Biologic keratoprosthesis materials.
Biologic keratoprosthesis materials.
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DOI：
10.1097/iio.0b013e3181924904
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发表时间：
2009
影响因子：
--
通讯作者：
Dohlman CH
中科院分区：
文献类型：
--
作者：
Ciolino JB;Dohlman CH
人工角膜（KPro；“人工角膜”）为角膜失明患者带来了视力恢复的希望。第一个 KPro 设计需要将光学透明材料穿过不透明的角膜。尽管在 200 多年前就已推出，但许多现代 KPro 设计中仍保留了基本概念。 Boston KPro 采用聚甲基丙烯酸甲酯 (PMMA)（惰性塑料）光学器件稳定在前板和背板之间。迄今为止，波士顿 KPro 已在全球范围内植入了 2000 多个，对于既往穿透性角膜移植术失败但没有化学损伤或自身免疫性瘢痕性疾病（例如史蒂文斯-约翰逊综合征或类天疱疮）的患者来说，其保留率很高。根据波士顿 KPro 多中心研究，初步诊断为移植物排斥的患者群体中 97% 的眼睛保留了 KPro，平均随访时间为 8.5 个月。 1 然而，患有瘢痕性自身免疫性疾病的患者的保留率为 83%，而初次诊断为化学损伤的患者的保留率为 89%。在较长的随访期内，患有自身免疫性疾病和化学损伤的患者的保留率进一步下降。 2, 3 对于这部分绝望的患者，我们继续寻找提高 KPro 保留率的方法。一些 KPro 型号与早期设计不同，其中央光学器件周围带有载体或触觉元件，旨在与角膜“生物整合”。理论上，KPro 有可能与角膜上皮、基质、内皮或角膜层的组合整合。大多数“可生物整合”KPro 研究都集中在与角膜上皮或造口角膜细胞的整合上。与角膜上皮的整合可能提供
The keratoprosthesis (KPro;‘‘artificial cornea’’) offers patients with cornea blindness, the hope of visual recovery. The first KPro designs entailed placing an optically clear material through an opaque cornea. Although introduced over 200 years ago, the basic concept is retained in many of the modern KPro designs. The Boston KPro, employs a polymethylmethacrylate (PMMA)(inert plastic) optic stabilized between a front and back plate. With over 2000 implanted world-wide to date, the Boston KPro has an excellent retention rate in patients who have failed prior penetrating keratoplasties, but lack chemical injuries or autoimmune cicatricial diseases, such as Stevens-Johnson syndrome or pemphigoid. From the Boston KPro multicenter study, the patient population who had a primary diagnosis of graft rejection retained the KPro in 97% of the eyes with a mean follow-up of 8.5 months. 1 However, patients with cicatricial autoimmune disease had a retention rate of 83% and those with chemical injuries as a primary diagnosis had an 89% retention rate. Over a longer follow-up period, the retention rate decreases further for patients with autoimmune diseases and chemical injuries. 2, 3 For this subset of desperate patients, we continue to search for methods of increasing the retention rate of a KPro. Some KPro models differ from early designs by surrounding a central optic with a carrier or haptic that is intended to ‘‘biointegrate’’with the cornea. In theory, the KPro could potentially integrate with the cornea epithelium, stroma, endothelium, or a combination of the corneal layers. Most of the ‘‘biointegratable’’KPro research has focused on integration with either the cornea epithelium or the stomal keratocytes. Integration with the cornea epithelium may offer the