生物工程角膜移植对真菌性角膜溃疡的临床疗效及其对组织形态学的影响  

The clinical effect of bioengineered corneal transplantation on fungal corneal ulcer and its influence on histomorphology

作　　者：刘全坤[1] 李恒[1] 杨旭[1] 苟文军[1] 李虹谕[1] 林莉[1] Liu Quankun;Li Heng;Yang Xu;Gou Wenjun;Li Hongyu;Lin Li(Department of Ophthalmology,Suining Central Hospital,Sichuan,Suining 629000,China)

机构地区：[1]遂宁市中心医院眼科,四川遂宁629000

出　　处：《中国医学前沿杂志（电子版）》2021年第11期102-106,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：四川省卫生和计划生育委员会科研课题(普及应用项目)(17PJ551)。

摘　　要：目的探讨生物工程角膜移植对真菌性角膜溃疡的临床疗效及对组织形态学的影响。方法选取2017年10月至2019年5月遂宁市中心医院收治的30例真菌性角膜溃疡患者为研究对象。采用脱细胞猪角膜基质构建的生物角膜对患眼进行角膜板层移植术,以对侧眼为对照。随访12个月,观察移植后移植物上皮化完成情况,利用共聚焦显微镜观察移植物角膜上皮细胞、内皮细胞密度和上皮下神经纤维修复情况。结果术后随访中患者均未再发现孢子和菌丝,术后1年,术眼角膜表面曲线光滑度与对侧眼相当。术后角膜上皮愈合时间为3 d至1周,随时间延长,患者眼部刺激性症状评分、新生血管评分、移植物透明度评分均呈下降趋势。术后3、6、12个月,术眼上皮细胞密度与对侧眼比较差异均无统计学意义(均P>0.05)。术后3、6、12个月,术眼内皮细胞密度均显著低于对侧眼(均P<0.05)。术后6个月,术眼上皮下神经纤维密度最低(P<0.05),术后12个月,术眼上皮下神经纤维密度逐渐增加,但仍显著低于对侧眼(P<0.05)。结论采用生物工程角膜行板层角膜移植治疗真菌性角膜溃疡的临床效果显著,安全性高,患者预后较好。Objective To explore the clinical effect of bioengineered corneal transplantation on fungal corneal ulcer and its influence on histomorphology.Method Thirty cases of fungal corneal ulcer patients admitted to Suining Central Hospital from October 2017 to May 2019 were selected as the research objects.Corneal lamellar transplantation was performed on the affected eye using a biological cornea constructed with acellular porcine corneal stroma,and the contralateral eye was used as the control.Follow up for 12 months,observe the epithelialization of the graft after transplantation,and observe the corneal epithelial cell and endothelial cell density of the graft and the repair of subepithelial nerve fibers using a confocal microscope.Result No spores and hyphae were found in the patients during the postoperative follow-up.One year after operation,the smoothness of the corneal surface of the surgical eye was equivalent to that of the contralateral eye.The postoperative corneal epithelial healing time was 3 days to 1 week.As time increased,the patient’s ocular irritation symptom score,neovascularization score,and graft transparency score all showed a downward trend.There were no statistically significant differences between the epithelial cell density of the surgical eye and the contralateral eye at 3,6,and 12 months after operation(all P>0.05).At 3,6,and 12 months after operation,the endothelial cell density of the operative eye were significantly lower than those of the contralateral eye(all P<0.05).At 6 moths after operation,the density of subepithelial nerve fibers was the lowest(P<0.05),12 months after operation,the density of subepithelial nerve fibers in the surgical eye gradually increased,but it was still significantly lower than that of the contralateral eye(P<0.05).Conclusion Lamellar keratoplasty with bioengineering cornea has good clinical effect,high safety and good prognosis in the treatment of fungal corneal ulcer.

关 键 词：生物工程 真菌性角膜溃疡 脱细胞猪角膜基质 

分 类 号：R772.21[医药卫生—眼科]