Objective: To investigate the long-term outcomes of corneal grafts after penetrating keratoplasty(PK) for congenital corneal opacity(CCO) in children aged 0 to 5 years and the related influencing factors. Methods: It was a retrospective series case study. Data of 39 children (55 eyes) who underwent PK surgery due to CCO in the keratology Department of Beijing Tongren Hospital from April 2014 to April 2018 and were followed up for more than 30 months were collected. Among them, there were 17 males (43.6%) and 22 females (56.4%). The age at operation was (16.2±13.3) months, and the follow-up time was (46.4±13.8) months. Clinical data such as basic information, preoperative diagnosis, operation age, operation method and postoperative complications were recorded. The corneal graft transparency was analyzed according to preoperative diagnosis, corneal neovascularization area, age at surgery, monocular or binocular surgery interval, primary surgery type and further surgery, and postoperative complications were observed. Results: At 12 months, 24 months and the last follow-up after PK, 78.2% (43/55), 70.9% (39/55) and 58.2% (32/55) of the affected eyes had clear corneal grafts, respectively.There was no statistical significance between Peters anomaly and sclerocornea (P>0.05), while the extent of neovascularization in the limbus had a significant effect on corneal graft transparency, and graft opacity was more likely to occur in patients with vessel area exceeding 2 quadrants (P<0.05).The highest corneal graft transparency was found in children aged 1 to 3 years 80.8%(21/26) (P<0.05), followed by children younger than 6 months (7/15).The translucency rate of the corneal graft was higher in patients undergoing unilateral surgery than in those undergoing bilateral surgery (P<0.05).Translucency of corneal graft was higher in children with simple surgery than with combined surgery (P<0.05), however, cataract surgery after PK had no significant effect on corneal graft transparency (P>0.05).The postoperative complications mainly included immune rejection in 19 eyes (34.5%), complicated cataract in 13 eyes (23.6%), glaucoma in 7 eyes (13.2%), persistent corneal epithelial defect in 7 eyes (13.2%). Conclusions: After PK in children with CCO, the transparent rate of corneal grafts decreases gradually with time, but the long-term translucency of corneal grafts can still be obtained. The range of corneal neovascularization, age at the time of surgery, whether the surgery was binocular and whether the surgery was combined had an effect on the transparency of corneal graft.
目的： 探讨0~5岁儿童先天性角膜混浊（CCO）行穿透性角膜移植术（PK）后远期效果以及植片存活的相关影响因素。 方法： 回顾性系列病例研究。收集2014年4月至2018年4月因CCO就诊于北京同仁医院角膜病科行PK术并坚持随访30个月以上的患儿资料39例（55只眼）。其中男性17例（43.6%），女性22例（56.4%），手术时年龄为（16.2±13.3）个月，随访时间为（46.4±13.8）个月。记录患儿的基本信息、术前诊断、手术年龄及手术方式、术后并发症等临床资料。按照术前诊断、角膜新生血管面积、手术时年龄段、单眼还是双眼接受手术以及双眼手术的间隔时间、初次手术形式及进一步手术情况分别对其角膜植片透明情况进行分析，并观察术后并发症情况。 结果： PK术后12、24个月及末次随访时，角膜植片透明的患眼分别占78.2%（43/55）、70.9%（39/55）和58.2%（32/55）。Peters异常与角膜巩膜化患儿术后角膜植片透明率的差异无统计学意义（P>0.05），而角膜缘新生血管范围对角膜植片的透明率有明显影响：血管范围超过2个象限者的角膜植片更易出现混浊（P<0.05）。1~3岁患儿角膜植片透明率80.8%（21/26）最高（P<0.05），其次是6个月以内的患儿（7/15）。单眼手术较行双眼手术者角膜植片透明率更高（P<0.05）。单纯手术较联合手术患儿术后角膜植片透明率更高（P<0.05），但PK术后再行白内障摘除手术对角膜植片透明率无明显影响（P>0.05）；术后主要并发症包括免疫排斥反应19只眼（34.5%），并发性白内障13只眼（23.6%），眼压升高7只眼（13.2%），持续性角膜上皮缺损7只眼（13.2%）。 结论： CCO患儿行PK术后角膜植片透明率随时间延长逐渐下降，但仍可获得较高的远期角膜植片透明率。角膜新生血管范围、手术时年龄、是否双眼手术及是否联合手术对角膜植片透明率有影响。.