复合型人工角膜植入治疗重度角膜盲及并发症处理  

The effects of transplantation of compound keratoprosthesis in clinical practice and managements of complications after operation

作　　者：袁进[1] 陈家祺[1] 周世有[1] 王智崇[1] 黄挺[1] 顾建军[1] 邵应峰[1] 

机构地区：[1]中山大学中山眼科中心眼科学国家重点实验室,广州510060

出　　处：《中华眼科杂志》2009年第2期104-109,共6页Chinese Journal of Ophthalmology

基　　金：卫生部临床学科重点建设项目资助（2004468）;中山大学5010计划资助项目（2007034）

摘　　要：目的探讨钛支架复合型人工角膜植入治疗重度角膜盲的临床价值，以及并发症的处理。方法回顾性系统病例研究。2002年3月至2005年6月期间中山大学中山眼科中心共完成永久性人工角膜植入9例（单侧眼9只），均为男性，年龄28～52岁。所有患者均为双眼损伤，受伤时间为1．5～5．0年。其中碱烧伤6只眼，爆炸伤3只眼，术前视力均为光感，其中2例光定位不准；均为多次角膜移植以及眼表重建手术失败的难治性重度角膜盲患者。手术分两阶段：一期手术显微镜下行钛支架复合型人工角膜植入联合自体耳软骨移植加固，二期行人工角膜前膜剪开，建立镜柱光学通路。术后评价视力恢复情况，分析并发症的发生原因，探讨相应的处理对策。结果患者随诊时间1～3年。术后7只眼裸眼视力≥0．1，其中2只眼经镜片矫正后达到0．6。术前光定位不准的2例患者术后视力为0．02和0．04。术后并发症的发生情况为复发性人工角膜前膜5例，进行前膜切除，其中1例联合施行自体唇黏膜移植；角膜局限性融解1例，进行脱细胞真皮加固；人工角膜后膜1例，显微镜下施行后膜钩除术。以上并发症经相应处理均得到控制。随访期内所有人工角膜均保持原位，未发生人工角膜排出、房水渗漏。结论人工角膜移植是使严重角膜盲患者复明的有效手段，联合自体耳软骨加固可减少并发症的发生，提高人工角膜植入的生物相容性。Objective To explore the clinical value and management of complications of the transplantation of Titanium skirt compounded keratoporsthesis for severe corneal blindness eyes. Methods It was a retrospective case series study. Nine eyes from 9 male patients, aged 28 to 52 years old, accepted permanent keratoprosthesis transplantation in Zhongshan Ophthalmic Center from March 2002 to June 2005. All patients had corneal lesion in both eyes for 1.5 to 5.0 years. Among the 9 treated eyes, 6 eyes was severe vascularization after alkali burns, 3 eyes explosive injuries. Light perception was remained in all patients before surgery,however, 2 eyes only had a questionable orientation of light perception among them. Surgical management was divided into two stages. In the first stage, transplantation of Titanium skirt compound keratoprosthesis was performed, and the explant was reinforced by the self auricular cartilage and Tenons capsule. The second stage of surgery was performed in 5 to 6 months later, in which the membrane in the front of keratoprosthesis was cut. After the surgery, visual acuity, visual field, intraocular pressure and retina were examined. The complications were noticed and managed. Results All treated eyes were followed up for 1 to 3 years. After the treatment, 7 eyes divorced from blindness with uncorrected visual acuity 20/200 （0. 1 ） , and 2 eyes among them got corrected visual acuity 20/30 （0. 6）. Two eyes with the questionable orientation of light perception before treatment gained uncorrected visual acuity 4/200 （ 0. 02 ） and 8/200 （ 0. 04 ） after treatment respectively. Complications were found to include 5 recurrent frontal membrane of keratoprosthesis, one back membrane of keratoprosthesis, and one limited corneal melting.Complications were controlled by the corresponding treatments, such as membrane resection for the recurrent frontal membrane of keratoprosthesis, curage under microscope for back membrane of keratoprosthesis, and reinforcement of acellular demis for corneal mel

关 键 词：眼损伤 角膜疾病 盲 角膜移植 假体和植入物 

分 类 号：R686[医药卫生—骨科学]