PMMA-硅胶夹持型人工角膜植入碱烧伤兔眼的实验研究

目的探讨自制的PMMA-硅胶夹持型人工角膜植入碱烧伤兔眼角膜的手术方法和疗效。方法建立兔眼碱烧伤模型：将PMMA-硅胶夹持型人工角膜植入碱烧伤后形成白斑的兔眼角膜,观察6个月。结果人工角膜手术操作顺利,术后1只实验兔眼出现了眼内炎,人工角膜脱出,另1只兔术后7周死亡,余3只兔眼在观察期内未见角膜组织溶解、房水渗漏、青光眼、感染或人工角膜前后膜增生等并发症,人工角膜稳定在位并保持透明。结论本实验自制的PMMA-硅胶夹持型人工角膜,手术操作简单,术中及术后并发症较小,似有实际临床应用价值。     

改良PHEMA-PMMA一体化人工角膜治疗兔角膜碱烧伤的实验研究

目的评价改良聚羟乙基丙烯酸甲酯（PHEMA）-聚甲基丙烯酸甲酯（PMMA）一体化人工角膜时兔角膜碱烧伤的治疗效果。方法通过两阶段化学聚合结合车床机械切削合成改良的一体化人工角膜。将PHEMA海绵边裙材料植入10只正常兔角膜板层间，另10只碱烧伤兔眼角膜囊袋内1期植入一体化PHEMA—PMMA人工角膜，术后用组织病理、免疫组织化学和电镜检查观察海绵边裙与角膜组织的生物学愈合情况。术后2个月行II期手术．术后随访观察3～6个月。结果接受板层间植入术的10只兔角膜未见任何并发症。术后2周成纤维细胞长入PHEMA海绵，术后2～3个月多量细胞长入伴有新生血管；海绵孔隙中生长细胞和角膜基质细胞波形蛋白（Vim）免疫反应阳性；电镜下，细胞在海绵材料间隙中生长状态良好，并分泌胶原和细胞外基质。接受人工角膜移植术的10只碱烧伤兔眼中，1眼1期术中角膜穿孔而被排除，另9眼Ⅱ期术后，3眼2周内人工角膜镜柱偏位，6眼观察期间人工角膜在位。结论PHEMA海绵能够与角膜组织达到良好的生物学愈合；人工角膜的片型和整体强度有待进一步改良。     

重度碱烧伤早期异种去细胞角膜材料移植

目的观察重度碱烧伤后,早期(伤后1周内)行异种去细胞角膜材料板层移植手术治疗的可行性和疗效,并与同种异体角膜材料进行比较性研究。方法将19只新西兰大白兔制作成角膜重度碱烧伤模型,伤后1周,取16只随机分为2组,每组8只。一组行猪去细胞角膜材料板层移植;另一组行同种异体板层兔角膜移植。其余3只烧伤后不作任何处理,为空白对照组。术后进行大体观察、裂隙灯、病理学、角膜内皮染色观察。结果重度碱烧伤异种去细胞角膜材料移植后2~3周,有新生血管侵入植片边缘,植片为灰白色半透明状,移植区角膜上皮愈合。6周后,角膜植片新生血管开始减退,植片局部变透明。观察至28周,植片存活良好,无免疫排斥反应发生,炎症静止,眼表维持相对正常的结构,与同种异体角膜移植组治疗效果相同,可为以后的增视性手术创造良好的条件。结论用异种去细胞角膜基质材料对重度碱烧伤角膜进行移植手术治疗,可减轻伤后炎症反应,防止严重并发症的发生,维持了眼表结构。疗效与同种异体角膜移植相同。     

