthy eyes(P = 0.61).Conclusion: 1.Preoperative primary disease,gender,age,operation method and graft size are the risk factors affecting the survival rate of corneal grafts in Dali Bai nationality area.Coor economic and immune rejection is an important reason for the failure of corneal transplantation.2.dry eye symptoms will persist after corneal transplantation. |
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