波士顿Ⅰ型人工角膜移植术治疗中国严重角膜盲患者的长期临床观察
파사돈Ⅰ형인공각막이식술치료중국엄중각막맹환자적장기림상관찰
Long-term outcomes of Boston type Ⅰ keratoprosthesis for Chinese severe corneal blindness
  • 万方数据
    中华实验眼科杂志 중화실험안과잡지
    Chinese Journal of Experimental Ophthalmology
    2015年 10期 930-934 ,共5页

    祝磊%王丽娅%张月琴%贺燚%李家臣%赵东卿%杨纪忠%李冰

    축뢰%왕려아%장월금%하일%리가신%조동경%양기충%리빙

    角膜移植术%角膜疾病/手术%假体植入%疗效%术后并发症%视力%中国人%前瞻性研究 角膜移植術%角膜疾病/手術%假體植入%療效%術後併髮癥%視力%中國人%前瞻性研究
    각막이식술%각막질병/수술%가체식입%료효%술후병발증%시력%중국인%전첨성연구
    Corneal transplantation%Corneal diseases/surgery%Prosthesis implantation%Treatment outcome%Postoperative complications%Visual acuity%Chinese%Prospective studies
    背景 角膜盲的原因主要是严重的角膜组织结构的破坏,常规的角膜移植术常无法达到复明的目的.人工角膜移植术适用于常规角膜移植术无法治疗的严重角膜盲,目前全球使用最为广泛的人工角膜是波士顿Ⅰ型人工角膜,但其在中国的临床应用尚少,其在中国患者中的临床应用疗效、并发症及其处理的报道少见.目的 研究波士顿Ⅰ型人工角膜用于中国严重角膜盲患者后的长期疗效和安全性.方法 采用前瞻性系列描述性病例观察研究,纳入2008年8月至2015年8月于河南省眼科研究所、山西省眼科医院就诊的不适合行常规角膜移植术的严重角膜盲患者15例16眼,包括眼表烧伤7例8眼、病毒性角膜炎3例3眼、Stevens-Johnson综合征1例l眼、眼外伤2例2眼、真菌性和细菌性角膜溃疡接受角膜移植术后血管化角膜白斑各1例1眼,所有患者均为男性,平均年龄(50.4±13.0)岁.纳入的患眼中14眼接受过治疗性角膜移植术1次或以上,有明确青光眼病史者7眼,人工晶状体(IOL)植入术后5眼,无晶状体眼4眼.术前最佳矫正视力(BCVA)为0.05者1眼,数指/眼前者7眼,手动/眼前者8眼.所有患眼均行波士顿Ⅰ型人工角膜移植术,术后定期观察术眼BCVA、并发症和人工角膜在位眼数.患者随访19～84个月,平均(47.5±23.8)个月.结果 术中根据术眼病变进行波士顿人工角膜移植术或联合手术,包括联合晶状体或IOL摘出术、虹膜切除术、前部玻璃体及增生膜切割术,波士顿人工角膜移植术过程均顺利,未见术中并发症发生.术后1个月14眼视力提高,其中3眼BCVA≥1.0,4眼0.5≤BCVA＜1.0,7眼0.1≤BCVA＜0.5,而其他2眼因术前有青光眼视神经损伤,故视力无提高.末次复诊时视力保持在0.1以上者9眼.术后常见并发症为人工角膜后膜(RMP)形成7眼,角膜溶解6眼,青光眼4眼;发生严重真菌性角膜溃疡、细菌性眼内炎和人工角膜脱出各1眼,为保留眼球均行穿透角膜移植术,取出人工角膜.术后13眼人工角膜在位.结论 波士顿Ⅰ型人工角膜可用于治疗不适合常规角膜移植术的严重角膜盲,术后长期随访、及时发现并有效处理并发症是保持人工角膜移植术成功和保存患者视力的关键.
    배경 각막맹적원인주요시엄중적각막조직결구적파배,상규적각막이식술상무법체도복명적목적.인공각막이식술괄용우상규각막이식술무법치료적엄중각막맹,목전전구사용최위엄범적인공각막시파사돈Ⅰ형인공각막,단기재중국적림상응용상소,기재중국환자중적림상응용료효、병발증급기처리적보도소견.목적 연구파사돈Ⅰ형인공각막용우중국엄중각막맹환자후적장기료효화안전성.방법 채용전첨성계렬묘술성병례관찰연구,납입2008년8월지2015년8월우하남성안과연구소、산서성안과의원취진적불괄합행상규각막이식술적엄중각막맹환자15례16안,포괄안표소상7례8안、병독성각막염3례3안、Stevens-Johnson종합정1례l안、안외상2례2안、진균성화세균성각막궤양접수각막이식술후혈관화각막백반각1례1안,소유환자균위남성,평균년령(50.4±13.0)세.납입적환안중14안접수과치료성각막이식술1차혹이상,유명학청광안병사자7안,인공정상체(IOL)식입술후5안,무정상체안4안.술전최가교정시력(BCVA)위0.05자1안,수지/안전자7안,수동/안전자8안.소유환안균행파사돈Ⅰ형인공각막이식술,술후정기관찰술안BCVA、병발증화인공각막재위안수.환자수방19～84개월,평균(47.5±23.8)개월.결과 술중근거술안병변진행파사돈인공각막이식술혹연합수술,포괄연합정상체혹IOL적출술、홍막절제술、전부파리체급증생막절할술,파사돈인공각막이식술과정균순리,미견술중병발증발생.술후1개월14안시력제고,기중3안BCVA≥1.0,4안0.5≤BCVA＜1.0,7안0.1≤BCVA＜0.5,이기타2안인술전유청광안시신경손상,고시력무제고.말차복진시시력보지재0.1이상자9안.술후상견병발증위인공각막후막(RMP)형성7안,각막용해6안,청광안4안;발생엄중진균성각막궤양、세균성안내염화인공각막탈출각1안,위보류안구균행천투각막이식술,취출인공각막.술후13안인공각막재위.결론 파사돈Ⅰ형인공각막가용우치료불괄합상규각막이식술적엄중각막맹,술후장기수방、급시발현병유효처리병발증시보지인공각막이식술성공화보존환자시력적관건.
