Sobrevida libre de rechazo o falla en pacientes sometidos a queratoplastia penetrante
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Fecha
2025
Autores
Carpio Cordero, José Enrique
Sánchez Barahona, Juan David
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Editor
Ediciones Universidad Simón Bolívar
Facultad de Ciencias de la Salud
Facultad de Ciencias de la Salud
Resumen
La queratoplastia penetrante (QP) es una técnica quirúrgica ampliamente empleada
para tratar enfermedades corneales que afectan la transparencia y funcionalidad
visual. A pesar de los avances, el rechazo inmunológico y la falla del injerto siguen
siendo desafíos relevantes para su sobrevida a largo plazo.
Objetivo: Evaluar la sobrevida libre de rechazo o falla del injerto en pacientes
sometidos a queratoplastia penetrante en una institución de referencia en
Barranquilla entre 2018 y 2023.
Métodos: Se realizó un estudio retrospectivo y analítico. Se incluyeron 299
pacientes mayores de 18 años con seguimiento postoperatorio ≥6 meses. Se
recolectaron variables clínicas, quirúrgicas y del donante. Se aplicaron análisis
descriptivos, pruebas de asociación (Chi-cuadrado, Wilcoxon) y curvas de KaplanMeier para estimar la sobrevida según sexo, medio de preservación y tiempo de
isquemia. Se utilizó R (v4.3.3) para el análisis.
Resultados: La sobrevida libre de rechazo o falla a los 12 meses fue del 91% (IC
95%: 87.6–94.5%). No se encontraron diferencias significativas por sexo ni por
tiempo de isquemia. La tasa de rechazo fue mayor en injertos preservados con
Optisol (22%) comparado con Eusol (7.3%, p<0.001), aunque la sobrevida general
fue similar. El queratocono fue más frecuente en hombres jóvenes, mientras que
leucomas y rechazos previos predominaron en mujeres mayores.
Conclusión: La QP muestra una alta efectividad a corto plazo. El medio de
preservación y la patología de base podrían influir en el riesgo de rechazo, lo que
resalta la necesidad de estrategias individualizadas.
Penetrating keratoplasty (PK) is a widely used surgical technique for treating corneal diseases that impair transparency and visual function. Despite technical advances, graft rejection and failure remain significant challenges for long-term survival. Objective: To evaluate rejection-free or graft failure-free survival in patients undergoing penetrating keratoplasty at a referral institution in Barranquilla between 2018 and 2023. Methods: A retrospective, analytical study was conducted. A total of 299 patients aged >18 years with ≥6 months of postoperative follow-up were included. Clinical, surgical, and donor variables were collected. Descriptive statistics, chi-square and Wilcoxon tests were used, and Kaplan-Meier survival curves estimated graft survival by sex, preservation medium, and ischemia time. R software (v4.3.3) was used for analysis. Results: Graft survival free of rejection/failure at 12 months was 91% (95% CI: 87.6– 94.5%). No significant differences were observed by sex or ischemia time. Rejection was more frequent with grafts preserved in Optisol (22%) compared to Eusol (7.3%, p<0.001), although overall survival was similar. Keratoconus was more prevalent in younger males, whereas leucomas and prior rejections were more common in older females. Conclusion: PK demonstrates high short-term effectiveness. Preservation medium and underlying pathology may influence rejection risk, highlighting the importance of individualized strategies.
Penetrating keratoplasty (PK) is a widely used surgical technique for treating corneal diseases that impair transparency and visual function. Despite technical advances, graft rejection and failure remain significant challenges for long-term survival. Objective: To evaluate rejection-free or graft failure-free survival in patients undergoing penetrating keratoplasty at a referral institution in Barranquilla between 2018 and 2023. Methods: A retrospective, analytical study was conducted. A total of 299 patients aged >18 years with ≥6 months of postoperative follow-up were included. Clinical, surgical, and donor variables were collected. Descriptive statistics, chi-square and Wilcoxon tests were used, and Kaplan-Meier survival curves estimated graft survival by sex, preservation medium, and ischemia time. R software (v4.3.3) was used for analysis. Results: Graft survival free of rejection/failure at 12 months was 91% (95% CI: 87.6– 94.5%). No significant differences were observed by sex or ischemia time. Rejection was more frequent with grafts preserved in Optisol (22%) compared to Eusol (7.3%, p<0.001), although overall survival was similar. Keratoconus was more prevalent in younger males, whereas leucomas and prior rejections were more common in older females. Conclusion: PK demonstrates high short-term effectiveness. Preservation medium and underlying pathology may influence rejection risk, highlighting the importance of individualized strategies.
Descripción
Palabras clave
Queratoplastia penetrante, Rechazo del injerto, Medio de preservación, Sobrevida, Córnea
