眼表重建手术治疗睑球粘连的临床研究  

Clinical research for ocular surface reconstruction in patients with symblepharon

作　　者：高明宏[1] 徐旭[1] 杜春光[1] 禹海[1] 于静[1] 周润海[1] 王颖[1] 

机构地区：[1]沈阳军区总医院眼科,沈阳110015

出　　处：《中国实用眼科杂志》2010年第8期863-866,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的 观察根据睑球粘连病变严重程度选择不同眼表重建术式的有效性. 方法选择2005 年1 月至2008 年06月在沈阳军区总医院眼科住院睑球粘连患者29例32只眼,根据睑球粘连及眼球运动受限程度分为4度.在切除睑球粘连病变瘢痕组织基础上,联合应用自体或异体角膜缘干细胞移植,应用自体结膜、自体口唇黏膜、羊膜组织等进行结膜囊重建,角膜受累者行板层角膜移植术.分别观察眼表面重建效果、眼球运动、视力、移植物情况及合并症,疗效分为完全成功、部分成功及失败. 结果经过超过1年以上时间随访,32只眼中完全成功21只眼（65.63%）,部分成功8只眼（25.00%）,失败3只眼（9.38%）.视力提高者为18只眼（56.25%）,合并症为睑球粘连复发、角膜植片排斥及持续性角膜上皮缺损.结论 根据睑球粘连病变严重程度选择不同眼表重建术式可取得较为满意地临床疗效.Objective To investigate the effects of various surgical strategies for ocular surface reconstruction in patients with symblepharon. Methods Twenty-nine patients （32 eyes） with symblepharon visited General Hospital, Shenyang Military Command between January 2005 and June 2008 were divided into 4 degrees depending on the severity of symblepharon and restriction of the ocular motility. The surgical procedure to correct symblepharon involves lysis of cicatrix followed by conjunctival-limbal autograft/allograft transplantation, plus fornix reconstruction with such a tissue substitute as autologous conjunctiva, autologous oral mucosa or amniotic membrane. Lamellar keratoplasty were performed simultaneously in cornea involved cases. Effects of ocular surface reconstruction, eye movement, visual acuity, development of grafts and complications were observed. Success was dened as an outcome of complete success or partial success and failure. Results For a follow-up of more than 1 year, the complete success was achieved in 21 eyes （65.63%）, the partial success was achieved in 8 eyes （25%） and failure resulted in 3 eyes （9.37%）. Anatomic improvement was accompanied by improved visual acuity. The complication include symblepharon recurrence, graft rejection and corneal epithelium defection. Conclusions For the treatment of symblepharon, various surgical strategies for ocular surface reconstruction depending on the severity can get better results.

关 键 词：睑球粘连 眼表重建 板层角膜移植 羊膜 口唇黏膜 

分 类 号：R779.6[医药卫生—眼科]