襻状支架人工角膜植入术的动物实验研究

目的：观察兔角膜碱烧伤后新生血管性角膜白斑在应用分子定向重排PMMA襻状支架人工角膜植入后的改变情况。方法：14只新西兰白兔，建立碱性角膜化学伤后偏中心新生血管性角膜白斑模型。将上述烧伤后1个月的新生血管性角膜白斑实验兔随机分为2组，每组7只，分别植入分子定向重排PMMA襻状支架人工角膜(实验组)和Fydorov-Zyev人工角膜(对照组)。结果：实验组：术后术眼均见刺激症状和角膜水肿，植床角膜水肿5—7d逐渐浅轻，2w后术眼刺激症状消失。术后人工角膜在位透明，1眼于术后7d出现人工角膜后膜，3眼于术后4—5w出现人工角膜前膜，钻除后有复发。对照组：人工角膜支架及自体耳软骨植入(第一期手术)后，术眼充血明显，植床角膜水肿，7—10d后逐渐消失，术后3w眼部刺激症状基本消失。人工角膜镜柱植入(第二期手术)后，术眼混合充血，近创缘处植床角膜水肿，2w后刺激症状基本消失，2眼于镜柱植入后5—10d出现人工角膜后膜，清除后1w又复发，3眼于术后4—6w出现人工角膜前膜，钻除后均有复发。结论：①襻状支架人工角膜与角膜植床之间的界面比Fydorov-Zyev型人工角膜的面积小，能减少支架对组织的损伤。②分子定向重排PMMA具有良好的生物相容性。③动物实验证实，襻状支架人工角膜植入后能稳定存留，无严重并发症，为应用于临床奠定了实验基础。     

壳聚糖复合人工角膜小型猪植入实验研究

目的 探讨壳聚糖纳米生物一体化人工角膜的生物相容性及植入小型猪角膜的治疗效果.方法 10只小型猪（藏香猪）均以左眼作为实验眼,建立角膜碱烧伤模型.人工角膜植入手术分两期进行：Ⅰ期手术将人工角膜植入碱烧伤猪角膜板层囊袋内;3个月后行Ⅱ期手术（角膜前板层开窗术）,钻切中央角膜前板层组织,暴露人工角膜光学区.术后观察6个月,行眼前段OCT检查、病理及免疫组化检测.结果 10只小型猪中1例在Ⅰ期术后2个月出现术眼感染性角膜溃疡,前板层溶解,最终导致人工角膜脱出.9例完成人工角膜Ⅱ期开窗手术,术后3例发生人工角膜前增生膜,4例出现后增生膜（其中2例前、后兼有）,余4例角膜中央光学区维持透明,荧光素染色无渗漏.组织学检查发现人工角膜裙边材料孔隙中有纤维组织长入;眼前段OCT显示猪眼前段解剖构基本正常;免疫组化分析发现前、后增生膜样本中血管内皮生长因子（VEGF）呈现高表达.结论 壳聚糖纳米生物一体化人工角膜的组织生物相容性良好,其裙边材料有利于角膜纤维组织及新生血管长入,该人工角膜的小型猪植入实验获有相对稳定的移植治疗效果.     

兔角膜重度碱烧伤后异种猫前板层角膜移植重建角膜眼表

目的研究猫新鲜前板层角膜移植治疗兔右眼角膜重度碱烧伤的疗效。方法将16只5个月龄的健康雄性新西兰白兔右眼制作重度角膜碱烧伤模型,随机分成A、B两组,每组各8只兔,其中A组为猫(4只)→兔异种前板层角膜移植组,植片直径为11.0mm,植床直径为10.0mm;B组未行手术。A组兔术后及B组造模后用500g.L-1葡萄糖及复方氯霉素滴术眼直至处死,记录两组疗效指数,并分别于术后1个月、2个月、3个月取材进行术眼角膜病理学及扫描电镜检查。结果3个月内A组8只角膜碱烧伤兔经异种猫前板层角膜移植后,7只移植角膜保持透明,1只出现局限性角膜混浊和角膜新生血管;而B组未手术的8只兔中出现角膜白斑、新生血管4只,角膜溃疡、穿孔3只,角膜溶解穿孔1只,并且有4只发生睑球粘连等并发症。A、B两组治疗后1个月、2个月、3个月平均疗效指数差异均有统计学意义(均为P<0.05)。A组透明角膜中组织学及扫描电镜下的结构特征清晰;B组兔角膜中有明显的角膜水肿和炎性细胞浸润,组织学及扫描电镜下的结构特征显示细胞连接混乱、消失。B组扫描电镜还提示随着时间的延长,上皮细胞部分生长、增多,细胞连接差,角膜上皮排列紊乱;角膜内皮细胞数量明显减少或无,...     

