自体角膜为载体Boston人工角膜治疗复杂性角膜盲

Role for autologous corneas as a carrier for the Boston Keratoprosthesis

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。

Objective The purpose of this study was to investigate the possibility for autologous corneas as a carrier for the Boston Keratoprosthesis. Methods It was a retrospective case series study. Ten eyes （10 patients） with severe cornea neovascularization that underwent Boston KPro type I implantation at the PLA General Hospital. Of these 10 eyes, 7 had severe chemical burns, 1 had an explosion injury, 1 experienced a multiple penetrate keratoplasty failure, and 1 had a severe neovascularization cornea from herpes simplex keratitis （HSK）. Patients were not appropriate candidates for anterior lamellar keratoplasty due to severely scarred eyelids or full-thickness central corneal scars. All patients received an aphakic KPro with a polymethyl methacrylate backplate and a titanium locking ring assembled around an 8.0-8.5 mm trephinated ipsilateral autologous cornea. An extracapsular cataract extraction was performed on all patients through the corneal trephination opening. Postoperative data from 1-12 months were reported, including compliance, visual outcomes and complications. Results Patients were followup for 5.7 ±3.8 months. Preoperative visual acuity ranged from counting fingers to light perception. Best corrected postoperative visual acuity ranged from 160/200 to light perception. Anatomic success was achieved in all eyes. Conclusion Autologous corneas as a carrier for the Boston Keratoprosthesis may be a solution for the shortage of donor cornea.