自体角膜为载体Boston人工角膜治疗复杂性角膜盲

目的评价复杂性角膜混浊患者使用自体角膜做载体的BostonI型人工角膜植入的临床效果。方法回顾性病例研究。10例角膜盲患者（10眼）,术眼病变严重,经至少2名以上国内著名角膜病专家会诊。无法通过角膜移植复明。其中严重碱烧伤7眼,爆炸伤1眼,角膜内皮失代偿多次角膜移植失败1眼．双眼病毒性角膜炎角膜严重血管化1眼。其中9例为双眼盲。术前视力光感或手动。所有病例均一期完成手术,术中使用8．0mm或8．5mm环钻钻取患者角膜,用患者混浊病变的角膜为载体。安装Boston人工角膜。形成患者角膜．人工角膜复合体,复合体作为植片如传统角膜移植实行角膜植床和植片缝合固定,术中常规行晶状体摘除术。结果术后观察1-12个月,平均（5．7±3．8）个月,除1眼视力光感外,其余裸眼视力为0．1～0．8。手术并发症包括角膜植床出血人玻璃体腔2例,继发性青光眼2例,人工角膜后膜4例。所有术眼均无术后漏水并发症发生。结论人工角膜特别适合于穿透性角膜移植难于成功的角膜盲患者,而且是目前对严重角膜瘢痕血管化、眼睑或泪液功能不良患者有效的复明手段。我国角膜供体严重匮乏,用自体角膜为载体可作为部分BostonI型人工角膜植入手术的可行方案。     

人工角膜植入术的临床研究

评价复杂性角膜混浊患者行人工角膜植入术的临床效果和并发症等。方法选择15例双眼盲目患者的单侧眼15只,术前视力均为光感,角膜混浊病变无法用常规角膜移植手术达到复明目的。其中严重碱烧伤6只眼,严重酸烧伤3只眼,铝水烧伤2只眼,爆炸伤1只眼,严重实质性眼干燥症1只眼,多次穿透性角膜移植失败角膜严重血管化2只眼。人工角膜(MICOF)由俄罗斯费德洛夫眼外科中心制造。手术分两期：一期手术将人工角膜支架植入角膜层问,选择病例行角膜表面或层问加固性手术。约3个月后行二期手术,植入带螺纹的人工角膜光学部。常规行晶状体、部分虹膜及前部玻璃体切除术,将外1／3上、下睑缘做永久性缝合。对完全睑球粘连者,用上、下睑皮肤覆盖角膜表面,仅暴露人工角膜光学部。结果二期术后观察4～26个月,平均9．5个月,除1只眼视力光感外,其余眼裸眼视力0．12～1．0。手术并发症包括分离角膜板层时穿入前房,晶状体皮质残留,柱镜前表面结膜上皮遮盖,柱镜前表面纤维增生组织遮盖,柱镜后壁沉着物,角膜溶解。结论人工角膜特别适合于穿透性角膜移植难于成功的双眼盲目者,而且是对目前严重角膜瘢痕血管化、严重眼睑或泪液功能不良患者有效的复明手段。该术式结合自体结膜遮盖、骨膜层问移植及睑裂部分缝合等,有利于人工角膜的长期存留。     

自体穿透性角膜移植治疗角膜盲的临床观察

目的：观察自体穿透性角膜移植手术治疗角膜盲的临床效果。

方法：采用回顾性分析,选择2014-01/2018-03行自体穿透性角膜移植治疗的患者8例8眼(角膜盲),随访1a,观察术中并发症、术后视力、术后角膜透明度和术后并发症等。

结果：术后1wk时8眼患者术后裸眼视力均>0.02,复明率100%; 术后1mo时5眼患者矫正视力超过0.3,3眼患者因术前白内障影响术后矫正,视力提高到0.08～0.2; 术后1a,8眼患者原角膜盲眼植片均透明,无感染复发或继发感染情况发生。

结论：自体角膜移植手术后角膜植片易于生长,无排斥反应,术后并发症较少,且治疗花费少,既可为单眼失明合并角膜盲的患者提供长期的有用视力,又可减轻其经济负担,为患者带来巨大利益。     

