带环形板层巩膜瓣全角膜移植术临床及免疫学探讨

Clinical and immunological studies on transplantation of total cornea with circular lamellar sclera

目的观察带环形板层巩膜瓣全角膜移植术（ｔｏｔａｌｃｏｒｎｅａｗｉｔｈｃｉｒｃｌｅｌａｍｅｌｅｒｓｃｌｅｒａｔｒａｎｓｐｌａｎｔａｔｉｏｎ，ＣＳＴ）的临床疗效，结合动物实验探讨其免疫学机制。方法对１０９例（１０９只眼）行角膜移植术的患者进行回顾性分析，按术式进行分组。比较手术后不同时期的排斥率及角膜新生血管出现的时间。动物实验分组及方法同临床。结果带环形板层巩膜瓣全角膜移植术组，角膜植片新生血管出现时间及排斥发生时间较全角膜移植术（ｔｏｔａｌｃｏｒｎｅａｔｒａｎｓｐｌａｎｔａｔｉｏｎ，ＴＣＴ）组延迟，而较部分穿透性角膜移植术（ｐｅｎｅｔｒａｔｉｎｇｋｅｒａｔｏｐｌａｓｔｙ，ＰＫＰ）组３～６个月时的排斥率明显增加。结论带环形板层巩膜瓣全角膜移植术是眼前节重建的重要方法，其免疫学机制复杂，而完整的异体角巩膜缘在免疫反应中占重要地位。

Objective To observe the clinical results of total cornea with circular lamellar sclera transplantation (CST) and study its immunological mechanisms by animal experiments. Methods 109 patients with corneal transplantation were retrospectively analyzed, and according to the methods of operation they were divided into groups to compare their rate of rejection and the time of occurrence of corneal neovascularization. The methods of grouping and operation in animal experiments were similar to that in the clinical practice. Results The time of occurrence of neovascularization and rejection of CST were later than that in the total corneal transplantation (TCT), and the postoperative rate of rejection at 3 to 6 months was obviously increased in comparison with that in the partial penetrating keratoplasty (PKP). Conclusion CST is an important method for rebuilding ocular anterior segment, and the donor limbus is active in the immunological of rejection.