适宜中国国情的角膜移植技术的挑战和创新

Challenges of corneal blindness and innovations in corneal transplant techniques appropriate to national conditions in China

角膜盲是我国仅次于白内障的致盲性疾病，角膜供体材料匮乏造成角膜盲患者绝对数量仍在逐年上升。与欧美发达国家不同，严重的感染性角膜炎、热烧伤、化学伤和各种眼内手术引起的大泡性角膜病仍然是我国角膜移植的主要适应证。我国角膜盲的防盲面临着患者病情重、依从性差、可支付能力低和角膜供体材料严重缺乏的多重挑战。近年来，我国的角膜专科医师根据特殊的国情，发展和创新了一系列深板层移植、内皮移植、人工角膜移植和组织工程角膜异种移植的新技术，从技术层面显著提高了供体角膜材料的利用率，降低了高危移植的排斥反应。然而，由于角膜供体材料极其缺乏的瓶颈依旧，能掌握当代角膜移植新技术的角膜专科医师数量稀少，目前推动角膜捐献的立法工作和深入组织工程异种角膜材料学研究、加强国际间眼库合作迫在眉睫，适宜国情的角膜移植技术的创新和推广工作仍然任重而道远。

Corneal blindness, second only to cataracts as a cause of blindness in China, is inflicting an increasing number of patients because of the extreme shortage of corneal donor tissue. Unlike the developed Western countries, the primary indications for corneal transplants in China are comprised of severe infectious keratitis, ocular acid burn, thermal burn, and bullous keratopathy caused by various complications from intraoeular surgeries. Preventing corneal blindness in China is complicated by multiple challenges such as late-stage corneal diseases, poor compliance, affordability and a critical shortage of tissue for transplants. In recent years, because of these especially difficult conditions, China＇s comeal specialists have developed and innovated a series of new techniques that include deep anterior lamellar keratoplasty, endothelial keratoplasty, keratoprosthesis and corneal xenotransplantation. These have significantly improved donor utilization and reduced rejection rates for high-risk keratoplasties. However, the unsolved shortage of donor corneas is still the main bottleneck in preventing corneal blindness, which has resulted in fewer opportunities to cultivate novice corneal surgeons. In order to quickly reduce the amount of corneal blindness, it is urgent to promote legislation for corneal donation, support research in corneal engineering xenotransplantation, and strengthen the international cooperation in eye banks. The innovation and training of new surgical techniques is still a long and arduous task in China.