On November 30, 2021, Professor Hong Jing's team from the eye center of the Third Hospital of Peking University completed the first artificial corneal endothelial transplantation in China, which was a complete success. Severe corneal edema in surgical patients (corneal thickness > 1800) μ m) , seriously exceeding the indication of human donor corneal endothelial transplantation (corneal thickness ≤ 1200) μ m) Scope of. It is reported that this is the first case of artificial corneal endothelial transplantation in China and the first time in the world to apply artificial corneal endothelial transplantation to corneal endothelial decompensated patients with severe corneal edema.
Corneal endothelial transplantation is a major breakthrough in the history of corneal transplantation. It can selectively remove the diseased corneal posterior elastic membrane and endothelial cells, preserve the healthy autologous stroma, and recover the visual acuity faster and better after operation. In the United States, from 2005 to 2014, the proportion of penetrating keratoplasty in all corneal transplantation operations decreased from 94.9% to 41.5%, while the proportion of endothelial transplantation increased from 3.2% to 55.9%. It can be seen that endothelial transplantation has gradually become the leading operation in American corneal transplantation. Endothelial transplantation has also been dominant in European countries such as Germany and Asian countries such as Singapore.
However, in China, the amount of corneal endothelial transplantation accounts for only 6-8% of the total amount of corneal transplantation. In addition to the new technology and great difficulty, the main problem lies in the serious shortage of corneal donors. The technology of corneal transplantation in China has become mature, but limited by the number of donors, the annual operation volume is less than 8000 cases. It is in this case that "every inch of graft is worth every inch of gold" that every corneal donor is priceless. It seems that only when it is used in penetrating keratoplasty can it be perfectly utilized; In contrast, it is somewhat extravagant to take only a thin layer of posterior elastic membrane and endothelium for endothelial transplantation.
However, the development of good technology should not be limited by the problem of donor materials. After ten years of research and development, eyeyon medical endoart, an Israeli eye company, has finally achieved success. Artificial corneal endothelial membrane is a pure synthetic material, which has many advantages that human corneal endothelium does not have, such as no concern of postoperative rejection and no possibility of invasion by viruses and other microorganisms. Its performance is different from that of human corneal endothelium. Therefore, the use of artificial corneal endothelium graft is undoubtedly a higher technical test for corneal endothelium transplantation.
Figure 1: group photo of the medical team participating in the operation
The patient, Ms. Zhang, is over 60 years old. Recently, she has suffered from eye diseases and frequently traveled to major ophthalmic hospitals for medical treatment. Since she was diagnosed with bilateral angle closure glaucoma, she has undergone left trabeculectomy and cataract extraction. However, the corneal endothelium was decompensated after operation, so the left eye corneal endothelium transplantation had to be performed again. The operation went smoothly, and the best corrected visual acuity was once 0.4. I thought I could live a peaceful life. Who expected that God would not be beautiful. After half a year, there was no incentive for corneal edema again, and it continued to aggravate. Once it got out of control, it was going to fall into the dilemma of blindness again.
Figure 2: preoperative condition of the patient's left eye
When she came to the hospital, she was admitted to the hospital for physical examination. Her left eye visual acuity was manual / 10cm, intraocular pressure was 7mmhg, corneal stroma was seriously edema, the central thickness of cornea reached 1658 microns, and the thickness of original corneal endothelial graft was 234 microns, totaling 1892 microns. This data is 3-4 times the normal central corneal thickness. Severe corneal edema leads to narrow anterior segment space and great compression of intraoperative operation space. According to previous international studies, it has been a relative contraindication of corneal endothelial transplantation.
Figure 3: preoperative doctor-patient group photo
In such severe edema, the eye can not be seen at all, and it is impossible to formulate a detailed operation plan before operation. At the beginning of the operation, with the courage and determination to explore the way in the fog and wait and see, the team used hypertonic fluid dehydration and anterior chamber gas dehydration for 20 minutes, and finally barely saw the edge of the implant. After a series of careful and safe operations, the artificial endothelial graft was finally sent into the eye. Surprisingly, corneal edema miraculously subsided with the attachment of artificial corneal endothelial graft.
Figure 4: silhouette of Professor Hong Jing's operation
Figure 5 Intraoperative and 2 weeks after operation: A. before operation, the cornea was completely white; B) gas support after artificial endothelial graft implantation; C OCT after gas support of artificial corneal endothelial graft; D corneal diffusion photos 2 weeks after operation, the iris can be seen clearly; E corneal fissure photos 2 weeks after operation showed that edema was significantly reduced; F OCT of anterior segment 2 weeks after operation.
After surgery, Professor Hong Jing talked about the current situation of extreme shortage of corneal donors in China compared with western countries, saying that the fundamental reason lies in the cultural differences between the East and the West. Since ancient times, Chinese people have believed that "the body and skin are not damaged by their parents". Many people instinctively have a rebellious attitude towards organ donation. At present, with the vigorous publicity of the state, people's attitude towards organ donation has improved to a certain extent, especially among young people - young people account for the vast majority of volunteers registered in the eye bank of the Third Hospital of Beijing Medical University. However, when the traditional concept is slowly reversed, there are still 2 million patients in urgent need of corneal transplantation in China waiting in the dark - with this in mind, the research and development of new materials and the development of artificial corneal transplantation technology can be the fundamental way to solve the dilemma of lack of corneal donors in China.
This is the first artificial corneal endothelial transplantation in China, and the successful implementation of artificial corneal endothelial transplantation in patients with severe corneal edema is also the first in the world. It is believed that the further development and popularization of artificial corneal endothelial transplantation technology in China will benefit more blind patients with corneal diseases, so that they can get rid of the endless sea of suffering waiting for donors and see the light as soon as possible.