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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: After penetrating keratoplasty, even if no immune rejection occurs, the density of endothelial cells in the grafts will decline at a super-physiological rate, that is, chronic failure of graft endothelial cells occurs. Objective: To evaluate the effect of topical glucocorticoid ophthalmic solution on the chronic failure of endothelial cells after penetrating keratoplasty. DESIGN, TIME AND SETTING: The clinical comparative analysis was performed at Department of Ophthalmology, Tongji Hospital, Tongji University from May 2004 to May 2009. Subjects: 54 cases of penetrating keratoplasty (54 eyes). Methods: The patients with penetrating keratoplasty were treated with tobramycin dexamethasone ophthalmic solution: 6 times / d for 1 month, 4 times / d for 2 months, 2 times / d for 1 month, Then divided into withdrawal group and long-term group. The long-term group with 2 / d, and then continue treatment until 12 months after the withdrawal group to stop any hormones or immunosuppressive drugs eye or systemic treatment. MAIN OUTCOME MEASURES: Patient endothelial cell density was followed up for 3.12 ± 0.28 years. Results: The decellularized endothelial cell density was significantly decreased within 36 months after penetrating keratoplasty and the endothelial cell density was significantly decreased at each time point compared with the previous follow-up (P <0.01). The density of endothelial cells in the withdrawal group decreased from (2438 ± 211) / mm2 preoperatively to (1424 ± 124) / mm2 postoperatively. The long term group was (2791 ± 229) / mm2 Decreased to (1614 ± 114) / mm2 postoperatively. The difference between the two groups was significant (P <0.01), but the trends of the two curves were basically the same, that is, the changes of glucocorticoids after penetrating keratoplasty Hormone eye drops did not affect the reduction of endothelial cell density (P> 0.05). CONCLUSION: Topical glucocorticoid ophthalmic treatment can not alleviate the rate of progression of chronic failure of endothelial cells.