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。     

人工角膜在治疗严重化学烧伤眼中的研究

目的探讨严重化学烧伤性角膜混浊患者行人工角膜植入术的临床效果和并发症等。方法选择2000年10月至2006年3月于解放军总医院眼科就治的28例因严重化学烧伤导致双眼盲目患者的单侧眼,术前视力14只眼为手动,14只眼为光感,并且角膜混浊病变无法采用常规角膜移植手术达到复明目的。其中严重碱烧伤20只眼,严重酸烧伤8只眼。人工角膜植入术分两期：Ⅰ期手术将人工角膜支架植入角膜层间,所选患眼行角膜表面或层间加固性手术。3个月后行Ⅱ期手术,植入带螺纹的人工角膜光学部。常规行晶状体、部分虹膜及前部玻璃体切除术,将外1／3上、下睑缘做永久性缝合。对完全睑球粘连者,用上、下睑皮肤覆盖角膜表面,仅暴露人工角膜光学部。结果Ⅱ期术后观察3—65个月,平均22．6个月,28只眼中有21只眼裸眼视力≥0．05（75％）,其中2只眼裸眼视力≥1．0。经镜片矫正后,11只眼（39％）视力为0．6—1．2;1只眼（4％）0．3～0．5;5只眼（18％）0．05—0．25;3只眼（11％）手动;3只眼（11％）光感;1只眼（4％）无光感。手术并发症包括分离角膜板层时穿人前房,晶状体皮质残留,继发性青光眼,镜柱前表面组织或上皮增生遮盖,镜柱后壁沉着物,角膜溶解,眼内炎,视网膜脱离。结论人工角膜是目前对严重角膜瘢痕、血管化的双眼化学烧伤患者有效的复明手段。该术式结合自体结膜遮盖、自体骨膜移植加固及睑裂部分缝合等,有利于人工角膜的长期存留。术后定期复查、积极预防并发症是保持视力的有效手段。     

领扣型人工角膜治疗高危移植角膜盲的多中心临床研究

目的评价领扣型人工角膜移植术治疗高危移植角膜盲的有效性和安全性。方法病例系列研究。前瞻性连续收集2019年7月至2020年1月在山东第一医科大学附属眼科医院、解放军总医院眼科医学部、中山大学中山眼科中心、复旦大学附属眼耳鼻喉科医院眼科和温州医科大学附属眼视光医院就诊且符合条件、拟行领扣型人工角膜移植术的高危移植角膜盲患者。术后随访12个月, 观察患者的术后视力, 以视力≥0.05为标准计算脱盲率并评定治疗的有效性;记录术后并发症情况、人工角膜在位情况, 以评定手术的安全性。结果 37例(37只眼)患者纳入研究, 男性32例, 女性5例;年龄范围为27～72岁。角膜移植手术后角膜植片混浊21只眼(56.8%), 眼部化学烧伤8只眼(21.6%), 眼部热烧伤5只眼(13.5%), 不明原因角膜混浊2只眼(5.4%), 角膜融解穿孔1只眼(2.7%)。2只眼于术后3个月退出研究, 35只眼完成术后6个月随访, 31只眼完成术后12个月随访。术后6个月83.8%术眼视力≥0.05, 术后12个月81.8%术眼视力≥0.05。合并青光眼11只眼, 术后12个月6只眼视力≥0.05。术后12个月...     

AlphaCor人工角膜移植治疗兔角膜碱烧伤

目的评价AlphaCor人工角膜移植对兔角膜碱烧伤的治疗效果。方法用1mol/LNaOH烧伤兔左眼建立角膜碱烧伤模型,选择角膜白斑、角膜缘新生血管〉2个象限的5只兔眼行人工角膜移植术。AlphaCor人工角膜移植手术分2期进行：Ⅰ期手术,将AlphaCor人工角膜植入角膜板层间;Ⅱ期手术,暴露人工角膜光学区。术后观察人工角膜、受体角膜及眼前节情况。结果碱烧伤后2～6周形成带新生血管的角膜白斑。Ⅰ期术后5例人工角膜均在位,2例人工角膜出现白色沉积物,其中1例并发角膜浅层基质溶解,另3例无并发症发生。Ⅱ期手术中麻醉死亡1例,其余术后人工角膜均在位,1例术后6周发生角膜感染、穿孔,另3例术后4～6周发生人工角膜前膜增生,未见其他并发症发生。结论 AlphaCor人工角膜移植治疗兔角膜碱烧伤具有良好的生物相容性,效果较好。     

