摘要
目的分析角膜移植手术前后眼库供体角膜内皮细胞形态和密度的变化及其影响因素。方法采用系列病例观察研究,纳入2020年7月至2021年6月于山东省眼库获取的用于穿透角膜移植术(PKP)和内皮移植术(EK)的118枚供体角膜,其中99枚(占83.90%)用于PKP,19枚(占16.10%)用于EK,分析眼库捐献者基本信息及角膜质量检测结果,与角膜移植术后1个月角膜内皮显微镜检测的内皮细胞密度(ECD)进行对比,观察手术前后内皮细胞的形态变化,分析导致角膜ECD和形态改变的因素。结果在采用PKP的99枚供体角膜中,不同年龄组术前眼库供体ECD和术后1个月植片ECD总体比较差异均有统计学意义(F=18.136、5.936,均P<0.01),其中31~60岁组和>60岁组术前供体ECD和术后1个月植片ECD均低于0~30岁组,>60岁组术前供体ECD和术后1个月植片ECD均低于31~60岁组,差异均有统计学意义(均P<0.01)。不同供体死亡原因组术前眼库供体ECD总体比较差异有统计学意义(F=4.524,P<0.01),其中外伤意外组术前眼库供体ECD均高于心脑血管疾病组、慢性器官衰竭组和恶性肿瘤组,差异均有统计学意义(均P<0.01)。死亡-取材时间≤6 h组术前眼库供体ECD为(2577.66±284.63)个/mm^(2),高于>6 h组的(2372.46±399.75)个/mm^(2),差异有统计学意义(t=2.289,P<0.05)。术后1个月,不同保存-手术时间组ECD总体比较差异有统计学意义(F=6.201,P<0.01),其中≤3 d组植片ECD均高于>3~6 d组和>6 d组,差异均有统计学意义(均P<0.01)。EK组术前供体角膜ECD明显高于PKP组,差异有统计学意义(t=-2.660,P<0.01)。术后1个月PKP组植片ECD明显高于EK组,差异有统计学意义(t=4.286,P<0.01)。PKP组和EK组ECD下降率分别为7.14%(0.01%,17.69%)和31.07%(22.11%,45.86%),差异有统计学意义(Z=4.969,P<0.01)。与无黑区组相比,有黑区组PKP术前眼库供体ECD较低,差异有统计学意义(t=6.789,P=0.011);术后1个月,2个组ECD比较差异无统计学意义(t=0.005,P=0.945)。多因素Logistic回归分析结果显示,保存-手术时间>6 d、供体死亡原因为恶性肿瘤是影响供体角膜内皮出现黑区的危险因素(OR=9.038,P=0.030;OR=6.577,P=0.018)。结论捐献者年龄越大,ECD越低;供体组织保存-手术时间的延长(>6 d)是导致角膜移植术后ECD下降的主要因素,EK术后早期ECD下降率明显高于PKP。保存-手术时间>6 d及供体死亡原因为恶性肿瘤是影响供体角膜内皮出现黑区的主要危险因素,生理性角膜黑区对术后ECD可能无显著影响。
Objective To analyze changes of donor corneal endothelial cell density(ECD)and morphology from eye bank before and after keratolasty and the influencing factors.Methods An observational case series study was performed.A total of 118 donor corneas,retrieved by the Shandong Province Eye Bank between July 2020 and June 2021 for penetrating keratoplasty(PKP)and endothelial keratoplasty(EK)were included.Among them,99 corneas(83.90%)were used for PKP,and 19(16.10%)for EK.The basic information of donors and the results of corneal quality tests were analyzed and compared with ECD measured by endothelial microscopy one month after keratolasty.Morphological changes in endothelial cells before and after surgery were observed,and factors influencing corneal ECD and morphology were analyzed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Shandong Eye Hospital(No.SDSYKYY20170319).Written informed consent was obtained from each subject.Results Among the 99 donor corneas for PKP,there were statistically significant differences in preoperative donor corneal ECD and 1-month postoperative ECD of implant among different age groups(F=18.136,5.936;both P<0.01),which were lower in the 31-60-year-old group and the>60-year-old group than in the 0-30-year-old group and higher in the 31-60-year-old group than in the>60-year-old group,with statistically significant differences(all P<0.01).There were statistically significant differences in the preoperative donor corneal ECD among different donor cause of death groups(F=4.524,P<0.01),which was higher in the traumatic accident group compared to the cardiovascular and cerebrovascular disease group,chronic organ failure group and malignant tumor group(all P<0.01).The preoperative donor ECD in the death-tissue retrieval time≤6 hours group was(2577.66±284.63)cells/mm^(2),which was higher than(2372.46±399.75)cells/mm^(2) in the death-tissue retrieval time>6 hours group,with a statistically significant difference(t=2.289,P<0.05).There were statistically significant differences in 1-month postoperative ECD among the preservation-surgery time≤3 days,3-6 days,and>6 days groups(F=6.201,P<0.01),with higher ECD in preservation-surgery time≤3 days groups than in 3-6 days and>6 days groups(both P<0.01).The preoperative donor corneal ECD applied to EK was significantly higher than that applied to PKP(t=-2.660,P<0.01).ECD at 1 month after surgery applied to PKP was significantly higher than that applied to EK(t=4.286,P<0.01).The ECD reduction rate was 7.14%(0.01%,17.69%)and 31.07%(22.11%,45.86%)in PKP group and EK group,respectively,with a statistically significant difference(Z=4.969,P<0.01).The ECD was lower in the group with dark area than in the non-dark area group before PKP,with a statistically significant difference(t=6.789,P=0.011).There was no significant difference in ECD at 1 month after keratoplasty between the two groups(t=0.005,P=0.945).Multivariate logistic regression model results showed that preservation-surgery time>6 days and the cause of donor death being malignant tumor were risk factors for the appearance of dark areas in donor corneal endothelium(OR=9.038,P=0.030;OR=6.577,P=0.018).Conclusions The older the donor,the lower the ECD.Prolonged preservation-surgery time(>6 days)is the main factor contributing to the decline in ECD after keratolasty.Compared to PKP,there is a higher endothelial cell loss after EK.The tissue preservation-surgery time>6 days and the cause of donor death being malignant tumor are the main risk factors affecting the appearance of dark areas in the donor corneal endothelium.But the presence of physiological dark areas does not significantly influence the ECD after surgery.
作者
姜晓月
庄晓云
杨彪
高利
高华
史伟云
李素霞
Jiang Xiaoyue;Zhuang Xiaoyun;Yang Biao;Gao Li;Gao Hua;Shi Weiyun;Li Suxia(Department of Ophthalmology,School of Clinical Medicine,Shandong Second Medical University,Weifang 261053,China;Eye Institute of Shandong First Medical University,Eye Hospital of Shandong First Medical University(Shandong Eye Hospital),State Key Laboratory Cultivation Base,Shandong Provincial Key Laboratory of Ophthalmology,School of Ophthalmology,Shandong First Medical University,Jinan 250021,China)
出处
《中华实验眼科杂志(中英文)》
北大核心
2025年第8期730-738,共9页
Chinese Journal Of Experimental Ophthalmology
基金
国家自然科学基金面上项目(82271059)
泰山学者计划(tsqn202211343)。
关键词
角膜
内皮细胞
眼库
角膜移植术
穿透角膜移植术
黑区
Cornea
Endothelial cells
Eye bank
Keratolasty
Penetrating keratolasty
Dark areas
