波士顿人工角膜临床应用及其进展

The Boston keratoprosthesis

波士顿人工角膜是全世界应用范围最广,最成功的人工角膜之一,它适用于严重角膜疾病和多次角膜移植失败的病例.它的长期预后因病种不同而不同,自身免疫性疾病,如瘢痕性类天疱疮和Stevens-Johnson综合征、中毒性表皮坏死溶解症,以及严重化学烧伤等疾病的预后较非感染性角膜病的预后差.在适应证的扩展方面,儿童遗传性角膜混浊病早期植入人工角膜可以有效地减少弱视的发生.波士顿人工角膜采用“领扣”式设计,使用聚甲基丙烯酸甲酯的生物材料.波士顿人工角膜使用供体角膜,也可使用患者自体角膜作为载体.针对我国角膜供体材料匮乏的特点,采用自体角膜为载体为角膜盲患者复明提供了一种选择.波士顿人工角膜经过多次改进,减少了严重并发症的发生,其中包括后盘的多孔设计,使角膜植片能够从房水中获得充足的营养,减少了角膜溶解的发生率,持续性佩戴角膜接触镜有效地防止了眼表水分的蒸发,有效地减少角膜组织的坏死和溶解,人工角膜的在位率明显提高.术后预防性地使用抗生素有效地预防了感染的发生,从而降低了眼内炎的发生率.

The Boston Keratoprosthesis （KPro） is one of several types of artificial cornea manufactured worldwide that are being implanted in increasing numbers in patients with severe corneal diseases and graft failures.To summerize the advances in design of the Boston type Ⅰ keratoprosthesis and in the treatment strategies to conquer the post operative complications have expanded the indications and application of this technology.Many modifications to the design of the Boston type Ⅰ keratoprosthesis and treatment of the patient in the post operative period have occurred.Also,the technology has been more widely accepted as a primary surgical option for patients with a poor preoperative prognosis for traditional penetrating keratoplasty.The outcomes of visual acuity,retention,and post-operative infection rates have all significantly improved since the technology has been modified and offers patients an alternative for visual rehabilitation.This is implanted into a carrier corneal graft or into the patient＇s own cornea.The allograft cornea can be the carrier,which may solve the shortage of donor cornea in China.