【摘要】：目的：評估MICOF人工角膜治療角膜盲患者的臨床療效,探討青光眼、無菌性玻璃體炎等術(shù)后并發(fā)癥的預(yù)防及診治。 方法：回顧性病例研究。收集2000年1月至2010年10月期間于解放軍總醫(yī)院眼科行MICOF人工角膜植入術(shù)患者96例(96眼)。最長隨訪時間10年。人工角膜分兩期植入。Ⅰ期手術(shù)時將鈦合金支架植入角膜板層；Ⅱ期手術(shù)3-4月后進行,植入聚甲基丙烯酸甲酯(polymenthyl methacrylate, PMMA)為主要材料的人工角膜光學(xué)鏡柱部分,同時切除前部虹膜、晶狀體及前節(jié)涌出的玻璃體。統(tǒng)計患者MICOF人工角膜植入術(shù)前、術(shù)中及術(shù)后的相關(guān)影響因素,分析青光眼、無菌性玻璃體炎等術(shù)后并發(fā)癥的發(fā)病原理、診斷方法及治療措施。 結(jié)果：MICOF人工角膜能夠顯著提高患者術(shù)后視力。術(shù)后6月,視力優(yōu)于20/100的患者達(dá)到80.7%(67/83),1年時比例為82.4%(61/74),2年時為72.7%(40/55),3年時為78.8%(26/33),4年時為78.9%(15/19),5年時100%(5/5),6年時80%(4/5),7年和8年時均為100%(2/2),9年時100%(1/1)。人工角膜前(后)膜(retroprosthetic membrane,RPM)是術(shù)后最為常見的并發(fā)癥,39眼次術(shù)后發(fā)生RPM,其中35眼次需要1次或多次RPM切除手術(shù)。RPM對視力多無影響,手術(shù)切除后視功能可恢復(fù)。MICOF人工角膜術(shù)后在位率100%,無一脫出。16眼需要進行1次或多次自體耳軟骨加固術(shù)。1眼于Ⅱ期術(shù)后2月發(fā)生孔源性視網(wǎng)膜脫離,經(jīng)玻璃體切除,鞏膜外冷凝注氣術(shù)后,視網(wǎng)膜復(fù)位,人工角膜穩(wěn)定。5眼并發(fā)角膜囊腫,角膜溶解及角膜滲漏各8眼。9眼術(shù)前行睫狀體冷凝控制眼壓。10眼術(shù)后眼壓升高,3眼發(fā)生青光眼。5眼術(shù)后藥物控制眼壓無效,需行睫狀體冷凝手術(shù)降低眼壓。最佳矯正視力分別從20/25降至20/100,20/80降至光感,20/60降至20/200,20/100降至手動,20/50降至指數(shù)。6眼于術(shù)后1至30月內(nèi)并發(fā)無菌性玻璃體炎。2例確診后即行玻璃體切除手術(shù),其余4例確診后球旁注射地塞米松合劑(地塞米松磷酸鈉注射液2.5mg,聯(lián)合硫酸慶大霉素注射液2萬單位及1%利多卡因注射液0.2m1)3天,此后球旁注射曲安奈德40mg�；颊咦罴殉C正視力多在經(jīng)治療后2至6周恢復(fù)。 結(jié)論：MICOF人工角膜可應(yīng)用于角膜瘢痕、血管化等角膜移植高危患者,顯著提高其術(shù)后視力,使部分角膜盲患者復(fù)明。青光眼是MICOF人工角膜植入術(shù)后對視功能威脅最大的并發(fā)癥,無菌性玻璃體炎可能是一種自身免疫性疾病。術(shù)后并發(fā)癥的診斷和治療對于術(shù)后視功能的維持至關(guān)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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