自体角膜转位移植联合双板层角膜移植治疗角膜穿孔效果评价

目的评价自体角膜转位联合双板层角膜移植术治疗角膜穿孔的临床效果。方法对2010年6月至2012年12月因角膜穿孔而实施自体角膜转位联合双板层角膜移植术的8例（8只眼）进行了回顾性分析。其中真菌性角膜溃疡穿孔5只眼,铜绿假单胞菌性角膜溃疡穿孔1只眼,角膜Mooren溃疡穿孔1只眼,圆锥角膜急性穿孔1只眼。结果所有患者眼表形态结构均得到有效的恢复,避免了摘除眼球,5只眼保留了有效视力,其中术后1个月矫正视力：手动3只眼,0．04者2只眼,0．05者1只眼,0．08者1只眼,0．1者1只眼。术后14d内8只眼角膜植片上皮均愈合完整,角膜植片与植床对合好。所有患者术后短期内均无其他并发症。结论自体角膜转位联合双板层角膜移植术治疗角膜穿孔安全有效,在缺少角膜供体材料的情况下,是一种有效挽救眼球的治疗方法。     

应用临时人工角膜行前后节联合手术治疗严重眼外伤

目的 比较应用临时人工角膜行玻璃体切割联合穿透性角膜移植术治疗不同类型严重眼外伤的临床效果.方法 对伴有严重角膜混浊的眼外伤患者20例(21只眼),包括爆炸伤11例(12只眼)、眼球穿通伤9例(9只眼).术前视力为光感～眼前手动,采用临时人工角膜代替病变角膜完成闭合式玻璃体切割、白内障切除、球内异物取出、视网膜复位等眼内操作后,再用新鲜供体角膜置换人工角膜.术后随访3～36个月,平均17月,随访视力、眼压、眼球解剖完整性及并发症.结果 全部眼爆炸伤和78%的眼球穿通伤,共19只眼(90%)保存眼球解剖结构完整性.11只眼(52%)保持最佳矫正视力≥0.05,其中眼爆炸伤9只眼(9/12),穿通伤2只眼(2/9).严重影响预后的并发症有持续性低眼压、复发性视网膜脱离,均发生在眼穿通伤.结论 临时人工角膜下行前后节联合手术是治疗伴有严重角膜混浊的外伤眼的惟一有效的方法,眼爆炸伤预后好于眼球穿通伤.     

低密度角膜内皮细胞白内障超声乳化术的临床观察

目的评价超声乳化吸除术在治疗低密度角膜内皮细胞白内障患者的可行性和手术效果。方法对10例（12只眼）角膜内皮细胞密度〈1500个/mm^2的白内障患者行白内障超声乳化吸除人工晶状体植入术。其中Fuchs角膜营养不良3只眼,抗青光眼术后4只眼,颗粒状角膜营养不良2只眼,穿透性角膜移植术后3只眼。使用角膜内皮显微镜检查所有患者术前术后角膜内皮细胞密度,并观察术后视力及角膜水肿变化。结果所有患者术后视力均有不同程度提高,术后3个月最佳矫正视力0.1-0.4者8只眼,≥0.5者4只眼。术后角膜水肿为轻中度,常于术后5-7 d恢复,无角膜内皮细胞失代偿。内皮细胞损失率8.83%。结论低密度角膜内皮细胞白内障患者在一定程度上可行白内障超声乳化联合人工晶状体植入术。严格掌握手术适应证、术中注意保护角膜内皮细胞和由经验丰富的术者完成手术是疗效满意的重要保证。     

Forty-five years of keratoprosthesis study and application at the Filatov Institute:a retrospective analysis of 1 060 cases

