生物人工角膜治疗感染性角膜炎的安全性和有效性  

The safety and efficacy of bio-artificial cornea in the treatment of infectious keratitis

作　　者：郑钦象[1] 华闪闪[1] 赵泽林[1] 李锦阳[1] 马慧香[1] 陈蔚[1] 

机构地区：[1]温州医科大学附属眼视光医院,325027

出　　处：《中华眼视光学与视觉科学杂志》2016年第4期215-218,225,共5页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：国家重大新药创制专项课题（2014ZX09303301）

摘　　要：目的评价使用生物人工角膜行深板层角膜移植治疗感染性角膜炎的安全性和有效性。方法前瞻性临床研究。2013年12月至2014年11月温州医科大学附属眼视光医院诊治的感染性角膜炎患者20例（20眼），使用生物人工角膜行深板层角膜移植术治疗。观察指标包括最佳矫正视力（BCVA）、生物人工角膜透明性、眼前节表现及并发症等，随访时间为6个月。疗效指标包括术后单眼的脱盲率和感染控制率。视力比较采用重复测量的方差分析，角膜透明性比较采用相关样本秩和检验。结果术后患者视力逐渐提高（F=94．97，P〈0．01），术后6个月视力（10gMAR）为0．44±0．26，较术前（2．08±0．35）显著提高，差异有统计学意义（P〈0．01）。术后1周角膜水肿逐渐消退，角膜植片逐渐透明，术后1个月完全透明（x^2=66．34，P〈0．01）。随访期内出现1例原发病复发，1例角膜基质排斥。术后6个月随访时，单眼脱盲率为19／19，感染控制率为19／20。结论生物人工角膜行深板层角膜移植不仅可有效地控制细菌性、真菌性、病毒性角膜炎患者的原发感染，而且术后视力提高显著。Objective To evaluate the safety and efficacy of bio-artificial cornea used in deep lamellar keratoplasty （DLK） in the treatment of infectious keratitis. Methods In this prospective noncomparative case series study, 20 cases with infectious keratitis were treated by DLK using bio-artificial corneas from December 2013 to November 2014 in Eye Hospital of Wenzhou Medical University. The best corrected visual acuity （BCVA）, transparency of bio-artificial corneas, slit lamp biomicroscope examinations before and after surgery were analyzed. The follow-up period was 6 months. The blindness relief rate and infection control rate were evaluated, and the postoperative improvements in BCVA were analyzed by repeated measures ANOVA, and the transparency of bio-artificial corneas were compared using Wilcoxon test. Results The preoperative BCVA was less than 0.05 in every case with a mean of 2.08＋0.35 （LogMAR）. The mean BCVA improved to 0.44±0.26 （LogMAR） 6 months after surgery （F=94.97, P〈0.01）. The bio-artificial cornea edema lessened quickly in the first postoperative week and became transparent since 1 month after surgery （x^2=66.34, P〈0.01）. One case developed a recurrence of fungal infection. Another case developed stromal rejection. The blindness relief rate was 19/19 and the infection control rate was 19/20 in the patients who fulfilled 6-month follow-up. Conclusion The 6-month outcomes showed that the bio-artificial cornea is a safe and effective alternative used in DLK to treat infectious keratitis. The bio-artificial cornea has advantages in keeping cornea transparency after DLK and the visual acuity improved significantly.

关 键 词：角膜炎 感染性 角膜移植 深板层 人工角膜 

分 类 号：R318.18[医药卫生—生物医学工程] R772.21[医药卫生—基础医学]