Risk Factors Analysis Of Graft Ulcer After Keratoplasty

Objective: To retrospectively analyze the risk factors of graft ulcer after keratoplasty and provide data for clinical prevention and treatment of graft ulcer.Methods: Collected on April 1,2006 to March 31,2017 in Shandong ophthalmic hospital2273 cases(2309 eyes)of corneal transplantation patients,male 1574 cases(1599 eyes),Female 691 cases(710 eyes),the patients with corneal transplant for 7 months ~ 81 years old,average 39.14±19.168 years,There were 2273 cases of monocular keratoplasty,36 cases of binocular keratoplasty,983 cases of penetrating keratoplasty,and 1326 cases of lamellar keratoplasty.Among them,156 patients developed graft ulcer,112 males(113 eyes)and 43females(43 eyes).The patients were aged from 7 months to 81 years at the time of corneal transplantation,with an average age of 40.31±21.454.There were 155 cases of monocular graft ulcer,1 case of binocular graft ulcer,56 cases of penetrating corneal transplantation,and100 cases of lamellar corneal transplantation.Primary disease was recorded(1.Infectious keratitis,2.Silkworm erosion corneal ulcer,3.Corneal dystrophy or degeneration;4.Keratoconus;5.Corneal burns,6.Corneal leukoplakia,7.Corneal neoplasm,8.Others);The number,time and direct risk factors of graft ulcer after keratoplasty(1.Suture related factors,2.Postoperative continuous epithelial defect or epithelial defect occurred in the past 1month,3.Infection,4.Abnormal eye surface,5.Recurrence of primary disease;6.Immune rejection;7.Others).SPSS22.0 statistical software was used for comparative analysis.The measurement data were expressed as mean standard ±deviation((?)±s).The counting data was expressed as rate(%),and the difference was statistically significant by chi-square test(P<0.05).Results: the chi-square test showed that there was a statistically significant difference in age composition between the grafted ulcer group and the non-prepared ulcer group(P<0.05).There was a statistically significant difference in the proportion of primary morbidity between the graft ulcer group and the non-graft ulcer group(P<0.05).The earliest occurrence of graft ulcer after corneal transplantation was 13 days and the latest was 49 months,mainly in the first 6 months after surgery(105 cases,67.3%),the most in the second month(31 cases,19.9%),followed by the third month(23 cases,14.7%).There were 32 cases(20.1%)at 7 ~ 12 months,9 cases(5.8%)at 13 ~ 18 months,3 cases(1.9%)at 19 ~ 24 months,1 case(0.6%)at 25 ~ 30 months,2 cases(1.3%)at 31 ~ 36 months,0 cases(37-42months),and 1 case(0.6%)at 43 months.Direct risk of graft ulcer:1.suture related factors(loose thread,bare knot,broken thread,etc.):47 cases(30.13%);2.epithelial defect: 32 cases(20.51%);3.infection: 30 cases(19.23%),26 cases of bacterial infection,4 cases of fungal infection;4.immune rejection: 20 cases(12.82%);5.abnormal ocular surface: 10 cases(6.41%),8 cases with dry eyes,2 cases with trichiasis;6.recurrence of HSK: 7 cases(4.49%);7.recurrent silkworm erosion corneal ulcer: 6 cases(3.85%);8.graft endothelial decompensation: 1 case(0.64%)9.others: 3 cases(1.92%).Conclusion:In conclusion,graft ulcer mainly occurs in the early postoperative period(within 6 months),and children and the elderly are at high risk.Mooren's ulcer and infectious keratitis are the main primary causes of graft ulcer after keratoplasty.Suture-related factors,epithelial defects,and infection impair the barrier function of the ocular epithelium and the epithelium of the cornea,leading to graft ulcers.