전층각막이식술을 받은 5세 이하 환아들의 수술 성적
Clinical Outcomes of Penetrating Keratoplasty in Patients Five Years or Younger
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목적: 5세 이하 환자에서 시행된 전층각막이식술의 성적과 이를 결정하는 인자를 알아본다. 대상과 방법: 전층각막이식술을 시행 받은 5세 이하 환아 29명 31안을 대상으로 환자의 성별, 나이, 원인 각막 질환, 수술 후 합병증,그리고 이식실패원인에 대해 후향적으로 조사하였다. 결과: 수술 후 평균 78.72 ± 8.94개월 후 총이식편생존율은 51.6%였다. 술 후 기간별 이식편 생존율은 술 후 6개월에 77.4%, 12개월에61.3%, 2년에 57.5%, 그리고 5년에 49.5%였다. 원인각막질환빈도는 공막각막화(35.5%), 피터 이상(25.8%), 선천 녹내장(9.7%) 순으로높았고, 원인각막질환에 따라 이식편의 생존시간에 유의한 차이가 있었다(p˂0.05). 수술 당시 연령을 기준으로 12개월 미만(n=13),12개월에서 48개월 사이(n=12), 그리고 48개월 이상(n=6)으로 구분하였을 때 연령에 따른 이식편 생존시간에 유의한 차이가 있었으나(p=0.037) 총이식편생존율에는 유의한 차이가 없었다. 결론: 5세 이하 환자에서 전층각막이식술을 한 경우 원인각막질환의 종류가 이식편의 생존율에 유의한 영향을 주었다.
Abstract
Purpose: To investigate the clinical outcomes of primary pediatric keratoplasty. Methods: Records of patients who underwent penetrating keratoplasty at the age of 5 years or younger were retrospectively reviewed. The survival rates of corneal grafts, postoperative complications, and causes of graft failure were evaluated. Results: A total of 31 penetrating keratoplasties were performed in 29 patients, two of which were bilateral. The mean follow-up period was 78.72 ± 8.94 months. The overall graft survival rate was 51.61%. The graft survival rate was 77.4% at 6 months, 61.3% at 12 months, 57.5% at 2 years, and 49.5% at 5 years after the surgery (the median survival time, 39.2months). The main surgical indications included sclerocornea (35.5%), followed by Peter’s anomaly (25.8%) and congenital glaucoma (9.7%). There were significant differences in graft survival time among the surgical indications, of which sclerocornea was the worst (p = 0.003). The main cause of graft failure was rejection (46.7%), followed by infection (26.7%) and primary endothelial decompensation (20%). When patients were sub-grouped according to age (under 12 months, between 12 to 48 months, and over 48 months), there was significant difference in graft survival time (p = 0.037) but not in overall graft survival rate (p = 0.154). Graft rejection occurred more frequently in patients between 12 to 48 months of age compared to other age groups (p = 0.016). Three out of 13 graft infections occurred in patients under 12 months of age. Conclusions: The type of disease causing corneal opacity was a significant factor affecting the clinical outcomes of penetrating keratoplasty in children.
참고문헌 (12)
- Bermejo E, "Congenital eye malformations: clinical-epidemiological analysis of 1,124,654 consecutive births in Spain", Am J Med Genet, 75, pp.497~504 (1998)
- Ganekal S, "Early outcomes of primary pediatric keratoplasty in patients with acquired, atraumatic corneal pathology", J AAPOS, 15, pp.353~355 (2011)
- Vanathi M, "Pediatric keratoplasty", Surv Ophthalmol, 54, pp.245~271 (2009)
- Al-Ghamdi A, "Primary pediatric kera toplasty: indications, graft survival, and visual outcome", J AAPOS, 11, pp.41~47 (2007)
- McClellan K, "Penetrating keratoplasty in children: visual and graft outcome", Br J Ophthalmol, 87, pp.1212~1214 (2003)
- Stulting RD, "Penetrating keratoplasty in children", Ophthalmology, 91, pp.1222~1230 (1984)
- Lowe MT, "The outcome of corneal transplantation in infants, children, and adolescents", Ophthalmology, 118, pp.492~497 (2011)
- Dana MR, "Corneal transplantation in children with Peters anomaly and mesenchymal dysgenesis. Multicenter Pediatric Keratoplasty Study", Ophthalmology, 104, pp.1580~1586 (1997)
- Rao KV, "Outcome of penetrating keratoplasty for Peters anomaly", Cornea, 27, pp.749~753 (2008)
- Yang LL, "Long-term visual outcome of penetrating keratoplasty in infants and children with Peters anomaly", J AAPOS, 13, pp.175~180 (2009)
- Yang LL, "Long-term results of corneal graft survival in infants and children with peters anomaly", Ophthalmology, 106, pp.833~848 (1999)
- Huang C, "Primary pediatric keratoplasty: indications and outcomes", Cornea, 28, pp.1003~1008 (2009)