반점각막이상증, TGFBI각막이상증, 푹스각막이상증 환자의 전층각막이식술 후 장기 예후
Long-Term Outcomes of Penetrating Keratoplasty in Treating Macular Corneal Dystrophy, TGFBI Dystrophy, and Fuchs’ Dystrophy
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목적: 반점각막이상증, transforming growth factor beta induced (TGFBI) 각막이상증, 푹스각막이상증 환자의 전층각막이식술 후 장기예후를 비교해 보고자 하였다. 대상과 방법: 반점각막이상증 28명 53안, TGFBI 각막이상증 13명 20안, 푹스각막이상증 29명 50안에 대해서 재발률, 이식편 생존율,내피세포 감소율, 다른 합병증 발생률을 비교하였다. 결과: 재발률은 TGFBI 각막이상증이 유의하게 높았고(p-value＜0.0001), 이식편 생존율은 푹스각막이상증이 유의하게 낮았다(p-value=0.03). 내피세포 수는 술 후 1년과 5년째까지는 세 군간에 차이가 없었으나, 술 후 10년째에는 푹스각막이상증에서 유의하게 적었다(p-value=0.0006). 거부반응, 이차성 녹내장, 지속각막상피결손과 같은 다른 합병증 발생률은 세 군에서 차이가 없었다(p-value=0.809,p-value=0.584, p-value=0.972). 결론: 반점각막이상증, TGFBI 각막이상증, 푹스각막이상증에서 전층각막이식술 후 장기간 예후가 다르다. 이는 세 각막이상증의 병인이 다르기 때문으로 생각한다.
Abstract
Purpose: To compare long-term outcomes of penetrating keratoplasty in treating macular corneal dystrophy, transforming growth factor beta induced (TGFBI) dystrophy, and Fuchs’ dystrophy. Methods: The present retrospective study describes the postoperative results of 123 eyes in 70 patients; 53 eyes with macular corneal dystrophy, 20 eyes with TGFBI dystrophy, and 50 eyes with Fuchs’ dystrophy. All patients received penetrating keratoplasty. The outcome measures included recurrence rate, graft rejection, graft survival rate and corneal endothelial density and other complications. Results: As compared with the other groups, TGFBI dystrophy had the highest recurrence rate (p-value < 0.0001). Fuchs’dystrophy had the lowest graft survival rate (p-value = 0.03). Corneal endothelial cell density was lowest in Fuchs’ dystrophy 10 years postoperatively (p-value = 0.0006), but there was no significant difference in corneal endothelial cell density between the 3 groups 1 and 5 years postoperatively. There was no significant difference between the 3 groups in other complications such as graft rejection, secondary glaucoma and persistent epithelial defect (p-value = 0.809, p-value =0.584, p-value = 0.972, respectively). Conclusions: Penetrating keratoplasty showed different long-term outcomes in treating 3 types of corneal dystrophies. The difficulty may depend on the pathogenesis of corneal dystrophies.
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