目的：旨在研究按移植指征分类以及移植前角膜血管形成对手术后5年内排斥反应和移植物失败率的相对风险。方法：分析1999—2017年间，英国移植登记处记录的所有因圆锥角膜(keratoconus,KC)、人工晶状体大泡性角膜病(pseudophakic bullous keratopathy,PBK)或既往感染(病毒/细菌/真菌/原生动物)而首次进行角膜移植的成年人。统计移植前受体角膜血管化象限的数量、血管化类型、移植后排斥反应的间隔时间(如果有的话)以及移植后5年的结果。通过多变量风险调整Cox回归法进行排斥反应和移植失败的危险因素建模。结果：KC、PBK和感染患者的角膜血管形成率分别为10%、25%和67%。只有当存在浅表和(或)深部血管形成时(HR分别为1.3和1.4，P=0.004)，存在两个以上象限的血管形成时，PBK患者移植排斥反应的风险才会增加(HR=1.5，P=0.0004)。因既往感染而接受移植的个体在四个象限的血管形成中发生排斥反应的风险增加(HR=1.6，P=0.003)。在任何一组中，经过风险调整后，与血管形成有关的移植失败率并未上升。对于含有血管的受体角膜，相对于穿透性KC和PBK移植，没有充分的证据显示板层移植在降低排斥反应或失败风险方面存在优势。结论：血管化是5年内角膜移植排斥反应的危险因素。移植的适应证对这种风险的具有临床意义。
Objective: To investigate the relative risk of pretransplant corneal vascularisation on rate of rejection and graft failure within 5 years of surgery when categorised by indication for transplantation. Methods: We analysed all adults recorded in the UK transplant registry who had a first cornea transplant for keratoconus (KC), pseudophakic bullous keratopathy (PBK) or previous infection (viral/bacterial/fungal/protozoan) between 1999 and 2017. We analysed the number of quadrants of the recipient cornea vascularised before transplant and type of vascularisation, the interval posttransplant to rejection, if any, and the outcome at 5 years post-transplant. Risk factors for rejection and transplant failure were modelled by multivariable risk-adjusted Cox regression. Results: Corneal vascularisation was recorded in 10%, 25% and 67% of patients with KC, PBK and infection, respectively. Individuals with PBK had an increased hazard of transplant rejection only when there were more than two quadrants of vascularisation (HR 1.5, p=0.004) when either superficial and/or deep vascularisation was present (HR 1.3 and 1.4, respectively, p=0.004). Individuals who had a transplant for previous infection had an increased hazard of rejection with four quadrants of vascularisation (HR 1.6, p=0.003). There was no risk-adjusted increase in transplant failure associated with vascularisation in any group. There was weak evidence of reduction in risk of rejection and/or failure associated with lamellar compared with penetrating transplantation in KC and PBK in vascularised recipient corneas. Conclusion: Vascularisation is a risk factor for corneal allograft rejection within 5 years. The indication for transplantation has a clinically significant effect on the magnitude of this risk.
目的：探究角膜移植日间手术患者的延续护理需求现状及其影响因素。方法：采用便利抽样法抽取行角膜移植日间手术的173例患者，采用课题组自行设计的一般资料调查表、角膜移植日间手术患者延续护理需求调查问卷进行调查。采用独立样本t检验、单因素方差分析、多元线性回归进行统计分析。结果：角膜移植日间术后患者延续护理需求得分为88.13±15.55，其中，对疾病相关知识的需求得分最高，为4.39±0.66，对心理护理的需求得分最低，为2.72±1.18；在延续护理实施方式方面，74.6%患者倾向于电话随访，只有5.8%倾向于上门服务；在影响因素方面，婚姻状况、视力、家庭月收入、文化程度是延续护理需求的影响因素。结论：角膜移植日间术后患者的延续护理需求较高，应根据患者延续护理需求及影响因素进行个性化指导，以提高角膜移植手术的成功率和减少并发症的发生。
Objective: To explore transition care needs among patients with keratoplasty in day ward and analyze the influencing factors. Methods: Using convenience sampling method, 173 patients undergoing keratoplasty in day ward were selected, and they were investigated by using a self-designed general information questionnaire and a questionnaire of transitional care needs of patients with keratoplasty in day ward. T-test, one-way analysis of variance (ANOVA), multiple linear regression were used to analyze the data. Results: The total score of transitional care needs among patients with keratoplasty in day ward was 88.13±15.55. The demand for disease related knowledge was the highest (4.39±0.66), the demand for mental nursing was the lowest (2.72±1.18). In terms of the way of implementation, 74.6% patients preferred telephone follow-up and only 5.8% preferred door-to-door service. Single-factor analysis showed that marital status, vision, monthly income, educational level were the factors influencing the demand for transitional care (P<0.05). Conclusion: Patients with keratoplasty in day ward have a high demand for transitional care. In order to improve the success rate of keratoplasty and reduce the incidence of complications, personalized guidance should be given according to patients’ transitional care needs and influencing factors.
真菌性角膜炎是我国导致角膜盲的重要原因之一。由于部分患者在感染早期缺乏合理治疗，导致病情迁延难治，最终行角膜移植是主要的治疗手段。然而真菌感染十分顽固，术后仍有一定概率复发。因此，了解真菌性角膜炎的最新研究进展以及不同类型抗真菌药物和角膜移植手术的优劣，根据适应证选择合理的治疗方案，才能最大程度控制感染，降低真菌复发率，挽救患者视力。与此同时，对角膜移植后真菌复发的相关文献进行研究，总结其复发规律、影响因素和临床特征以及治疗手段和预后。为制订合理的、符合国情的治疗策略提供参考依据。
Fungal keratitis is one of the important causes of corneal blindness in China. Due to the lack of reasonable treatment for some patients in the early stage of infection, the disease is protracted and refractory, and eventually, corneal transplantation is the main treatment. However, Fungal keratitis infection is very stubborn, and there is still a certain probability of recurrence after surgery. Therefore, understanding the latest research advances in fungal keratitis as well as the advantages and disadvantages of different types of antifungal drugs and corneal transplantation, and choosing a reasonable treatment plan according to the indications can maximize the control of the infection, reduce the recurrence rate of the fungus and save the vision of patients. In addition, the relevant literature on fungal recurrence after corneal transplantation was studied to summarize its recurrence pattern, influencing factors and clinical features, as well as treatment means and prognosis. The purpose of this study is to provide a reference basis for formulating a reasonable treatment strategy in line with China’s national conditions.
[摘 要] 目的：减轻行角膜移植术的患儿及家属的心理负担，提高患儿对手术的耐受性，减少术后并发症。方法：对45例将进行角膜移植的患儿进行围手术期护理。结果：所有患儿经过精心的治疗和护理后均恢复良好，视力均有提高。结论：术前做好充足的准备、术前心理护理，术后严密观察生命体征和眼部敷料的情况，做好相关的生活和饮食指导，遵医嘱及时有效用药，注意患儿异常的反应及眼部的情况，及时发现并处理并发症，给予细致的出院指导，有利于患儿早日康复。
Abstract Objective: To reduce the psychological burden of the children and families who are scheduled to the corneal transplantation, and to improve the patients’ tolerance and reduce postoperative complications. Methods: The perioperative care was given to 45 patients with corneal transplantation. Results: All children were treated well by careful treatment and care. Conclusion: Before operation, comprehensive preparation and psychological nursing care should be delivered. After operation, the physicians and nurses should guide the patients to live a healthy lifestyle, remind them to take the drugs timely, identify the abnormal symptoms and postoperative complications in children with abnormal responses, implement effective treatment timely to accelerate postoperative recovery
