角膜移植手術的現況與未來

10.6666/ClinMed.201804_81(4).0041

許志堅

角膜移植(corneal transplantation) ； keratoprothesis(人工角膜) ； 生物工程角膜(bio-engineered cornea) ； 異種角膜移植(xenograft corneal transplantation)

臨床醫學月刊

81卷4期（2018 / 04 / 27）

235 - 242

繁體中文

角膜是眼睛相當重要的屈光組織之一，其透明度對視力的影響很大。角膜疾病是世界上除白內障外，致盲原因的第二位。而目前解決角膜疾病致盲的方法，最根本是先治療原本病灶，若角膜過於混濁、視力低下則再進行角膜移植(corneal transplantation)。在過去的十年來角膜移植手術的發展由全層角膜移植手術(penetrating keratoplasty)，慢慢地轉換到選擇性層狀角膜移植手術(selective lamellar keratoplasty)。其不但可以減少移植後病人本身對角膜供體(corneal donor)的排斥，縫合的傷口可以更快速的恢復，視力也可以盡快達到穩定。由於在大多數國家中，角膜捐贈並不盛行，角膜供體(cornea donor)的來源缺乏。選擇性的層狀角膜移植或許可讓一個角膜供體提供給兩個受贈者接受手術，來增加供體的可利用率，但此作法目前並不盛行。因此除異體角膜移植外，一直都有人在嘗試製造人工角膜(keratoprosthesis)，生物工程角膜(bio-engineered cornea)，及施行異種角膜移植(xenograft corneal transplantation)，想要取代目前正常模式下的異體角膜移植(allograft corneal transplantation)。在未來，這些方式或許真能取代異體角膜供體移植，但就目前來說，還有很長的一段路需要走。

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