AIM: To present results of the keratoprosthesis method used at The Filatov Institute of Eye Diseases and Tissue Therapy.METHODS:A retrospective case series analysis was used to describe the development of new types of keratoprostheses and methods of implantation as well as different ways of leukoma strengthening.RESULTS:Keratoprosthesis was performed in 1 060 eyes of 1 040 patients with leukomas of different etiology:burns, 725 eyes (68.4%); trauma, 120 eyes (11.3%); keratitis and ocular pemphigoid, 108 eyes (10.2%); and bullous keratopathy, 107 eyes (10.1%). Visual acuity before keratoprosthesis consisted of light perception in 962 eyes (92%), and 98 eyes (8%) had minimal visual acuity (1/200-1/50). Both eyes were blind (visual acuity less than 1/200) in 955 patients (91.8%). The period of blindness varied from 1 to 52 years. As a result of keratoprosthesis, visual acuity of ≥1/200 was restored in 1 023 of 1 060 eyes (96.5%). Visual acuity of 20/200-20/20 was achieved in 716 eyes (67.5%). At the last follow-up visit visual acuity of ≥1/200 was preserved in 806 eyes (76%), visual acuity of 20/200-20/20 was measured in 583 of 1 060 eyes (55%) and good keratoprosthesis fixation in the cornea was achieved in 986 of 1 060 eyes (93%). The minimal follow-up was 12 months (range, 12 months to 37 years, median 5 years).CONCLUSION: Our techniques of keratoprosthesis effectively restore vision in patients with leukomas that cannot be treated by optical corneal grafting.     

Long-term outcomes of the MICOF keratoprosthesis surgery

PurposeTo evaluate long-term anatomical and functional outcomes of the MICOF keratoprosthesis to treat end-stage corneal blindness.DesignRetrospective review of consecutive clinical case series.ParticipantsBetween October 2000 and October 2015, at the Department of Ophthalmology of Chinese PLA General Hospital (PLAGH), a total of 132 eyes of 131 patients had undergone a MICOF keratoprosthesis implantation. Of those, 91 eyes of 90 patients were included in this study.MethodsPreoperative information, surgical procedures, and postoperative data were collected for each included eye.Main outcome measuresBest-corrected visual acuity (BCVA), keratoprosthesis retention, and significant postoperative complications were reported.ResultsThe most common indications for surgery were chemical or thermal burns (68.1%, 62 of 91 eyes) and explosive injury (12.1%, 11 of 91 eyes), followed by Stevens-Johnson Syndrome (10.0%, 9 of 91 eyes), Sjögren's syndrome (4.4%, 4 of 91 eyes), mucous membrane pemphigoid (3.3%, 3 of 91 eyes) and multi-penetrating keratoplasty failure (2.2%, 2 of 91 eyes). The mean follow-up duration was 8.38 ± 3.22 years (range: 5–17.25 years, median: 7.67 years).All patbients had a preoperative visual acuity of hand motions or worse. A MICOF keratoprosthesis significantly improved patients' visual function with bilateral end-stage corneal blindness. Postoperative visual acuity improved to 20/200 or better in 41 eyes (45.1%, of 91 eyes) and to 20/100 or better in 32 eyes (35.2% of 91 eyes) at the last follow-up visit. Preexisting glaucoma was present in 17 (18.7% of 91 eyes). The most common postoperative complications were overgrowth of the surface mucosa (31.9%, 29 of 91 eyes), glaucoma (25.3%, 23 of 91 eyes), retro-prosthetic membrane (15.4%, 14 of 91 eyes), keratoprosthesis device extrusion (15.4%, 14 of 91 eyes), superficial tissue thinning (14.3%, 13 of 91 eyes), endophthalmitis (13.2%, 12 of 91 eyes), titanium frame exposure (13.2%, 12 of 91 eyes), optical cylinder ante-displacement (13.2%, 12 of 91 eyes), cornea melting (7.7%, 7 of 91 eyes), retinal detachment (6.6%, 6 of 91 eyes) and aqueous humour leakage (2.2%, 2 of 91 eyes). 84.6% (77 of 91 eyes) of the eyes retained their initial keratoprosthesis at the latest follow-up.ConclusionsA MICOF keratoprosthesis is a reliable approach to rescue vision in end-stage corneal blinded patients and has better retention than a Boston Kpro TypeⅡ.     

