生物工程角膜移植临床失败病例分析

Analysis of clinical failure of bioengineered corneal transplantation

目的:探讨生物工程角膜移植术后出现的不良反应及其相关因素。方法:对生物工程角膜移植术患者71例,按感染源不同分为三组,真菌性角膜炎组、细菌性角膜炎组、病毒性角膜炎组。术后1、3周、1、3、6个月对患者进行定期随访,观察生物工程角膜移植片存活情况,将角膜移植片溶解、角膜移植片血管化、角膜移植片排斥、角膜感染复发、角膜植片衰竭定为移植失败,观察并统计每组角膜移植失败情况出现的概率。结果:真菌性角膜炎15例,移植失败1例,失败率6.67%;细菌性角膜炎49例,移植失败10例,失败率20.41%;病毒性角膜炎7例,移植失败4例,失败率57.14%。Logistic回归分析显示,感染源的差异对角膜移植失败与否的影响具有统计学意义;其中病毒性角炎组移植失败率明显高于其他两组。细菌性角膜炎移植失败病例中,角膜植片溶解2例,占20%;角膜移植片血管化4例,占40%;角膜移植片排斥3例,占30%;角膜感染复发1例,占10%。在细菌性角膜炎移植失败的病例中,具有眼表睑缘高炎性反应的患者角膜移植失败的风险更高。结论:生物工程角膜可以作为同种异体角膜的替代角膜供体应用于板层角膜移植,缓解临床角膜供体缺乏的压力。但生物工程角膜在应用于病毒性角膜炎、病灶超过角膜缘、睑缘高炎性反应、角膜新生血管丰富的患者时,应予以谨慎选择;手术技巧上应避免缝线过紧、创缘不齐的细节问题,以避免手术失败。

Objective:To investigate the adverse reactions and related factors after bioengineered corneal transplantation.Methods:A total of 71 patients undergoing bioengineered corneal graft were gathered.According to different sources of infection,they were divided into group A(fungal keratitis),group B(bacterial keratitis),and group C(viral keratitis).Patients were followed up regularly at 1 week,3 weeks,1 month,3 months and 6 months after operation to observe the survival of bioengineered corneal grafts.Corneal graft dissolution,corneal graft vascularization,corneal graft rejection,corneal infection recurrence and corneal graft failure were defined as graft failure.The probability of each corneal graft failure was observed and counted.Results:In group A,there were 15 cases of fungal keratitis,1 case of transplantation failure,and the failure rate was 6.67%.In group B,there were 49 cases of bacterial keratitis,10 cases of transplantation failure,and the failure rate was 20.41%.In group C,there were 7 cases of viral keratitis,4 cases of transplantation failure,and the failure rate was 57.14%.Logisitic regression analysis showed that the difference of source of infection had statistically significant impact on the failure of corneal transplantion.The transplantation failure rate in group C was significantly higher than that in other two groups(all P<0.05).Among the failed cases of bacterial keratitis,corneal graft dissolution occurred in 2 cases(20.00%);there were 4 cases of corneal graft vascularization,accounting for 40.00%;corneal graft rejection occurred in 3 cases(30.00%);corneal infection recurred in 1 case,accounting for 10.00%.In cases of bacterial keratitis,patients with blepharal hyperinflammation had higher risk of corneal transplantation failure.Conclusion:Bioengineered corneas can be used as alternative corneas for lamellar keratoplasty to relieve the clinical pressure of deficiency of corneal donors.However,bioengineered corneas should be selected cautiously when applied to patients with viral keratitis,lesions beyond the corneal limbus,hyperinflammatory blephatic verge reactions,and corneal neovascularization.The details of too tight and poorly wound margins should be avoided in surgical technique in order to avoid surgical failure.