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角膜移植和眼库的全球调查

Gain P, Jullienne R, He Z

期刊名称:Archives of Ophthalmology 眼科学纪要

卷期:第134卷(2016年)2期

关键词:

律鹏 教授

 律鹏   教授   兰州大学第二医院

 

角膜病是全球最重要的致盲眼病之一,是我国的第二大致盲眼病,中国约有300万角膜盲患者,而角膜移植则是治疗的最主要方式。全球而言,最难解决的瓶颈问题是角膜供体严重不足。该文就2012年8月到2013年8月期间全球148个国家的角膜移植和眼库情况进行了调查,结果不容乐观。每70名需要角膜移植的患者只有1名患者获得了角膜移植的机会。作者提出需要在全球各国在角膜捐献方面做出更多的努力,同时应该加大生物角膜等方面的研发与推广。

 

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摘要

 重要性:当角膜病变严重而导致视功能障碍时角膜移植可有效恢复视功能。角膜移植一直被认为是世界上最频繁的移植类型,然而据我们所知,目前世界上并没有详尽的数据可表明角膜供给与需求之间的关系,而这样的数据对于地区、国家甚至全球在战胜角膜病中显得尤为重要。

目的:描述全球角膜移植供需的情况。
设计、地点和对象:系统回顾收集从2012年8月至2013年8月间世界各国及国际公开发表的文献中关于角膜和眼库的报告。第二步:采访眼库工作人员和/或角膜移植医生关于其与角膜移植相关的工作内容。采访通过国际眼科杂志或眼库大会或电话、邮件等方式进行。国家的供给/需求水平通过7级系统评分进行分类。这些数据来源于全世界148个国家或地区。
主要成果和措施:每一个国家均有角膜移植和角膜采购。
结果:2012年,我们确定了116个国家进行的184576角膜移植。这些采购自283530个角膜并贮存在742个眼库中。最突出的指征为Fuchs营养不良(占全部角膜移植的39%),初始角膜水肿主要影响老年个体;圆锥角膜(27%),一种可缓慢造成青年人角膜变形的角膜疾病和感染性角膜炎(20%)。在美国人均角膜移植为199.10-6,为全世界角膜移植率最高的国家。其次是黎巴嫩(122.10-6)和加拿大(117.10-6),而这116个具有角膜移植的国家中位数19.10-6.眼角膜仅在其中82个国家中有采购。只有美国和斯里兰卡出口了大量捐献的角膜。而全世界约53%的人口并没有机会接受角膜移植。
结论和相关性:我们的研究相对量化了全球角膜移植中角膜的严重短缺,每70个需要角膜移植的患者仅有1人获得角膜移植的机会。必须在所有国家中继续积极鼓励角膜捐献,而同时开发可替代的和互补解决方案也是至关重要的,例如生物角膜工程等。
IMPORTANCE:Corneal transplantation restores visual function when visual impairment caused by a corneal disease becomes too severe. It is considered the world’s most frequent type of transplantation, but, to our knowledge, there are no exhaustive data allowing measurement of supply and demand, although such data are essential in defining local, national, and global strategies to fight corneal blindness.
OBJECTIVE:To describe the worldwide situation of corneal transplantation supply and demand.
DESIGN, SETTING, AND PARTICIPANTS:Data were collected between August 2012 and August 2013 from a systematic review of published literature in parallel with national and international reports on corneal transplantation and eye banking. In a second step, eye bank staff and/or corneal surgeons were interviewed on their local activities. Interviews were performed during international ophthalmology or eye-banking congresses or by telephone or email. Countries’ national supply/demand status was classified using a 7-grade system. Data were collected from 148 countries.
MAIN OUTCOMES AND MEASURES:Corneal transplantation and corneal procurements per capita in each country.RESULTS:In 2012, we identified 184576 corneal transplants performed in 116 countries. These were procured from 283530 corneas and stored in 742 eye banks. The top indications were Fuchs dystrophy (39% of all corneal transplants performed), a primary corneal edema mostly affecting elderly individuals; keratoconus (27%), a corneal disease that slowly deforms the cornea in young people; and sequellae of infectious keratitis (20%). The United States, with 199.10-6 corneal transplants per capita, had the highest transplantation rate, followed by Lebanon (122.10-6) and Canada (117.10-6), while the median of the 116 transplanting countries was 19.10-6. Corneas were procured in only 82 countries. Only the United States and Sri Lanka exported large numbers of donor corneas. About 53% of the world’s population had no access to corneal transplantation.
CONCLUSIONS AND RELEVANCE:Our survey globally quantified the considerable shortage of corneal graft tissue, with only 1 cornea available for 70 needed. Efforts to encourage cornea donation must continue in all countries, but it is also essential to develop alternative and/or complementary solutions, such as corneal bioengineering.

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