复合自体脂肪干细胞的脱细胞猪角膜基质移植治疗兔角膜碱烧伤

目的:研究复合脂肪干细胞的脱细胞猪角膜基质对碱烧伤角膜的治疗效果。方法:制备晾干的脱细胞猪角膜基质,取第3代体外培养的兔自体脂肪干细胞,体外种植到脱细胞猪角膜基质上,培养3d后用于板层角膜移植。结果:板层角膜移植2mo后,术眼角膜基本恢复透明,未发生排斥反应,新生血管较少,3mo后新生血管基本消退。结论:复合自体脂肪干细胞的脱细胞猪角膜基质对兔碱烧伤角膜具有良好的修复能力。     

穿透人工角膜植入术的初步临床观察

目的 应用穿透人工角膜植入术使角膜移植失败或难以进行角膜移植的角膜白斑患者脱盲。方法 应用Yakimenko型人工角膜对4例化学烧伤后角膜白斑和1例爆炸伤后的角膜白斑进行了穿透人工角膜植入术。术前3例光定位准确，2例光定位不准确。结果 术后1眼视力无变化。4眼视力有不同程度的提高(0．09～0．6)、其中最好的1例术后裸眼视力为0．6，矫正视力为0．8，观察时间9个月～3年。结论 应用耳软骨加固人工角膜植床是一个行之有效的方法，对不能行角膜移植和角膜移植失败但尚存光感的角膜白斑患者，穿透人工角膜植入术是目前首选的复明手术。     

改良聚羟乙基丙烯酸甲酯-聚甲基丙烯酸甲酯一体化人工角膜植入兔与猴角膜的实验研究(英文)

目的:探讨聚羟乙基丙烯酸甲酯(PHEMA)海绵支架材料与角膜组织的生物相容性,评价改良聚羟乙基丙烯酸甲酯(PHEMA)—聚甲基丙烯酸甲酯(PMMA)一体化人工角膜植入兔与猴角膜的初步临床效果。方法:通过两个阶段化学聚合结合车床机械切削合成改良的一体化人工角膜。实验分为两个部分完成。第1部分(A组):将PHEMA海绵边裙材料植入10只正常兔角膜板层间,术后2,4wk及2,3,4mo分别行组织病理、免疫组织化学及电镜检查,观察海绵边裙与角膜组织的生物学愈合情况。第2部分(B组):8只兔眼和2只猴眼角膜囊袋内I期植入一体化人工角膜,术后临床观察材料与组织的愈合情况;术后3mo时行Ⅱ期手术切除术眼角膜中央前板层角膜组织,暴露人工角膜中央镜柱,术后随访时间3 ～6mo,初步观察临床治疗效果。结果:1)A组接受角膜板层间边裙植入术的10只兔眼,随访期间未见并发症:组织病理学显示,PHEMA海绵边裙材料植入术后2wk始有成纤维细胞长入,术后2 ～3mo时多量成纤维细胞长入并伴有新生血管生长;免疫组织化学显示,海绵孔隙中长入的细胞和角膜基质细胞均对波形蛋白免疫反应呈阳性;电镜下可见,成纤维细胞在海绵材料间隙中生长,细胞生长状态良好,并分泌胶原和细胞外基质。2)B组接受一体化人工角膜移植术的,6只兔眼一体化人工角膜均在位,另2只兔眼I期术后有前板层角膜基质融解。接受一体化人工角膜移植术的2只猴眼,I期和Ⅱ期术后均未见明显并发症。结论:PHEMA海绵能与角膜组织良好的生物学愈合;改良PHEMA-PMMA一体化人工角膜植入术后能获得相对稳定的治疗效果。     

