Objective To observe the characteristics and regularity of recurrent and immune rejection after large-diameter penetrating keratoplasty (LDPK) for the treatment of severe fungal keratitis; to provide a reference for improving the postoperative long-term survival of corneal grafts. Methods In a retrospective case series study, 70 patients (70 eyes) with severe fungal keratitis who underwent LDPK (≥9.0 mm) at Qingdao Eye Hospital between January 2009 and December 2013 were included. The follow-up after surgery ranged from 6 to 48 months. The fungal strains were identified, the characteristics and frequency of recurrent and immune rejection episodes were monitored and the long-term survival of corneal grafts was evaluated. Uncorrected visual acuity and best corrected visual acuity were recorded. Results The average time of onset for all patients was 23.7±11.7 days. Fungal cultures showed that the main fungus was fusarium (72%). Postoperatively, 8 patients (11%) underwent recurrent fungal infection and the average recurrence time was 6.8±2.9 days. Sixty-five patients (93%) successfully maintained the structural integrity of the globe. The immunologic rejection occurred within one month after the surgery in 26 patients (37%) and the average rejection time was 17.8±5.1 days. Of these, 21 cases were treated in time, and the grafts became transparent after routine anti-rejection therapy, while the remaining grafts became partially or entirely opaque. Thirty-nine patients (56%) had a clear corneal graft at the last follow-up. Average endothelial cell density was 1 306±816/mm2, average UCVA was 4.0±3.8, and average BCVA was 4.5±4.1. Conclusion LDPK is an effective surgical method in the management of severe keratitis with a high success rate in restoring anatomical integrity and providing useful vision. Postoperatively, there is a regularity in the duration of time between fungal recurrence and immune rejection, which indicates the use of glucocorticoids within 2 weeks after surgery to prevent recurrent and immune rejection episodes.
王月新,王黛,张阳阳,王君怡,贾艳妮,高华. 大直径穿透性角膜移植治疗真菌性角膜炎术后复发和免疫排斥反应规律[J]. 中华眼视光学与视觉科学杂志, 2015, 17(11): 685-689.
Wang Yuexin*|Wang Dai|Zhang Yangyang|Wang Junyi|Jia Yanni|Gao Hua. The regularity of recurrent and immune rejection after large-diameter penetrating keratoplasty for the treatment of fungal keratitis. Chinese Journal of Optometry Ophthalmology and Visual science, 2015, 17(11): 685-689. DOI: 10.3760/cma.j.issn.1674-845X.2015.11.011
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