Ophthalmology:眼角膜移植效果或與捐贈者年齡關係不大

如果你需要眼角膜移植來改善視力，也許不用太過擔心捐贈者的年齡。美國《眼科學》雜誌15日發表的一項新研究表明，來自71歲捐贈者的角膜在移植10年後，其健康程度與來自35歲捐贈者的角膜大體相似。

美國國家眼科研究所資助發起的這項研究共分析了663名接受角膜移植手術的患者，結果發現，移植的角膜來自12歲至65歲和66歲至75歲兩個年齡段捐贈者的患者，手術後10年的移植成功率類似，分別為77%與71%。

目前，絕大部分角膜捐贈者的年齡介於34歲至71歲之間。新研究表明，來自這一年齡段捐贈者的角膜移植手術10年後的成功率為75%。

不過當把研究的人群按年齡進一步細分時，研究人員確實發現了些許差別：移植的角膜來自12歲至33歲捐贈者的患者，手術後10年的移植成功率升至96%；來自72歲至75歲捐獻者的患者，手術後10年的移植成功率降至62%。

但研究負責人之一、辛辛那提大學愛德華·霍華德教授依然認為，總體而言，年老的和年輕的角膜組織在移植效果上大體相似，「我們的研究支持將角膜捐贈的年齡擴展至65歲以上」。

美國國家眼科研究所表示，醫生們做角膜移植手術通常選擇來自年輕捐贈者的角膜，有些醫生甚至設置了嚴格的捐贈年齡上限，50歲以上的就拒絕使用。這項研究於2000年啟動，那時多數醫生不願意接受來自65歲以上捐贈者的角膜。 （生物谷Bioon.com）

生物谷推薦的英文摘要

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.