多层角膜基质透镜重叠治疗角膜溃疡穿孔  

Treatment of large corneal perforations with acellular multilayer of corneal stromal lenticules harvested from femtosecond laser lenticule extraction

作　　者：薛春燕[1] 夏元[1] 陈月芹[1] 杨丽萍[1] 黄振平[1] 

机构地区：[1]南京军区南京总医院眼科,210002

出　　处：《中华眼科杂志》2015年第9期655-659,共5页Chinese Journal of Ophthalmology

摘　　要：目的 探讨多层角膜基质透镜重叠组成的角膜板层植片保存后用于较大直径角膜溃疡穿孔紧急修补的效果.方法 回顾性病例系列研究.收集南京军区南京总医院眼科2013年6至11月角膜溃疡穿孔的患者5例,包括神经营养性角膜溃疡穿孔1例,严重变应性角膜结膜炎角膜穿孔1例,真菌性角膜溃疡穿孔3例,使用角膜基质透镜粘合而成的角膜板层材料进行紧急修补并观察其治疗效果.角膜基质透镜来自于接受全飞秒角膜屈光手术的近视眼患者,所有捐献者均经知情同意及血液传染病检查.3或4片基质透镜粘合成一个直径6.0～6.5 mm,中央厚度300～400μm的角膜基质板层材料,置于消毒的纯甘油,-80℃冰箱保存备用.当角膜穿孔大于3 mm,且无新鲜或保存的角膜材料可用时,可将此合成的角膜板层材料用于角膜穿孔的修补.结果 5例患者角膜溃疡愈合,前房形成良好.随访结果显示,周边穿孔愈合后视力良好,中央部穿孔也为择期光学性角膜移植创造条件.结论 多层角膜基质透镜重叠组成的角膜板层植片可以安全有效地应用于角膜穿孔的紧急修补,保存眼球结构.Objective To describe a novel surgical technique for the treatment of large corneal perforations by using acellular multilayer of corneal stromal lenticules.Methods Prospective study.The acellular tissue used for the repair was harvested from myopic patients during the femtosecond laser （FS） refractive surgery.Informed consent,blood test and donor eligibility were obtained in each case.Three or four layers of lenticules were stacked up and stored at-80℃ in pure sterile glycerin.The diameter is 6.0 to 6.5 mm and central thickness was 300 to 400 μm.If the diameter of the corneal ulcer perforation was larger than 3 mm and corneal grafts were not available,we used this kind of patches to seal the perforations.It was a retrospective case series study.Five cases of corneal ulcer perforation were enrolled in this study.One was neuropathic keratitis,one was atopic keratoconjunctivitis,and the other three were fungal keratitis.Acellular multilayer of stromal lenticules were used in these cases for emergent therapy.Results The sealing of the perforation and the re-establishment of the anterior chamber were achieved successfully in all the cases.For the pericentral perforations,visual recovery was achieved.And efficient palliative management was done for the central perforations.Conclusions The reported technique seems to represent a good alternative emergency procedure for the management of large corneal perforations.It is a very useful method for Chinese hospitals where the shortage of cornea donors is a very serious problem and the amount of FS surgeries are increasing.

关 键 词：角膜溃疡 角膜穿孔 角膜基质 角膜外科手术 激光 角膜移植 激光 飞秒 

分 类 号：R779.6[医药卫生—眼科]