Langefeld S, Kompa S, Redbrake C, Brenman K, Kirchhof B, Schrage N F
Augenklinik der RWTH Aachen, Germany.
Graefes Arch Clin Exp Ophthalmol. 2000 Sep;238(9):722-6. doi: 10.1007/s004170000163.
A new keratoprosthesis was used during pars plana vitrectomy in order to test the optical quality, watertightness, short-term biocompatibility and handling of the new device. The implantability was also tested, given that this keratoprosthesis might in future be left in place for several months. This Aachen keratoprosthesis (Aachen-KPro) is developed to be used as permanent implant to restore vision in corneal blind patients.
The Aachen-KPro was used during pars plana vitrectomy in 10 patients with opaque corneas. In four cases, trauma precipitated the ocular disease. Eye burn was the cause of corneal and retinal disorders in another four cases. One patient had a history of congenital glaucoma with myopia, and one of uveitis with corneal dystrophy. After trephination of 6.5 mm in diameter, the Aachen-KPro, composed of soft silicone rubber, was temporarily placed in the trephination hole. After completion of the vitrectomy, the Aachen-KPro was replaced by a 7 mm corneal graft.
Intraoperative use of the Aachen-KPro allowed uncomplicated intraoperative handling, smooth adaptation to the corneal rim in the trephination hole, and an undistorted view of the central and peripheral retina. Leakage, even during scleral depression, could be avoided by individual suturing of the scleral rim. After a follow-up period of 1-10 months, the retina was still attached in all cases. The corneal graft was clear after surgery in four eyes, and edema was found in three cases. Amnion or conjunctiva was placed over three patients' transplants.
We report the first temporary implantations of a new keratoprosthesis in 10 patients. Its flexibility and good optical qualities allowed control of intraoperative procedures. The outcome and prognosis of the vitreoretinal surgery and keratoplasty were related to the primary diagnosis. The Aachen-KPro has shown advantages, especially in eyes where the anterior eye segment is severely damaged by eye burn or previous surgical interventions. In the future, prolonged use of the Aa-chen-KPro is planned for selected eyes.
在玻璃体切割术中使用了一种新型角膜假体，以测试该新装置的光学质量、水密性、短期生物相容性及操作性。鉴于这种角膜假体未来可能会在眼内留存数月，因此还对其可植入性进行了测试。这种亚琛角膜假体（Aachen-KPro）被开发用作永久性植入物，以恢复角膜盲患者的视力。
在10例角膜混浊患者的玻璃体切割术中使用了亚琛角膜假体。其中4例因外伤引发眼部疾病。另外4例中，眼部烧伤是角膜和视网膜病变的原因。1例患者有先天性青光眼合并近视病史，1例有葡萄膜炎合并角膜营养不良病史。在进行直径6.5毫米的环钻术之后，将由软硅橡胶制成的亚琛角膜假体临时置于环钻孔中。玻璃体切割术完成后，用7毫米的角膜移植片替换亚琛角膜假体。
术中使用亚琛角膜假体使手术操作顺利，能顺利适配环钻孔中的角膜边缘，且能清晰观察中央和周边视网膜。通过对巩膜边缘进行个体化缝合，即使在巩膜压迫时也可避免渗漏。随访1至10个月后，所有病例的视网膜均保持附着状态。术后4只眼的角膜移植片透明，3例出现水肿。3例患者的移植片上覆盖了羊膜或结膜。
我们报告了10例患者首次临时植入新型角膜假体的情况。其柔韧性和良好的光学质量有助于术中操作的控制。玻璃体视网膜手术和角膜移植术的结果及预后与原发诊断相关。亚琛角膜假体已显示出优势，尤其是在眼前节因眼部烧伤或既往手术干预而严重受损的眼中。未来，计划对选定的眼睛延长使用亚琛角膜假体。
