全層角膜移植の術前の母角膜の状態と術後成績との関係

Relation between the state of recipient cornea and outcome of penetrating keratoplasty

　全層角膜移植術の術前の母角膜の状態が手術予後に及ぼす影響について検討するため，1985年から1991年の間に当科で施行された全層角膜移植術症例のなかから，同一の提供者から得た2眼のうち1眼は周辺角膜の状態が良好な例（A群）に，他の1眼は角膜の状態が不良な例（B群）に移植された24組48眼を抽出して比較した。透明治癒率，視力改善率はA群がB群より有意に良好であり，拒絶反応の発生率はA群で有意に低かった。術後同時期に観察し得た角膜の内皮細胞数はB群で少ない傾向がみられた。ほぼ同一の状態と推定される同一提供者の角膜が移植された症例の間で術後成績を比較することによって，母角膜の状態が全層角膜移植術の予後に影響を及ぼすことが確認された。

Two grafts from one donor are usually trans-planted to two patients in penetrating keratoplasty (PKP). We reviewed the results of 48 PKPs using grafts from 24 donors during the foregoing 7-year period. The cases were divided into 2 paired groups: one with slightly affected recipient cornea and the other with severely damaged cornea with neovascularization. The former was defined as group A and the other as group B. The rate of transparent healing was 96% for group A and 63% for group B. The difference was significant (p＜ 0.05). The incidence of immune reaction was 25% for group A and 58% for group B. The difference was significant (p＜0.05).

Endothelial cell density of grafted cornea tended to be less in group B than in group A. The visual acuity improved more in group A than in group B (p＜0.05). The findings show that the state of the recipient cornea is a major factor in the outcome of PKP.