鹅异种板层角膜移植应用价值的回顾

A Review of the Application Value of Goose Xenogenic Lamellar Keratoplasty

摘要: 目的：探讨患有严重角膜感染疾病的患者施行鹅异种板层角膜移植的临床应用价值。方法：鹅角膜片的制作：按摘除尸体眼球的方法，无菌操作下摘取健康活鹅眼球，先用等渗盐水冲洗，再用1:2000单位庆大霉素溶液冲洗，将鹅眼球角膜朝上，下方用无菌纱布垫好，盛放于1:2000单位庆大霉素溶液的器皿里，在手术时根据植床大小、形状钻取或剪取全层鹅角膜，刮掉内皮即可使用。结果：移植片的转归：10例中，术后1个月~1年植片透明愈合1例，半透明4例，混浊3例，植片脱落2例。随访5~8年植片半透明4例，混浊6例(其中植片有新生血管2例，脱落2例包括在内)。视力：10例中，出院时视力较术前提高3行以上或从眼前手动、指数提高到0.1以上者3例，无变化7例；随访4个月~8年视力提高3行以上或从眼前手动、指数提高到0.1以上者3例，无变化6例，有1例植片由透明变成混浊，视力由出院时0.5下降到眼前手动。结论：鹅异种板层角膜移植属治疗性板层角膜移植，主要用于治疗感染性角膜病，良性肿瘤等，在治疗久治不愈时，尤其对角膜濒临穿孔或己穿孔的病人更有价值。

Abstract: Objective: To explore the clinical application value of goose xenogenic lamellar keratoplasty in patients with severe corneal infections. Methods: Preparation of goose corneal grafts: Healthy live goose eyeballs were harvested under sterile conditions using the method of cadaver eyeball removal. The corneas were first rinsed with isotonic saline and then flushed with a gentamicin solution (1:2000 units). The corneas were positioned upward, supported below with sterile gauze, and placed in a container containing the gentamicin solution (1:2000 units). During surgery, full-thickness goose corneal grafts were excised or cut according to the size and shape of the recipient bed, and the endothelium was scraped off before use. Results: Graft outcomes: Among 10 cases, one graft achieved transparent healing within 1 month to 1 year postoperatively, four grafts were semi-transparent, three grafts were opaque, and two grafts were lost. During follow-up (5~8 years), four grafts remained semi-transparent, while six grafts became opaque (including two cases with neovascularization and two cases of graft loss). Visual Acuity: Among the 10 cases, three patients showed improved vision by three or more lines from preoperative levels or from manual counting to 0.1 or above at discharge, while seven patients showed no change. During follow-up (4 months to 8 years), three patients achieved improved vision by three or more lines or from manual counting to 0.1 or above, while six patients showed no change. One graft transitioned from transparent to opaque, and the patient’s vision declined from 0.5 at discharge to manual counting. Conclusion: Goose xenogenic lamellar keratoplasty is a therapeutic form of lamellar corneal transplantation primarily used to treat infectious keratitis and benign tumors. It holds particular value in cases of refractory conditions, especially for patients with corneal perforation or impending perforation.