Purpose: 

The purpose of this study was to investigate the clinical features, surgical outcomes, and prognostic factors of penetrating keratoplasty (PKP) after open globe injury (OGI).

Methods: 

A retrospective review of all patients treated for OGI between January 2000 and July 2017 was conducted. Demographic, preoperative, perioperative, and postoperative data were collected for those who underwent PKP after OGI. The predictive value of each preoperative variable on graft failure was assessed using univariate and multivariable Cox proportional hazards models, and the predictive value of variables on post-PKP visual outcome was assessed using both univariate and multivariable logistic regression models. All eyes that underwent PKP after OGI were included unless they had less than 365 days of follow-up.

Results: 

Forty-six eyes that underwent PKP met inclusion criteria. The median age was 46 years (interquartile range = 23.00–61.25), median follow-up was 78.5 months (interquartile range = 38.63–122.02), and 37 of 46 subjects (80.4%) were male. The observed 1- and 5-year graft survival estimates were 80.4% and 41.7%, respectively. Factors statistically associated with graft failure in multivariable analyses were rejection episode, hazard ratio (HR) = 3.29; retinal detachment (RD), HR = 3.47; and endophthalmitis, HR = 6.27. Fifteen of 42 eyes (35.7%) regained ambulatory vision (20/200 or better). The strongest predictors of vision worse than 20/200 at the last follow-up were RD, odds ratio (OR) = 43.88; graft rejection, OR = 12.42; and injury outside the workplace, OR = 25.05.

Conclusions: 

Despite a high graft survival at 1 year, most of the patients did not regain ambulatory vision. Graft rejection, RD, and endophthalmitis were risk factors for graft failure. These factors should be considered when counseling patients regarding PKP after OGI.

中文翻译：

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开放性眼球损伤后穿透性角膜移植术的结果

目的： 

本研究的目的是探讨开放性眼球损伤（OGI）后穿透性角膜移植术（PKP）的临床特征、手术结果和预后因素。

方法： 

对 2000 年 1 月至 2017 年 7 月期间所有接受 OGI 治疗的患者进行了回顾性审查。收集 OGI 后接受 PKP 的患者的人口统计学、术前、围手术期和术后数据。使用单变量和多变量 Cox 比例风险模型评估每个术前变量对移植失败的预测价值，并使用单变量和多变量逻辑回归模型评估变量对 PKP 后视觉结果的预测价值。所有在 OGI 后接受 PKP 的眼睛都被包括在内，除非它们的随访时间少于 365 天。

结果： 

接受 PKP 的 46 只眼睛符合纳入标准。中位年龄为 46 岁（四分位距 = 23.00–61.25），中位随访时间为 78.5 个月（四分位距 = 38.63–122.02），46 名受试者中有 37 名（80.4%）为男性。观察到的 1 年和 5 年移植物存活率估计分别为 80.4% 和 41.7%。多变量分析中与移植失败统计相关的因素是排斥反应，风险比（HR）= 3.29；视网膜脱离（RD），HR = 3.47；和眼内炎，HR = 6.27。42 只眼睛中的 15 只 (35.7%) 恢复了动态视力（20/200 或更好）。最后一次随访时视力低于 20/200 的最强预测因子是 RD，比值比 (OR) = 43.88；移植排斥，OR = 12.42；和工作场所外的伤害，OR = 25.05。

结论： 

尽管一年后移植物存活率较高，但大多数患者并未恢复动态视力。移植排斥、RD和眼内炎是移植失败的危险因素。在向患者提供 OGI 后 PKP 咨询时应考虑这些因素。