高危角膜移植排斥兔模型的建立及对比研究

背景 理想的角膜移植排斥动物模型是研究高危角膜移植免疫排斥机制的基础,具有重要的意义. 目的 比较各种建立兔高危角膜移植排斥模型方法的临床特点,探索合适的角膜移植排斥动物模型的建立方法.方法 45只新西兰白兔作为角膜移植受体,并按照造模方法的不同按随机数字表法随机分为缝线组、碱烧伤组和异种移植组,每组15只.分别用在角膜4个象限各间断缝1根5-0丝线法和1 mol/LNaOH碱烧伤法诱导角膜新生血管(CNV),再建立兔同种异体角膜移植；另一组以猫角膜为供体,建立猫-兔异种角膜移植模型.于第2周和第4周观察植片的组织学情况,对3个组角膜植片裂隙灯下观察植片排斥反应、炎症和新生血管,对植片水肿程度及炎症指数(IF)进行评分,根据角膜混浊、水肿及新生血管合计值计算排斥指数(RI).用免疫组织化学法检测CD4+T细胞和CD8+T细胞在植片组织中的表达. 结果 缝线组、碱烧伤组和异种移植组分别有14、15、15只兔完成穿透角膜移植术.术后2周,3个组IF中位数分别为0.556、0.778、0.222,差异有统计学意义(H=25.736,P=0.000),异种移植组IF值低于缝线组和碱烧伤组,差异均有统计学意义(Z=3.841、3.993,P=0.000),缝线组IF值低于碱烧伤组,差异有统计学意义(Z=3.568,P=0.000).术后2周,3个组RI中位数分别为2、6、3,差异有统计学意义(H=22.432,P=0.000),异种移植组RI高于缝线组而低于碱烧伤组,差异均有统计学意义(Z=2.373,P=0.018；Z=3.936,P=0.000),缝线组RI低于碱烧伤组,差异有统计学意义(Z=3.729,P=0.000).3个组植片存活时间分别为(17.9±2.0)、(13.4±2.4)、(15.5±2.0)d,差异有统计学意义(F=9.474,P=0.001).异种移植组的新生血管面积均低于缝线组和碱烧伤组(P＜0.05).术后2周和4周,组织病理学检查可见异种移植组植片中的炎性细胞少于缝线组和碱烧伤组,3个组植片中均出现以CD4+T细胞为主的细胞浸润. 结论 猫-兔异种角膜移植模型较缝线和碱烧伤法制作的角膜移植模型炎症反应轻、新生血管少,角膜免疫排斥反应稳定、适度,是理想的高危角膜移植动物模型.     

Cornea sparing by endoscopically guided vitreoretinal surgery

PURPOSE: To report a series of eyes with acute severe corneal edema and vitreoretinal complications treated with endoscopic vitreous surgery without a keratoprosthesis to the cornea. DESIGN: Retrospective, small, noncomparative case series. PARTICIPANTS: Seven patients with unilateral acute severe corneal edema, poor view of the fundus, and vitreoretinal complications were reviewed. Five eyes were postcataract surgery, one eye was postpenetrating intraocular blunt trauma by a ferrous foreign body, and one eye had endophthalmitis. INTERVENTION: Vitreous surgery was performed on each eye under the guidance of endoscopy. Topical steroid treatment was administered to the cornea for several weeks after the vitreoretinal surgery, until the corneal edema had been completely resolved. MAIN OUTCOME MEASURES AND RESULTS: The edematous corneas recovered within an average of 9 weeks (range, 6-13 weeks). The preoperative visual acuity ranged from 6/90 to hand motion at 0.5 m, and the final postoperative visual acuity was 6/30 or better after an average follow-up of 14 months (range, 3-23 months). CONCLUSIONS: (1) Endoscopic surgery for vitreoretinal complications in eyes with acute severe corneal edema can obviate keratoprosthesis and keratoplasty. (2) By minimizing further damage to the corneal endothelium, endoscopic vitreoretinal surgery might benefit corneal recovery.     

