摘要
目的 探讨羊膜重建急性烧伤期眼表面的可行性 ,比较新鲜和保存羊膜的疗效差异 ,评价手术方法及其疗效。方法 全角膜Ⅲ度以上烧伤且全周角膜缘坏死的临床连续病例分别接受羊膜移植 (19例 2 0只眼 )或全板层角膜移植手术 (2 2例 2 4只眼 )。 19例羊膜移植患者中 8例 8只眼接受新鲜羊膜移植 ,11例 12只眼接受保存羊膜移植。患者术后随访 12～ 2 6个月 ,平均 (15± 2 )个月。结果 羊膜移植后眼表迅速稳定。新鲜羊膜移植者眼表面迅即并维持上皮化。保存羊膜移植者第 2或3周才完成上皮化 ,且 12只眼中有 3只眼不能完全上皮化 ,最后由于持续性上皮缺损而发生羊膜融解 ,其后接受了板层角膜移植。眼表上皮化的术眼随着时间的延长新生血管开始沿着羊膜从角膜周边长入 ,羊膜被逐渐吸收。新生血管多为表浅性。新鲜羊膜多数 (7/ 8)在术后 2～ 8(4 .3± 0 8)个月、保存羊膜多数 (10 / 12 )在术后 1～ 3(2 .0± 0 .3)个月基本被吸收或融解 (t=4 .2 2 ,P <0 0 1)。羊膜移植重建的结膜眼表均获成功 ,仅 1例发生影响眼球运动的中度睑球粘连。板层角膜移植组 2 2例 (2 4只眼 )均保全眼球 ,但在术后大多发生角膜植片上皮反复脱落 ,最终植片新生血管化 ,其中 4只眼由于角膜植片融解而接受植片更换 ,7只眼因植片上皮持续?
Objective To investigate the possibility of ocular surface reconstruction with amniotic membrane in the acute stage of burn injury, to compare the results using fresh and preserved amniotic membranes and to evaluate the surgical methods and their effects. Methods Consecutive patients of whole corneal burn above degree Ⅲ with complete destruction of the limbus were divided into two groups to receive amniotic membrane transplantation (8 eyes of 8 patients with fresh amnion, 12 eyes of 11 patients with preserved one) or lamellar keratoplasty (24 eyes of 22 patients). The follow-up period was 12 to 26 months with an average of (15±2) months. Results The ocular surface became stabilized after the transplantation of amniotic membrane. In eyes treated with fresh amniotic membrane, the corneal surface was epithelized immediately. In eyes treated with preserved amniotic membrane, the corneal surface was epithelized only after 2～3 weeks. Lamellar keratoplasty was performed in 3 of 12 eyes with preserved amnion transplantation because the amnion was dissolved due to persistent epithelial defects. Amnions were absorbed with time and superficial neovasularization followed in the corneal surfaces. Seven of eight transplanted fresh amnions were absorbed within 2 to 8 months [mean time (4.3±0.8) months], and 10 of 12 preserved amnions were absorbed within 1 to 3 months [mean time (2.0±0.3) months]. The difference was statistically significant (t=4.22,P<0.01). The conjunctival surface was successfully reconstructed with amniotic membrane at the acute stage of burn injury. Moderate symblepharon occurred in one case only. Corneal dissolution never occurred in all patients who received lamellar keratoplasty, but recurrent erosion of corneal epithelium occurred in the grafts and corneal neovasularization developed eventually. Corneal graft had to be performed again on four eyes and symblapharonplasty had to be performed on seven eyes. Mild to medium symblepharon was observed in 5 of 24 eyes received lamellar keratoplasty. Visual acuity could be maintained at hand movement in eyes treated with amniotic membrane transplantation without secondary glaucoma and cataract. Visual acuity was figure counting in most cases with lamellar keratoplasty. Conclusions Amniotic membrane transplantation (especially using a fresh membrane) can effectively reduce the inflammation of the cornea at the acute stage of burn injury, can prevent corneal ulcer and perforation and can make the stabilization process faster. It can also decrease corneal neovascularization as well as establish better conditions for successful keratoplasty.
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2004年第2期97-100,共4页
Chinese Journal of Ophthalmology
基金
高校博士点专项科研基金资助项目 (A0 3 2 0 0 116)
中山医科大学"2 11工程"基金资助项目(A13 2 0 0 10 3 1)
