自体角膜缘移植联合深板层角膜移植治疗单眼瘢痕期热、化学烧伤  

Combination of auto-limbal grafting with deep lamellar keratoplasty for unilateral ocular burn

作　　者：朱也飞[1] 姚玉峰[1] 裘文亚[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院眼科,杭州310016

出　　处：《眼科研究》2004年第4期395-398,共4页Chinese Ophthalmic Research

摘　　要：目的　探讨自体角膜缘移植联合深板层角膜移植治疗单眼瘢痕期热、化学烧伤的临床疗效。方法　对单眼热、化学烧伤后 ,临床表现为角膜表面严重结膜化、新生血管化和瘢痕化的患者共 3 9例 ( 3 9眼 ) ,行自体角膜缘移植联合深板层角膜移植术。观察术中并发症、术后眼表面的重建、角膜透明度恢复及术后视力提高等指标。结果　 3 9眼中的3 4眼符合本研究的纳入标准。其中的 3 2眼 ( 94 1% )术后 7d内完成角膜上皮化。重建的角膜上皮稳定 ,印迹细胞学检查表现为无杯状细胞的非角化鳞状上皮。 3 4眼中的 11眼术后出现双前房 ,10眼的双前房于 1个月内消失。 3 4眼中的2 9眼 ( 85 3 % )术后角膜透明 ,3眼有不同程度的角膜瘢痕 ,2眼出现持续性的角膜水肿。术后 3 0眼 ( 88 2 % )视力显著提高。结论　自体角膜缘移植联合深板层角膜移植术能有效地重建单眼瘢痕期热、化学烧伤患者的眼表面 ,恢复角膜的透明性 ,明显提高视力。ObjectiveTo evaluate the efficacy of autologous limbal grafting (ALT) combined with deep lamellar keratoplasty (DLK) for ocular surface reconstruction in severe late-stage chemical or thermal burns eyes.MethodsThirty-nine eyes of 39 patients with a history of severe chemical or thermal burns for a mean of 47±28.7 months were treated by ALT combined with DLK.The treating outcome including postoperative ocular surface recovery,corneal epithelial stability,optical corneal rehabilitation and visual acuity were evaluated.ResultsThirty-four of 39 eyes with ALT +DLK met the criteria of the study.Of 34 operated eyes,full corneal epithelialization was achieved in 32 eyes (94.1%) within 7 days after surgery.The reconstructed corneal surface remained stable,and the renewed epithelium was cytologically characterized by nonkeratinized squamous cells without goblet cells.After surgery,fluid was identified between Descemet’s membrane in 11 of 34 eyes,and the donor corneal graft resulting in a pseudo-chamber completely resolved in 10 eyes within 30 days.Postoperatively,transparent cornea was accomplished in 29 eyes (85.3%),whereas mild cornea clouding,nebulomacular corneal opacity and heavy corneal scarring were observed in 3 eyes.Persistent corneal edema was identified in 2 eyes.Postoperative vision was improved in 30 eyes (88.2%).ConclusionA combined procedure of ALT and DLK can anatomically reconstruct ocular surface and improve postoperative visual acuity in the eyes with severe late-stage chemical or thermal burns.

关 键 词：深板层角膜移植 自体角膜缘移植 眼热烧伤 眼化学烧伤 

分 类 号：R779.65[医药卫生—眼科]