A tectonic keratoprosthesis using expanded polytetrafluoroethylene as a supporting skirt in humans.

A tectonic keratoplasty was performed with a keratoprosthesis using expanded polytetrafluoroethylene as a supporting skirt, on the left eye of a 23-year-old woman who needed an emergency corneal transplantation due to corneal perforation. The keratoprosthesis implanted, consisted of a supporting skirt which was made of expanded polytetrafluoroethylene (PTFE), and an optic portion which was made of polymethylmethacrylate (PMMA). The optic portion and the supporting skirt were attached by cyanoacrylate tissue adhesive (Histoacryl). Two months post-operatively, the keratoprosthesis was extruded, leaving an opacified, vascularized cornea. A penetrating keratoplasty was performed 1 month later. The excised cornea was composed of granulation tissue. To our knowledge, this is the first case of tectonic keratoprosthesis using expanded PTFE as a supporting skirt in humans.     

Corneal replacement using a synthetic hydrogel cornea,AlphaCor: device,preliminary outcomes and complications

PURPOSE: Clinical assessment of outcome of corneal replacement with a synthetic cornea, AlphaCor, in patients considered at too high risk for conventional penetrating keratoplasty with donor tissue to be successful, but excluding indications such as end-stage dry eye that might be suited to traditional prosthokeratoplasty. METHODS: All patients in the multicentre clinical trial were managed according to an approved protocol, with Ethics Committee approval in each centre. Preoperative visual acuity ranged from perception of light (PL) to 6/60 (20/200). Implantation was by means of an intralamellar technique, with a conjunctival flap in most cases. Tissues anterior to the optic were removed as a secondary procedure. RESULTS: Up to 30 November 2001, 40 AlphaCor devices had been implanted in 38 patients, of mean age 60 years. Follow-up ranged from 0.5 months to 3 years. There had been one extrusion (2.5%) and four cases (10%) where a device had been removed due to melt-related complications. All five of these cases received a donor corneal graft after the device was removed, with these grafts remaining anatomically satisfactory and epithelialised to date. Corneal melts in AlphaCor recipients were found to be strongly associated with a history of ocular herpes simplex infection. Two further devices (5%) were removed owing to reduced optic clarity after presumed drug-related deposition, and have been successfully replaced with second devices. Mean preoperative best-corrected visual acuity was hand movements. Visual acuities after surgery ranged from PL to 6/6(-2) (20/20(-2)). CONCLUSIONS: Early results suggest that the AlphaCor, previously known as the Chirila keratoprosthesis (Chirila KPro), has a low incidence of the complications traditionally associated with keratoprostheses and can be effective in restoring vision in patients considered untreatable by conventional corneal transplantation. Importantly, the device can be replaced with a donor graft in the event of development of a significant complication. A history of ocular herpes simplex is a contraindication to AlphaCor implantation. Ongoing monitoring of clinical outcomes in all patients will allow the indications for AlphaCor, as opposed to donor grafts, to be determined.     

Implantation of a Keratoprosthesis of Novel Design in Rabbits

Purpose To evaluate a keratoprosthesis, implanted by penetrating keratoplasty, in rabbits.Methods We implanted our keratoprosthesis (optics and flange portions of polymethylmethacrylate and a polyurethane skirt with micropores) into 14 eyes of 14 rabbits. In four eyes, we evaluated histologically the junction between the keratoprosthesis and host cornea. Long-term keratoprosthesis survival was evaluated in ten eyes by slit-lamp biomicroscopy.Results The histological study showed good approximation of the keratoprosthesis to the host cornea in the junction area, with overlying superficial corneal stroma on the skirt, keratocyte and collagen fiber ingrowth into the micropores, and partial migration of epithelial cells onto the skirt. However, in the long-term survival study, eight out of ten eyes developed acute suture-related inflammation, considered to be from bacterial infection, requiring enucleation 30 ± 18 weeks after implantation. The remaining two eyes have survived for 70 and 76 weeks.Conclusions Our keratoprosthesis was well tolerated in the short term. However, further modifications are necessary to avoid corneal infection. Jpn J Ophthalmol 2004;48:448–453 © Japanese Ophthalmological Society 2004     

