目的：使用前段光学相干断层扫描(AS-OCT)评估在穿透性角膜移植术(PK)后角膜上皮厚度的变化，并确定上皮厚度在移植排斥反应早期检测中的作用。

方法：前瞻性比较观察研究。共纳入20例20眼接受穿透性角膜移植术患者做为研究组，对照组16例16眼。术后2wk、1mo和3mo使用AS-OCT测量角膜厚度。术后3mo，与对照组排斥反应和上皮厚度及分布参数进行比较。

结果：术后1mo，研究组的上、下、最大和最小上皮厚度值均显著低于术后2wk(P=0.0004， 0.0001， 0.0001， 0.04)，术后3mo与1mo相比无显著差异(P=0.4， 0.1， 0.8)。与术后2wk相比，1mo时上皮厚度的降低明显高于基质厚度(P=0.04)。角膜上皮厚度变化显示，研究组和对照组的角膜上皮厚度分布模式相似，出现明显的角膜水肿。但是，对照组中央角膜厚度(CCT)明显更高。

结论：角膜移植术后移植物上皮重塑的定量评估显示，早期变化有助于角膜移植物厚度的显著改善。角膜上皮厚度和分布模式的变化可作为角膜移植排斥反应的指标。

METHODS: This prospective comparative observational study included 20 patients(20 eyes)who underwent PK as study group and 16 patients(16 eyes)as control group. Corneal epithelial thickness mapping using AS-OCT was performed at 2wk, 1 and 3mo postoperatively. The parameters of epithelial thickness and distribution at the 3mo were compared to 16 patients(16 eyes)with allograft rejection following PK.

RESULTS: There was significant decline in the superior, inferior, maximum, and minimum epithelial thickness values of the study group at 1mo compared to 2wk(P=0.0004, 0.0001, 0.0001, 0.04 respectively)with no significant differences at 3mo compared to 1mo(P=0.4, 0.1, 0.8)respectively. Percentage of reduction in epithelial thickness was significantly higher than that of stromal thickness at 1mo compared to 2wk(P=0.04). The epithelial thickness maps showed a similar pattern of epithelial thickness distribution in the study group and in the rejection group showing considerable corneal edema. However, the allograft rejection group showed irregular pattern of epithelial thickness distribution in patients showing relatively higher central corneal thickness(CCT)as measured by pachymetry map.

CONCLUSION: Quantitative assessment of graft epithelial remodeling following PK shows early changes that contribute to significant corneal graft thickness changes. Changes in corneal epithelial thickness and pattern of distribution could be used as an indicator for corneal graft rejection.