综述
ENGLISH ABSTRACT
角膜前弹力层移植术治疗圆锥角膜研究现状
赵英涵
洪晶 [综述]
作者及单位信息
·
DOI: 10.3760/cma.j.cn115989-20200307-00151
Research status of Bowman layer transplantation in the treatment of keratoconus
Zhao Yinghan
Hong Jing
Authors Info & Affiliations
Zhao Yinghan
Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
Hong Jing
Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
·
DOI: 10.3760/cma.j.cn115989-20200307-00151
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摘要

角膜前弹力层分隔角膜上皮和前基质。可能与保持角膜的透明性和稳定角膜形态与生物力学有密切的联系。圆锥角膜出现前弹力层的断裂和基质胶原填充等组织病理表现。角膜前弹力层移植术是一种新型的角膜移植术,适用于角膜接触镜治疗效果不佳,且不适合紫外线角膜交联和角膜基质环植入治疗的进展性重度圆锥角膜患者。手术使用完整眼球或前板层角膜植片作为供体来源,用基质床或基质袋法将植片植入患眼的角膜基质层。手术并发症包括术中角膜穿孔及术后急性角膜水肿。手术后5年总体成功率84%,术后患者视觉质量、角膜形态有明显改善,同时可有效预防疾病进展,推迟或避免进行穿透角膜移植术或深板层角膜移植术。该手术具有创伤小、术中及术后并发症少的优势,但其手术技术精度高、难度大。本文就角膜前弹力层移植术的理论基础、最新的手术技术及预后和转归情况进行综述。

圆锥角膜;前弹力层;角膜前弹力层移植术
ABSTRACT

The Bowman membrane separates the corneal epithelium from the anterior stroma.It may be closely associated with retaining corneal transparency and stabilizing corneal morphology and biomechanics.Keratoconus presents with histopathological manifestations such as disruption of the Bowman membrane and stromal collagen filling.Bowman layer transplantation is a new type of keratoplasty for patients with progressive severe keratoconus who show no good efficacy after corneal contact lenses treatment and are not suitable for ultraviolet corneal cross-linking and corneal ring implantation therapy.The procedure uses an intact eye or anterior lamellar corneal implant as the donor and the implant is implanted into the corneal stroma of the affected eye using the stromal bed or stromal pocket method.Complications include intraoperative corneal perforation and acute postoperative corneal edema.The postoperative 5-year overall surgical success rate is 84%, with significant improvement in visual quality and corneal morphology, as well as prevention of disease progression and delay or avoidance of penetrating keratoplasty and deep lamellar keratoplasty.Bowman layer transplantation has the advantages of minimal trauma and few intraoperative and postoperative complications, but this surgical technique requires a high degree of precision and is difficult.The theoretical basis of Bowman layer transplantation, the latest surgical techniques and the prognosis and regression were reviewed in this article.

Keratoconus;Bowman membrane;Bowman layer transplantation
Hong Jing, Email: mocdef.aabnis4691gnijgnoh
引用本文

赵英涵,洪晶. 角膜前弹力层移植术治疗圆锥角膜研究现状[J]. 中华实验眼科杂志,2023,41(03):285-288.

DOI:10.3760/cma.j.cn115989-20200307-00151

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圆锥角膜是一种非炎症性、双侧非对称的角膜扩张性疾病。以角膜基质变薄为主要病理改变,表现为角膜局限性圆锥样突起及角膜曲率改变。圆锥角膜患者的视力缺陷往往表现为近视和不规则散光。随着角膜逐渐扩张和变薄,不规则散光程度逐渐进展,患者视力也逐渐下降进而丧失,因此圆锥角膜成为了角膜移植的主要适应证之一[ 1 ]
对于轻、中度圆锥角膜,可采用多种治疗手段延缓疾病进展,包括佩戴硬性透氧角膜接触镜、紫外光角膜胶原交联和角膜基质环植入[ 2 ]。穿透角膜移植术(penetrating keratoplasty,PK)是重度圆锥角膜传统的首选治疗方式,近年来深板层角膜移植术(deep lamellar keratoplasty,DLKP)也逐渐成为重度圆锥角膜一种较为成熟的治疗手段。Meta分析结果显示DLKP治疗圆锥角膜术后最佳矫正视力达0.5及以上的眼数明显少于PK,但2种治疗方案在术后角膜散光及屈光不正的等效球镜度方面无明显差异,而DLKP术后发生内皮型排斥反应的患者少于PK,即PK术后视觉质量略优于DLKP,但DLKP更有利于保留患者术后角膜内皮数、减少排斥反应[ 3 ]。目前DLKP是治疗未发生角膜穿孔的进展期圆锥角膜的有效手段之一,但临床上仍缺少更安全、术后视觉效果更好的治疗手段。
随着医疗技术的不断发展,角膜前弹力层移植术(Bowman layer transplantation)成为治疗进行性重度圆锥角膜的新思路之一。现有关于角膜前弹力层移植术治疗圆锥角膜的研究有限,但已有研究对其术后进行长达7年的随访[ 4 ]。由于角膜前弹力层移植术需要对基质层间进行人工分离和供体前弹力膜的处理,手术技术难度较大,目前尚未在临床得到广泛应用[ 2 ]。本文就角膜前弹力层移植术的理论基础、最新的手术技术及预后和转归情况进行综述,以提高对角膜前弹力层移植术的认识。
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洪晶,Email:mocdef.aabnis4691gnijgnoh
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