国产化人工角膜植入兔眼的稳定性评估

目的 评价国产化人工角膜在兔眼角膜中的中长期稳定性.方法 实验研究.采用长耳大白兔10只,均选右眼作为国产化Moroz改良型永久性人工角膜植入眼,左眼为对照眼.手术分两期完成,一期手术用第三眼睑(软骨组织与人耳软骨有类似效果)加固角膜前层,联合自体结膜遮盖植入人工角膜支架;3个月后进行二期手术,植人人工角膜镜柱.全部手术完成后观察6个月以上.术后抗生素滴眼预防感染,定期观察,照相记录.最终行眼组织病理学检查.并与左眼进行对照.结果 除1只兔在二期术中因麻醉意外死亡外,9只兔均顺利完成手术和术后观察,术后各观察时间点人工角膜均在位,眼表血管化良好,未发生角膜组织融解、房水渗漏、高眼压、感染等严重并发症.组织病理学检查显示:加固的软骨组织均在位,人工角膜支架与周围组织紧密结合,有较活跃的纤维组织增生包绕,角膜炎症反应很轻.对侧眼无异常.结论 国产化人工角膜具有良好的生物相容性和中长期在位稳定性,用耳软骨加固和自体结膜遮盖有助于提高人工角膜稳定性.     

Complications of AlphaCor keratoprosthesis: a clinicopathologic report

PURPOSE: To describe the clinical and histopathologic features of intractable secondary glaucoma induced by AlphaCor keratoprosthesis. METHODS: An elderly woman with pseudoexfoliation glaucoma and pseudophakic bullous keratopathy in the right eye had graft failures after penetrating keratoplasty. Her best-corrected visual acuity at presentation was counting fingers in the right eye and 20/30 in the left eye. Examination showed severe corneal neovascularization. Chirila keratoprosthesis type II was implanted in 2 stages. Ten months later, the patient developed dense retrocorneal membrane, 360 degrees occlusion of angles, intractable glaucoma, no light perception, and nasal stromal melting associated with partial extrusion of the keratoprosthesis. RESULTS: Histopathology revealed invasion of the porous material of the keratoprosthesis by reactive fibroblasts and multinucleated foreign-body giant cells. In the area of dehiscence, we noted thinning and lysis of the collagen fibers, infiltration of lymphocytes, and plasma cells with a sheet of fibroinflammatory tissue extending into the anterior chamber. CONCLUSIONS: Corneal stromal melting and retrocorneal prosthetic membrane formation after AlphaCor keratoprosthesis implantation led to intractable glaucoma and extrusion of the implant.     

Preliminary results after implantation of four AlphaCor artificial corneas

Purpose The purpose was to evaluate the validity of implantation of the artificial cornea (AlphaCor) in human corneas considered too high risk for penetrating keratoplasty with donor tissue.Methods Four keratoprostheses, made from poly(2-hydroxyethyl methacrylate) (PHEMA) with a porous skirt and a transparent optical part, were implanted into the cornea of four patients. Keratocytes invading the skirt provide a watertight fixation with the scarred corneal tissue. Deep to the clear optical part, the posterior corneal lamella was excised to a diameter of 3.5 mm before the device was implanted, and the anterior lamella was trephined similarly 3 months after AlphaCor implantation.Results The eyes selected to receive an artificial cornea had significant neovascularisation, and 0–3 previous failed grafts. Follow-up for 6 months revealed best visual acuity between 20/400 and 20/50. Factors limiting the visual acuity outcome were optic atrophy and age-related macular disease. One patient underwent an extracapsular cataract extraction after the device was implanted, as a senile cataract was then noted. One complication occurred, a central corneal stromal melt, which was managed by covering with a 9-mm donor lamella.Conclusion The flexible device AlphaCor may provide a substitute for donor corneal tissue in desperate cases. Advantages include the simple implantation technique, which avoids trauma to the surrounding structures. Visual acuity results may be limited by pre-existing pathology, but it appears that a patient's visual potential can be achieved. Further follow-up to exclude long-term complications is required.     