    Background Corneal blindness is associated with the change of corneal structure, and conventional keratoplasty cannot regain vision in these eyes.Keratoprosthesis is well used for patients unsuitable for standard keratoplasty.Boston type Ⅰ keratoprosthesis is one of the most commonly employed in the world,but it has not been well used in China.Objective This study was to evaluate the long-term outcome and safety of Boston type Ⅰ keratoprosthesis in China.Methods A pilot study was carried out for a descriptive prospective clinical trial under the approval of Ethic Committee of Henan Provincial People's Hospital and Henan Eye Institute.Sixteen eyes of 15 patients with severe corneal blindness which were not suitable for usual management were recruited, with the gender being males and ages of (50.4± 13.0) years.The causes of blindness included thermal and chemical injury in 8 eyes of 7 patients,herpes simplex keratitis in 3 eyes of 3 patients,Stevens-Johnson syndrome in 1 eye of 1 patient,mechanical trauma in 2 eyes of 2 patients and infectious keratitis in 2 eyes of 2 patients.Fourteen of the 16 eyes received therapeutic keratoplasty once or more before, and 7 eyes had glaucoma history,pseudophakia was in 5 eyes and aphakia was in 4 eyes.The best corrected visual acuity (BCVA) is 0.05 in 1 eye,finger counting in 7 eyes and hand motion in 8 eyes.Implantation of Boston type Ⅰ keratoprosthesis was performed on the 16 eyes and followed-up for (47.5 ±23.8) months (ranged from 19 throughout 84 months) after obtaining of written informed consent from each patient.The postoperative BCVA,postoperative complication and eye numbers of keratoprosthesis in site were recorded.Results The surgeries of Boston type Ⅰ keratoprosthesis or combination procedures,such as lens or intraocular lens (IOL) extraction,iridectomy,cyclitic membrane removal and vitrectomy were successful in all the eyes.One month after surgery,the postoperative BCVA was obviously improved in 14 eyes, with the BCVA ≥ 1.0 in 3 eyes,0.5 ≤ BCVA＜ 1.0 in 4 eyes and O.1 ≤ BCVA＜0.5 in 7 eyes, the vision was unchanged in 2 eyes due to end-stage glaucoma before operation.BCVA remained ≥ 0.1 in 9 eyes at the end of following-up duration.Postoperative complications included retromembrane proliferation in 7 eyes,corneal melting in 6 eyes and glaucoma in 4 eyes.Severe postoperative complications were fungal keratitis,endophthalmitis and device extrusion respectively and keratoprosthesis prolapse,so penetrating keratoplasty was carried out to replace the keratoprosthesis.Implanted Boston type Ⅰ keratoprosthesis was in site in 13 eyes at the end of following-up.Conclusions The Boston type Ⅰ keratoprosthesis might be a viable method to provide visual recovery for the eyes with severe corneal blindness unsuitable for standard keratoplasty.It is mandatory for long-term follow-up and prevention and management of postoperative complications.
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