波士顿I型人工角膜治疗眼部严重陈旧性化学伤的初步研究  

Preliminary study of Boston keratoprosthesis in treatment of severe late stage ocular chemical burns

作　　者：陈家祺[1] 翟嘉洁 顾建军[1] 邵应峰[1] 刘永民 袁进[1] 周世有[1] 

机构地区：[1]中山大学中山眼科中心,广州510060 [2]广东省视觉眼科学研究所

出　　处：《中华眼科杂志》2012年第6期537-541,共5页Chinese Journal of Ophthalmology

基　　金：广州市科技支撑计划（2010GN-E00221）

摘　　要：目的探讨眼部陈旧性化学伤患者植入波士顿I型人工角膜的初步临床效果和并发症。方法2009年5月至2011年11月，对6例眼部陈旧性化学伤患者植入波士顿I型人工角膜，所有患者术前视力均为光感及光定位不准，并且角膜混浊病变无法采用常规角膜移植手术达到复明目的。其中包括2例碱烧伤、3例硫酸烧伤及1例乙醇烧伤，Shirrner I试验仅1例正常，3例为中度干眼。患者均为男性，年龄27～55岁。结果患者的随访期17个月到26个月，平均随访期为2年，术后6只眼视力为0．05～0．5，其中5例眼视力≥0．1。在观察期内，所有人工角膜均无脱出。随访期内指测眼压正常，B超未见视网膜脱离。2例出现人工角膜后膜，进行YAG激光切除。1例出现术后眼压升高，经植入房水引流阀后，眼压已控制。结论波士顿I型人工角膜是目前对严重角膜疤痕、血管化的双眼化学烧伤患者有效的复明手段。术后定期复查、积极预防并发症是保持视力的有效手段。Objective To evaluate preliminary clinical outcome of Boston type I keratoprosthesis in ocular chemical burn patients. Methods Six keratoprosthesis were implanted into 6 patients of bilateral blindness. Visual acuity in these patients before the operation was light perception and all of them were unsuitable for standard penetrating corneal transplantation. The causes for corneal opacity were alkali burn in 2, sulfate acid burn in 3 and ethanol injury in 1 patient. Shirmer＇s test revealed severe dry eye in 3 patients, only one eye had normal lacrimal secretion. All patients were male, with follow-up period ranged from 17 to 26 months （ mean 24 months）. Results The postoperative visual acuity ranged from 0.05 to 0. 5,5 of them was better than 0.1. The retention rate within the follow-up period was 100%. Intraocular pressure was in normal limit, no retinal detachment was detected by type B ultrasonic examination. Postoperatively, retrokeratoprothestic membrane occurred in 2 cases and was treated with YAG laser membranectomy, one eye complicated with elevated intraocular pressure and treated with shunt implantation. Conclusion The Boston type 1 keratoprosthesis is a viable option for patients with obsolete chemical burns.

关 键 词：角膜 眼烧伤 烧伤 化学 假体植入 眼外科手术 

分 类 号：R779.65[医药卫生—眼科]