生物羊膜移植治疗眼表中度碱烧伤的共焦激光显微镜观察  

The ocular surface changes of moderate alkali burns patients by biological amniotic membrane transplantation on confocal microscopy

作　　者：高妍[1] 王效武[1] 李春晖[2] 李冰[1] 赵矩伟[1] 

机构地区：[1]山西省眼科医院角膜科,山西省太原市030002 [2]山西医科大学第一医院眼科 ,山西省太原市030001

出　　处：《中国实用眼科杂志》2012年第8期908-912,共5页Chinese Journal of Practical Ophthalmology

摘　　要：目的应用共焦激光显微镜观察生物羊膜移植术对早期、中期中度的眼表碱烧伤的临床效果。方法临床病例自身对照研究。对2008年9月至2010年12月在山西省眼科医院就诊的病人选择45例（62只眼）Roper-Hall分度为Ⅱ度或Ⅲ度的患者，根据眼部受伤时间分组，A组（36只眼）为受伤24h至2w，B组（26只眼）为受伤2w至30d。对所有眼表碱烧伤患者生物羊膜移植术，术前术后分别行眼表共焦激光显微镜观察，统计各组角膜缘炎性细胞与杯状细胞密度；并进行临床观察及评分，内容包括：视力、裂隙灯检查，角膜荧光染色，睑球粘连分级，角膜新生血管评分。采用配对设计的两样本均数t检验，以P〈0．05为差异有统计学意义。结果A组碱烧伤患者角膜上皮细胞形态不规则，上皮细胞下可见较多炎性细胞浸润，基底层细胞高亮的核减少；内皮层细胞边界模糊不清，难以分辨细胞形态；偶见结膜杯状细胞。B组碱烧伤患者角膜上皮细胞依旧形态不规则，细胞边界较模糊；表层细胞下炎性细胞减少，可见高亮反光的结模样细胞生长；可见结膜杯状细胞。术后两组患者角膜上皮细胞形态均有改善，炎性细胞减少，结膜杯状细胞增多。术前A、B组角膜上皮细胞下炎性细胞密度每视野分别为（5409．38±302．59）个、（4614．22±386．29）个，术后A、B组角膜上皮细胞下炎性细胞密度每视野分别为（2854．12±307．41）个、（2218．34±198．69）个，两组间术前术后自身比较差异有统计学意义（P〈0．05）。术前A、B组杯状细胞密度分别每视野为（5．38±3．12）个、（9．42±6．51）个，术后A、B组杯细胞密度分别每视野为（13．50±4．93）个、（15．63±3．78）个，两组间术前术后比较差异有统计学意义（P〈0．05）。角膜荧光染色积分两组间术前后比较差异无统计学意义（P〉0．05），�Objective To investigate the clinical effect of biological amnion transplantation on moderate ocular surface alkali burns. To evaluate the possibility of biological amnion treatment for ocular alkali burns during early stage. Methods Thirty-two alkali burns patients who classified as II III degree according to Roper-Hall classification were enrolled in this study. They were divided into two groups to the course of disease： group A had 24 eyes （24 hours-2 weeks）, group B had 18 eyes （2 weeks-1 month）. All patients underwent biological amnion transplantation by the same surgeon. The limbus and bulbar conjunctiva were observed by laser scanning confocal microscope before and after the surgery, and the densities of the inflammatory cells and goblet cells were calculated. All patients were given clinical exam and value the scores of acuity vision, corneal fluorescent staining, degree of symblepharon and comeal neovascularization. Matching t test was used to compare the changes between two groups. Results The corneal epithelia of the patients in group A manifested irregular features. There were numerous small inflammatory cells beneath the superficial epithelia and very few goblet cells. The images of the endothelial layer were unclear, and it was hard to discriminate the morphology of each cell. In group B, it was still hard to discriminate the morphology of the comeal epithelia. The inflammatory cells beneath the superficial epithelia decreased, and there were few goblet cells. The morphology of the comeal epithelia was improved, and the inflammatory Cells decreased with the goblet cells increasing in both groups. The densities of inflammatory cells beneath the superficial epithelia were （5409±302） cell/field, （3814±286） cell/field in group A and B respectively before operation, that were （2854±307） cell/field, （2018±198） cell/field in group A and B respectively after operation. The P value was 〈0.05 by matching t test. The densities of goblet cells were （5±2） cell/field, （10±

关 键 词：碱烧伤 眼表 生物羊膜 移植 疗效 

分 类 号：R276.7[医药卫生—中医五官科学]