生物角膜用于人角膜板层移植术后的临床疗效及激光扫描共焦显微镜动态观察  

Clinical effect of bioengineered cornea and in vivo confocal microscopy observation after human lamellar keraplasty

作　　者：王素娟[1] 张月琴[1] 李金[1] 余晓菲[1] 窦新岩 王丽娅[1] 

机构地区：[1]郑州大学人民医院河南省眼科研究所河南省立眼科医院,450003

出　　处：《中华实验眼科杂志》2016年第2期144-149,共6页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金项目（81170831、81270991）;河南省基础与前沿计划项目（10230040024、112300410036、112300410093、132102310087）;河南省医学科技攻关计划攻关项目（201203170、201203171）

摘　　要：背景近年来由于角膜供体材料的缺乏，异种角膜移植研究逐渐受到研究者的关注，猪角膜脱细胞基质构建的生物角膜支架具有良好的生物相容性并已制备成生物角膜材料，但其用于人眼角膜移植后的临床效果及其组织形态学变化特征尚不清楚。目的观察用生物角膜进行人板层角膜移植术后的临床效果，并利用激光扫描共焦显微镜进行活体动态观察，评估生物角膜作为新型角膜替代材料进行人眼角膜板层移植的可行性。方法采用前瞻性系列病例观察研究方法，于2014年2—8月在河南省立眼科医院纳入药物治疗无效的感染性角膜炎或陈旧性角膜白斑患者15例15眼，包括真菌性角膜炎4例，细菌性角膜炎1例，混合感染性角膜炎9例，陈旧性角膜白斑1例。采用猪角膜脱细胞基质构建的生物角膜行患眼生物角膜板层移植术，以术眼的对侧正常眼作为对照。分别于术后3d、7d、1个月、3个月、6个月、9个月和12个月对术眼进行随访，对植片愈合情况进行评分，随访时间为1年。疗效指标主要包括角膜透明度、新生血管形成、角膜植片有无溶解或感染复发、最佳矫正视力（logMAR）。分别于术后3、6、9和12个月利用激光扫描共焦显微镜对角膜进行动态观察，记录和分析移植后角膜上皮和内皮细胞的形态和密度、角膜基质的形态特征以及角膜上皮下神经纤维的恢复情况。结果术眼术后3d早期出现角膜水肿等炎症反应，术后7d炎症反应消退。术后1个月植片透明，随访期间未出现角膜溶解、感染复发现象。术后6个月时1例患者出现青光眼，术后12个月时1例患者发生排斥反应。术眼术前及术后不同时间点间logMAR、角膜透明度评分、角膜新生血管评分的总体比较差异均有统计学意义（X2=92．63、59．37、10．50，均P〈0．05），其中术后视力、角膜透明度均较术前明显改Background Xenotransplantation is arousing more attention of researchers because of the lack of corneal donors. Biological corneal scaffolds constructed by porcine corneal acellular stroma appears to have an acceptable biocompatibility. However,its clinical effects and the histomorphological features in the corneal tissue of receipts＇ are still unclear. Objective This study was to evaluate the viability of bioengineered corneas as a new material of human lamellar keratoplasty and observe the in vivo biological features after human keratoplasty under the laser confocal microscope. Methods A prospective serial cases observational study was carried out. Fifteen eyes of 15 patients with infectious keratitis were enrolled in Henan Eye Hospital from February to August 2014 under the approval of Ethic Committee of Henan Eye Hospital and informed consent of each patient, including 4 eyes of fungal keratitis,1 eye of bacterial keratitis, 9 eyes of mixed infectious keratitis and 1 eye of leucoma. Corneal lamellar transplantation was performed on the eyes with the bioengineered corneas as grafts and the follow-up time was one year. The survival of grafts was assessed and scored, and the indices including corneal transparency, neovascularization, graft lysis or inflammatory recurrence and visual acuity （logMAR） were evaluated. The morphology and density of corneal epithelial cells and endothelial cells, corneal stroma and subepithelial neural fibers were examined by laser confocal microscope 3,6,9 and 12 months after surgery. Results Postoperative inflammatory response was seen 3 days and disappeared 7 days after surgery. The grafts were clear 1 month after surgery, and no corneal dissolution was found during the follow-up duration. Glaucoma occurred in 1 eye at 6 months and graft rejection occurred in another eye 12 months after surgery. The logMAR, corneal transparency scores and corneal neovascularization scores improved after surgery in comparison with before surgery,with a significant difference among various time

关 键 词：角膜移植 异种移植 植片生存/免疫 共焦显微镜 人 生物工程角膜 猪角膜脱细胞基质 

分 类 号：R779.65[医药卫生—眼科]