MICOF人工角膜在角膜盲患者中的应用研究

发布时间：2019-06-14 07:29

【摘要】：目的：评估MICOF人工角膜治疗角膜盲患者的临床疗效,探讨青光眼、无菌性玻璃体炎等术后并发症的预防及诊治。 方法：回顾性病例研究。收集2000年1月至2010年10月期间于解放军总医院眼科行MICOF人工角膜植入术患者96例(96眼)。最长随访时间10年。人工角膜分两期植入。Ⅰ期手术时将钛合金支架植入角膜板层；Ⅱ期手术3-4月后进行,植入聚甲基丙烯酸甲酯(polymenthyl methacrylate, PMMA)为主要材料的人工角膜光学镜柱部分,同时切除前部虹膜、晶状体及前节涌出的玻璃体。统计患者MICOF人工角膜植入术前、术中及术后的相关影响因素,分析青光眼、无菌性玻璃体炎等术后并发症的发病原理、诊断方法及治疗措施。 结果：MICOF人工角膜能够显著提高患者术后视力。术后6月,视力优于20/100的患者达到80.7%(67/83),1年时比例为82.4%(61/74),2年时为72.7%(40/55),3年时为78.8%(26/33),4年时为78.9%(15/19),5年时100%(5/5),6年时80%(4/5),7年和8年时均为100%(2/2),9年时100%(1/1)。人工角膜前(后)膜(retroprosthetic membrane,RPM)是术后最为常见的并发症,39眼次术后发生RPM,其中35眼次需要1次或多次RPM切除手术。RPM对视力多无影响,手术切除后视功能可恢复。MICOF人工角膜术后在位率100%,无一脱出。16眼需要进行1次或多次自体耳软骨加固术。1眼于Ⅱ期术后2月发生孔源性视网膜脱离,经玻璃体切除,巩膜外冷凝注气术后,视网膜复位,人工角膜稳定。5眼并发角膜囊肿,角膜溶解及角膜渗漏各8眼。9眼术前行睫状体冷凝控制眼压。10眼术后眼压升高,3眼发生青光眼。5眼术后药物控制眼压无效,需行睫状体冷凝手术降低眼压。最佳矫正视力分别从20/25降至20/100,20/80降至光感,20/60降至20/200,20/100降至手动,20/50降至指数。6眼于术后1至30月内并发无菌性玻璃体炎。2例确诊后即行玻璃体切除手术,其余4例确诊后球旁注射地塞米松合剂(地塞米松磷酸钠注射液2.5mg,联合硫酸庆大霉素注射液2万单位及1%利多卡因注射液0.2m1)3天,此后球旁注射曲安奈德40mg。患者最佳矫正视力多在经治疗后2至6周恢复。 结论：MICOF人工角膜可应用于角膜瘢痕、血管化等角膜移植高危患者,显著提高其术后视力,使部分角膜盲患者复明。青光眼是MICOF人工角膜植入术后对视功能威胁最大的并发症,无菌性玻璃体炎可能是一种自身免疫性疾病。术后并发症的诊断和治疗对于术后视功能的维持至关重要。
[Abstract]:Objective: to evaluate the clinical efficacy of MICOF artificial cornea in the treatment of corneal blindness and to explore the prevention, diagnosis and treatment of postoperative complications such as glaucoma and aseptic vitreous inflammation. Methods: a retrospective case study was conducted. From January 2000 to October 2010, 96 patients (96 eyes) underwent MICOF artificial corneal implantation in the ophthalmology of PLA General Hospital. The maximum follow-up time was 10 years. The artificial cornea was implanted in two stages. Titanium alloy stent was implanted into corneal lamina during stage I operation. After 3-4 months of operation, polymethyl methacrylate (polymenthyl methacrylate, PMMA) was implanted into the intraocular lens column, and the anterior iris, lens and anterior segment of vitreous were resected at the same time. The related influencing factors of MICOF artificial corneal implantation before, during and after operation were analyzed, and the pathogenesis, diagnosis and treatment of postoperative complications such as glaucoma and aseptic vitreous inflammation were analyzed. Results: MICOF artificial cornea could significantly improve the postoperative visual acuity of the patients. At 6 months after operation, the visual acuity was 80.7% (67 鈮，

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