重度眼部碱烧伤早期多次羊膜移植治疗疗效分析  

To analysis the early efficacy of multiple amniotic membrane transplantation in the treatment of severe ocular alkali burn

作　　者：庄宪丽[1] 史伟云[1] 王婷[1] 高华[1] 陈敏[1] 张菊[1] 

机构地区：[1]青岛大学医学院山东省眼科研究所,266021

出　　处：《临床眼科杂志》2008年第3期217-220,共4页Journal of Clinical Ophthalmology

摘　　要：目的探讨重度眼部碱烧伤早期多次羊膜移植的适应证及治疗效果。方法回顾性分析我院2004年7月至2007年5月20例（24只眼）重度眼部碱烧伤患者早期采用两次及以上羊膜移植治疗效果。术后对眼表稳定情况、上皮愈合情况及新生血管、视力等进行观察随访。进一步探讨重度眼部碱烧伤早期羊膜移植的次数及适应证。结果20例（24只眼）患者中，9只眼在行2次羊膜移植术后7～14d之间羊膜开始溶解，拆线后羊膜脱落。眼表炎症基本控制，荧光素钠染色角膜上皮完整。角膜缘缺血基本改善。11只眼2次羊膜术后表现为角膜上皮未愈合，直径大于3mm以上，角膜缘缺血大于1／4象限，再行第3次移植，3只眼行4次羊膜移植，1只眼行5次羊膜移植。其中2只眼在行2次羊膜移植后，3只眼分别在3、4、5次羊膜移植后上皮仍缺损，且眼睑部分缺损，球结膜缺血明显，故给予永久性睑裂缝合术；各有2只眼在行第3、4、5次羊膜移植时发现角膜基质已出现自溶，故及时改为板层角膜移植术；1只眼行3次羊膜移植时，角膜基质自溶且溃疡在角膜周边，故改为结膜瓣遮盖术。结论重度眼部碱烧伤早期应积极采取羊膜移植进行治疗，多次羊膜移植对早期眼表的稳定十分有效，但应密切观察，防止盲目多次羊膜移植下的角膜溃疡扩大和穿孔的发生。Objective To study the indication and therapeutic effect of multiple amniotic membrane transplantation in the treatment of severe ocular alkali burn. Methods We make a retrospective analysis of therapeutic effect of 20 cases （ 24 eyes ） severe ocular alkali burn patients with early twice or more than twice amniotic membrane transplant treatment in our hospital from July 2004 to May 2007. Then observe ocular surface stability, epithelial healing, angiogenesis and visual activity after operation to further study the indication and times of multiple amniotic membrane transplantation in the treatment of severe ocular alkali burn. Results 20 patients （ 24 eyes ）, 9 eyes amniotic membrane dissolved between 7 - 14 days after second amniotic membrane transplant, and the amniotic membrane ablate after sutures out. Ocular surface inflammation was under control, fluoreseein sodium showed corneal epithelial integrity and corneal limbal isehemia was improved. 11 eyes＇ corneal epithelium still defect after two anmiotic membrane, the diameter of it more than 3 mm or more, cornea limbal isehemia more than 1/4 quadrant, Then did the third transplantation, 3 eyes to four times amniotic membrane transplant, 1 eye to 5 times. In which 2eyes after second amniotic membrane transplantion, each 3 eyes after 3, 4, 5 times, the epithelial still defect, and the eyelid segmental defect, conjunctival isehemia Obviously, so we did them permanence blepharorrhaphy; each 2 eyes in 3, 4, 5 times amniotic membrane transplantion found corneal stroma was autolysis, so we did them lamellar keratoplasty; 1 eye found the corneal stroma autolysis and peripheral corneal ulcer in the third amniotic membrane transplant, so we did conjunctival flap covering for it. Conclusion Severe ocular alkali burn should actively take multiple amniotic membrane transplantation for treatment in the early, multiple amniotic membrane transplant is very effective for the stability of ocular surface, but it should be closely observed to prevent corneal ulcer expans

关 键 词：眼部碱烧伤 早期 重度 羊膜移植 多次 

分 类 号：R779.6[医药卫生—眼科]