飞秒激光辅助的深板层角膜移植术治疗角膜基质病变

目的评价飞秒激光辅助的深板层角膜移植术（DALK）治疗角膜基质病变的早期临床效果及安全性。方法系列病例研究。13例（14眼）各种角膜基质病变患者（外伤后角膜瘢痕1眼,角膜炎后角膜瘢痕8眼,角膜基质层营养不良5眼）采用飞秒激光辅助的DALK术进行治疗。评价指标包括手术前后裸眼视力、最佳矫正视力、内皮细胞密度和并发症。结果所有手术均顺利完成,术中无任何并发症。平均随访时间（7．3±3．8）个月（2—14个月）。与术前相比,有11眼裸眼视力提高（78．6％）,平均提高1．7行（未变～6行）;所有患者最佳矫正视力均较术前提高,平均提高2．4行（1—8行）。有3眼采用治疗性准分子激光消融术进行辅助治疗,最后一次随访时统计,内皮细胞密度丢失率为1％,未见植片排斥、感染、上皮植入等并发症。结论飞秒激光辅助的DALK术可提高各种角膜基质病变患者的裸眼视力及最佳矫正视力,飞秒激光可透过混浊的角膜进行基质深层的有效光滑的切割。     

Boston keratoprosthesis type 1 for limbal stem cell deficiency after severe chemical corneal injury: A systematic review

Purpose

To systematically review the published literature on outcomes of Boston keratoprosthesis type 1 for the treatment of limbal stem cell deficiency secondary to severe chemical corneal injury.

Implantation of Iakymenko keratoprosthesis in patients with severe ocular injury

AIM: To present the results of implantation of Iakymenko keratoprosthesis in five patients with vascularized corneal leukoma caused by severe ocular injury. METHODS: Iakymenko keratoprosthesis was implanted into 5 eyes of 5 patients: 4 patients were suffered from chemical burns and 1 patient from explosive injury. The preoperative visual acuity ranged from light perception to hand motion. The implantation surgery was composed of two-stage procedures. The follow-up period was from 9 months to 11 years. The outcome measures were visual acuity, retention, and complications of the keratoprosthesis. RESULTS: Vision improvements were achieved in most patients. All keratoprosthesis were retained within the follow-up period. Corneal melting occurred in one patient and fibrous closure in another patient, both of which were successfully treated. Retinal detachment occurred in one patient after surgery. CONCLUSION: Iakymenko keratoprosthesis seems to be a promising alternative for the patients with severe corneal injury, but further investigation is needed to evaluate the role of Iakymenko keratoprosthesis.     

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。     

Penetrating keratoplasty combined with vitreoretinal surgery for severe ocular injury with blood-stained cornea and no light perception

OBJECTIVE: To evaluate the effects of treatment of severe ocular injury with blood-stained cornea and no light perception by combined penetrating keratoplasty and vitreoretinal surgery, and to analyze the relevant factors. METHODS: Records of 7 severely injured eyes of 7 patients with blood-stained cornea and no light perception who underwent penetrating keratoplasty combined with vitrectomy using a temporary keratoprosthesis were evaluated retrospectively. The preoperative visual acuity was no light perception in all injured eyes with a mean intraocular pressure of 3 mm Hg and a range from 2 to 5 mm Hg. The average interval from emergency wound closure to vitrectomy was 18 days with a range from 12 to 21 days. The mean follow-up was 28 months with a range from 26 to 30 months. RESULTS: The postoperative visual acuity was better than light perception in 5 eyes with the best corrected visual acuity from light perception to 0.06. The retina was attached in 5 eyes. The postoperative intraocular pressure ranged from 5 to 15 mm Hg with a mean of 12 mm Hg; it was significantly higher than the preoperative one (p < 0.05). The postoperative complications mainly included temporary intraocular elevation (1 eye), corneal neovascularization (4 eyes), corneal rejection (4 eyes), retinal detachment (2 eyes) and ocular atrophy (2 eyes). CONCLUSION: Penetrating keratoplasty combined with vitrectomy using a temporary keratoprosthesis is a safe and effective method in treating severe ocular injury with blood-stained cornea and no light perception.