生物工程角膜板层角膜移植在真菌性角膜溃疡患者中的应用

Application of Bioengineered Lamellar Keratoplasty in Patients Fungal Corneal Ulcer

目的探讨生物工程角膜板层角膜移植在真菌性角膜溃疡患者中的有效性及安全性。方法选取44例真菌性角膜溃疡患者为研究对象,根据使用的角膜材料分为生物工程组[采用脱细胞猪角膜基质(APCM)进行板层角膜移植,20例]和人供体组(采用人供体角膜材料进行板层角膜移植,24例)。比较两组术后不同时间角膜植片透明度评分、最佳矫正视力(BCVA)和术后角膜上皮愈合时间、术后并发症及复发率。结果术后1、3、6、12个月,随着时间的延长两组角膜植片透明度评分均逐渐降低,术后1、3、6个月生物工程组角膜植片透明度评分高于人供体组(P<0.05),但术后12个月两组角膜植片透明度评分比较,差异无统计学意义(P>0.05)。术后3、6、12个月,随着时间的延长两组患眼BCVA均逐渐增加,但生物工程组患眼术后3、6、12个月的BCVA均低于人供体组(P<0.05);两组角膜上皮愈合时间及术后角膜上皮愈合延迟、角膜植片排斥、角膜植片溶解、新生血管长入角膜植片4项并发症发生率和术后复发率比较,差异无统计学意义(P>0.05)。结论以APCM为材料进行板层角膜移植治疗真菌性角膜溃疡临床效果好,安全性高,可作为生物工程角膜应用于角膜病致盲的治疗。

Objective To investigate the efficacy and safety of bioengineered lamellar keratoplasty in the treatment of fungal corneal ulcer patients.Methods A total of 44 patients with fungal corneal ulcer were selected as the study objects and divided into bioengineering group[20 cases using acellular porcine corneal matrix(APCM)for lamellar corneal transplantation]and human donor group(24 cases using human donor corneal material for lamellar corneal transplantation)according to different corneal materials used.Corneal graft transparency score,best corrected visual acuity(BCVA),corneal epithelial healing time,postoperative complications and recurrence rate were compared between the two groups at different time after surgery.Results At 1,3,6 and 12 months after surgery,the corneal graft transparency score of both groups decreased gradually with the extension of time,and the corneal graft transparency score of the bioengineering group was higher than that of the human donor group at 1,3 and 6 months after surgery(P<0.05),but there was no statistical significance in the corneal graft transparency score between the two groups at 12 months after surgery(P>0.05).At 3,6 and 12 months after surgery,BCVA in both groups increased gradually with the extension of time,but BCVA in the bioengineering group at 3,6 and 12 months after surgery was lower than that in the human donor group(P<0.05).There were no significant differences in the healing time of corneal epithelium,the incidence of postoperative corneal epithelial healing delay,corneal graft rejection,corneal graft dissolution,neovasculation into corneal graft and postoperative recurrence between the two groups(P>0.05).Conclusion Using APCM as material,lamellar keratoplasty has good clinical effect and high safety in the treatment of fungal corneal ulcer,and can be used as a bioengineered cornea in the treatment of blindness caused by corneal disease.