Histological study of graft failure in AlphaCor transplantation

To report clinical and histopathologic findings in a case of a failed AlphaCor artificial cornea explanted due to corneal stromal melting. We describe the case of a 77-year-old man who received multiple penetrating keratoplasties (PKPs) and subsequent placement of an AlphaCor artificial cornea. Examination showed total corneal infiltration as well as an AlphaCor that was partially dehisced from the host cornea. After explantation, the implant and adjacent host tissue underwent hematoxylin and eosin staining and high-resolution scanning electron microscopy (HR-SEM). Histopathologic analysis of the specimens revealed infiltration of the skirt pores by reactive corneal fibroblasts. Although the AlphaCor implant is an established method of treating multiple failed PKPs, in this case, HR-SEM imaging strongly suggests that the strength of the interface between the implant and corneal tissue is highly dependent on collagen deposition between the pores found in the implant skirt. Collagen deposition then increases the mechanical strength of the cornea–skirt interface.     

严重眼球破裂伤无光感眼合并角膜血染的手术治疗

目的 探讨严重眼球破裂伤无光感眼合并角膜血染的手术治疗效果，并分析相关因素。 方法 7例患者7只眼因严重眼球破裂伤无光感合并角膜血染接受2期临时人工角膜下玻璃体切割联合角膜移植手术。2期手术前7只眼均角膜血染，前房及玻璃体积血，视网膜脉络膜脱离。1期与2期手术间隔时间平均18d(12～21d)。手术前视力均无光感，眼压平均3 mm Hg(1mm Hg=0.133 kPa)(2～5 mm Hg)。随访平均时间12个月(6～30个月)。 结果 5只眼恢复光感以上视力，矫正视力从光感至0.05。视网膜复位5只眼(5/7)。眼压平均12 mm Hg(5～15 mm Hg)，明显高于手术前眼压(P＜0.05)。并发症包括一过性高眼压(1 只眼)，角膜新生血管(4只眼)，角膜排斥反应(4只眼)，眼球萎缩(2只眼)。 结论 临时人工角膜下玻璃体切割联合角膜移植手术是挽球严重眼球破裂伤无光感眼合并角膜血染的安全有效的方法。（中华眼底病杂志，2004，20：212-214）     

环行板层巩膜瓣联合全板层角膜移植术治疗严重眼部化学伤临床及免疫学探讨

目的 观察环行板层巩膜瓣联合全板层角膜移植术治疗严重眼部化学伤的疗效。探讨其免疫学机制。方法 对５５例５５眼行角膜移植术的患者进行回顾性分析,将４２例行环行板层巩膜瓣联合全板层角膜移植术治疗的严重眼部化学伤（Ⅰ组）与同期１３例行全角膜移植术（Ⅱ组,亦为化学伤）的患者进行对照,比较手术后角膜的透明度、新生血管出现的时间、排斥率及排斥反应出现的时间。结果 环行板层巩膜瓣联合全板层膜移植组与全角膜移植组比较。角膜植片新生血管出现的时间及排斥反应出现的时间均延迟。排斥率下降,透明率明显提高。结论 环行板层巩膜瓣联合全板层角膜移植术是严重眼部化学伤后重建眼前节的有效方法。其免疫学机制复杂,术后维持泪膜的质量。综合抗排斥反应是提高手术效果的关键。