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目的:探讨聚羟乙基丙烯酸甲酯(PHEMA)海绵支架材料与角膜组织的生物相容性,评价改良聚羟乙基丙烯酸甲酯(PHEMA)—聚甲基丙烯酸甲酯(PMMA)一体化人工角膜植入兔与猴角膜的初步临床效果。方法:通过两个阶段化学聚合结合车床机械切削合成改良的一体化人工角膜。实验分为两个部分完成。第1部分(A组):将PHEMA海绵边裙材料植入10只正常兔角膜板层间,术后2,4wk及2,3,4mo分别行组织病理、免疫组织化学及电镜检查,观察海绵边裙与角膜组织的生物学愈合情况。第2部分(B组):8只兔眼和2只猴眼角膜囊袋内I期植入一体化人工角膜,术后临床观察材料与组织的愈合情况;术后3mo时行Ⅱ期手术切除术眼角膜中央前板层角膜组织,暴露人工角膜中央镜柱,术后随访时间3 ～6mo,初步观察临床治疗效果。结果:1)A组接受角膜板层间边裙植入术的10只兔眼,随访期间未见并发症:组织病理学显示,PHEMA海绵边裙材料植入术后2wk始有成纤维细胞长入,术后2 ～3mo时多量成纤维细胞长入并伴有新生血管生长;免疫组织化学显示,海绵孔隙中长入的细胞和角膜基质细胞均对波形蛋白免疫反应呈阳性;电镜下可见,成纤维细胞在海绵材料间隙中生长,细胞生长状态良好,并分泌胶原和细胞外基质。2)B组接受一体化人工角膜移植术的,6只兔眼一体化人工角膜均在位,另2只兔眼I期术后有前板层角膜基质融解。接受一体化人工角膜移植术的2只猴眼,I期和Ⅱ期术后均未见明显并发症。结论:PHEMA海绵能与角膜组织良好的生物学愈合;改良PHEMA-PMMA一体化人工角膜植入术后能获得相对稳定的治疗效果。
OBJECTIVE: To investigate the biocompatibility of PHEMA sponge scaffold with corneal tissue and to evaluate the effect of PHEMA-PMMA on the integration of artificial Primary clinical effect of corneal implantation in rabbit and monkey cornea. METHODS: A modified, integrated cornea was synthesized by two-stage chemical polymerization combined with lathe mechanical cutting. The experiment is divided into two parts to complete. Part 1 (group A): The PHEMA sponge skirt material was implanted into the cornea of 10 normal rabbits. The histopathology, immunohistochemistry and electron microscopy were performed at 2, 4, and 2, Edge skirt and corneal tissue biological healing situation. Part 2 (Group B): I corneal pouch of 8 rabbit eyes and 2 monkeys were implanted with I-corneal allograft cornea. The healing of the materials and tissues was observed clinically postoperatively. Corneal central corneal surgery before the corneal tissue, central cornea exposed cornea, postoperative follow-up time of 3 ~ 6mo, preliminary observation of clinical treatment. Results: 1) In group A, 10 rabbits with corneal interphalangeal skirts were implanted. No complications were observed during the follow-up period. Histopathology showed that fibroblasts grew at 2 weeks after PHEMA sponge skirt material implantation A large number of fibroblasts grew into and accompanied with neovascularization at 2 ~ 3 months postoperatively. Immunohistochemistry showed that all the cells in the sponge pores and corneal stroma cells were positive for vimentin. Electron microscopy showed that, Fibroblasts grow in the sponge gap, grow well and secrete collagen and extracellular matrix. 2) Group B received allograft artificial corneal transplantation. All rabbits with corneal allografts were in place, and the other 2 rabbits received preoperative lamellar corneal stroma. Two monkey eyes undergoing combined artificial corneal transplantation showed no obvious complications after stage I and stage II. CONCLUSION: PHEMA sponge can heal well with corneal tissue. The improved PHEMA-PMMA integrated artificial corneal implantation can achieve relatively stable therapeutic effect.