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Ophthalmology:眼角膜移植效果或与捐赠者年龄关系不大

来源:新华网 2013-12-04 20:33

如果你需要眼角膜移植来改善视力,也许不用太过担心捐赠者的年龄。美国《眼科学》杂志15日发表的一项新研究表明,来自71岁捐赠者的角膜在移植10年后,其健康程度与来自35岁捐赠者的角膜大体相似。

美国国家眼科研究所资助发起的这项研究共分析了663名接受角膜移植手术的患者,结果发现,移植的角膜来自12岁至65岁和66岁至75岁两个年龄段捐赠者的患者,手术后10年的移植成功率类似,分别为77%与71%。

目前,绝大部分角膜捐赠者的年龄介于34岁至71岁之间。新研究表明,来自这一年龄段捐赠者的角膜移植手术10年后的成功率为75%。

不过当把研究的人群按年龄进一步细分时,研究人员确实发现了些许差别:移植的角膜来自12岁至33岁捐赠者的患者,手术后10年的移植成功率升至96%;来自72岁至75岁捐献者的患者,手术后10年的移植成功率降至62%。

但研究负责人之一、辛辛那提大学爱德华·霍华德教授依然认为,总体而言,年老的和年轻的角膜组织在移植效果上大体相似,“我们的研究支持将角膜捐赠的年龄扩展至65岁以上”。

美国国家眼科研究所表示,医生们做角膜移植手术通常选择来自年轻捐赠者的角膜,有些医生甚至设置了严格的捐赠年龄上限,50岁以上的就拒绝使用。这项研究于2000年启动,那时多数医生不愿意接受来自65岁以上捐赠者的角膜。 (生物谷Bioon.com)

生物谷推荐的英文摘要

Ophthalmology                 doi.org/10.1016/j.ophtha.2013.08.026

The Effect of Donor Age on Penetrating Keratoplasty for Endothelial Disease : Graft Survival after 10 Years in the Cornea Donor Study

Mark J. Mannis, MD1, Edward J. Holland, MD2, Robin L. Gal, MSPH3, Mariya Dontchev, MPH3, Craig Kollman, PhD3, Dan Raghinaru, MS3, Steven P. Dunn, MD4, Robert L. Schultze, MD5, David D. Verdier, MD6, Jonathan H. Lass, MD7, Irving M. Raber, MD8, Joel Sugar, MD9, Mark S. Gorovoy, MD10, Alan Sugar, MD11, R. Doyle Stulting, MD, PhD12, Monty M. Montoya, MBA13, Jeffrey G. Penta, MBA14, Beth Ann Benetz, MA7, Roy W. Beck, MD, PhD3

Objective

To determine whether the 10-year success rate of penetrating keratoplasty for corneal endothelial disorders is associated with donor age.

Design

Multicenter, prospective, double-masked clinical trial.

Participants

A total of 1090 participants undergoing penetrating keratoplasty at 80 sites for Fuchs' dystrophy (62%), pseudophakic/aphakic corneal edema (34%), or another corneal endothelial disorder (4%) and followed for up to 12 years.

Methods

Forty-three eye banks provided corneas from donors aged 12 to 75 years, using a randomized approach to assign donor corneas to study participants without respect to recipient factors. Surgery and postoperative care were performed according to the surgeons' usual routines.

Main Outcome Measures

Graft failure defined as a regraft or, in the absence of a regraft, a cloudy cornea that was sufficiently opaque to compromise vision for 3 consecutive months.

Results

In the primary analysis, the 10-year success rate was 77% for 707 corneas from donors aged 12 to 65 years compared with 71% for 383 donors aged 66 to 75 years (difference, +6%; 95% confidence interval, 1 to +12; P = 0.11). When analyzed as a continuous variable, higher donor age was associated with lower graft success beyond the first 5 years (P<0.001). Exploring this association further, we observed that the 10-year success rate was relatively constant for donors aged 34 to 71 years (75%). The success rate was higher for 80 donors aged 12 to 33 years (96%) and lower for 130 donors aged 72 to 75 years (62%). The relative decrease in the success rate with donor ages 72 to 75 years was not observed until after year 6.

Conclusions

Although the primary analysis did not show a significant difference in 10-year success rates comparing donor ages 12 to 65 years and 66 to 75 years, there was evidence of a donor age effect at the extremes of the age range. Because we observed a fairly constant 10-year success rate for donors aged 34 to 71 years, which account for approximately 75% of corneas in the United States available for transplant, the Cornea Donor Study results indicate that donor age is not an important factor in most penetrating keratoplasties for endothelial disease.

 

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