角膜前弹力层移植术治疗圆锥角膜研究现状

Research status of Bowman layer transplantation in the treatment of keratoconus

角膜前弹力层分隔角膜上皮和前基质。可能与保持角膜的透明性和稳定角膜形态与生物力学有密切的联系。圆锥角膜出现前弹力层的断裂和基质胶原填充等组织病理表现。角膜前弹力层移植术是一种新型的角膜移植术,适用于角膜接触镜治疗效果不佳,且不适合紫外线角膜交联和角膜基质环植入治疗的进展性重度圆锥角膜患者。手术使用完整眼球或前板层角膜植片作为供体来源,用基质床或基质袋法将植片植入患眼的角膜基质层。手术并发症包括术中角膜穿孔及术后急性角膜水肿。手术后5年总体成功率84%,术后患者视觉质量、角膜形态有明显改善,同时可有效预防疾病进展,推迟或避免进行穿透角膜移植术或深板层角膜移植术。该手术具有创伤小、术中及术后并发症少的优势,但其手术技术精度高、难度大。本文就角膜前弹力层移植术的理论基础、最新的手术技术及预后和转归情况进行综述。

The Bowman membrane separates the corneal epithelium from the anterior stroma.It may be closely associated with retaining corneal transparency and stabilizing corneal morphology and biomechanics.Keratoconus presents with histopathological manifestations such as disruption of the Bowman membrane and stromal collagen filling.Bowman layer transplantation is a new type of keratoplasty for patients with progressive severe keratoconus who show no good efficacy after corneal contact lenses treatment and are not suitable for ultraviolet corneal cross-linking and corneal ring implantation therapy.The procedure uses an intact eye or anterior lamellar corneal implant as the donor and the implant is implanted into the corneal stroma of the affected eye using the stromal bed or stromal pocket method.Complications include intraoperative corneal perforation and acute postoperative corneal edema.The postoperative 5-year overall surgical success rate is 84%,with significant improvement in visual quality and corneal morphology,as well as prevention of disease progression and delay or avoidance of penetrating keratoplasty and deep lamellar keratoplasty.Bowman layer transplantation has the advantages of minimal trauma and few intraoperative and postoperative complications,but this surgical technique requires a high degree of precision and is difficult.The theoretical basis of Bowman layer transplantation,the latest surgical techniques and the prognosis and regression were reviewed in this article.