羊膜移植联合自体角膜缘移植术治疗陈旧性眼表烧伤  

Amniotic membrane transplantation with autograft for ocular surface reconstruction in chemical and thermal burns

作　　者：侯光辉[1] 徐锦堂[2] 孙秉基[3] 江振友[2] 卢争鸣[1] 

机构地区：[1]暨南大学医学院三附院珠海市人民医院眼科,519000 [2]暨南大学医学院一附院眼科 [3]河南省眼科研究所

出　　处：《中国实用眼科杂志》2003年第9期652-654,共3页Chinese Journal of Practical Ophthalmology

基　　金：广东省卫生厅科研基金资助 (编号 :2 0 0 0 1 32 )

摘　　要：目的 :探讨羊膜移植术联合自体角膜缘移植术对眼表烧伤的治疗效果。方法 :对 11例 11只眼陈旧性眼表烧伤 ,先将增生的薄层纤维血管组织清除干净 ;暴露出透明的角膜及光滑的巩膜面。用保存羊膜 ,及从健眼取得的自体角膜缘进行联合移植。结果 :平均随访 9 0± 2 2个月。术后角膜表面重度血管化的患眼数所占的比率 ( 3 / 11)明显小于术前 ( 9/ 11) (P <0 0 5 )。 3例( 3只眼 )手术失败 ,角膜表面重新血管化。广泛睑球粘连的 2例术后随访期 ,眼球运动障碍解除 ,形成较深的下穹隆部 ,未见重新睑球粘连。术后 0 -Ⅰ级角膜透明度的患眼数所占的比率 ( 7/ 11)明显大于术前 ( 1/ 11) (P <0 0 5 )。手术前 ( 9/ 11)、及手术后单眼盲目率 ( 4 / 11)相比较有显著性差异 (P <0 0 5 )。结论 :①单眼陈旧性眼表烧伤累及角膜厚度小于全厚 1/ 3、全角膜表面被纤维血管组织覆盖 ,或有广泛睑球粘连时 ,用羊膜移植联合自体角膜缘移植术治疗可受到促进角膜表面上皮愈合、抑制纤维血管化、改善角膜透明度、增进视力的较好效果。②眼表烧伤后角膜表层溃疡 ,应用羊膜移植术联合自体角膜缘移植术治疗效果较好。Objective:To investigate and evaluate the effects of amniotic membrane transplantation with autograft for ocular surface reconstruction in patients with chemical and thermal burns. Methods:After the proliferative tissues in the ocular surface of 11 eyes of 11 cases of old single ocular chemical burns and thermal burns were excised,in which no more than 1/3 of the corneal depth were invaded by corneal superficial extensive fibrovascularization,with or without symblepharon.Ocular surface reconstruction on the exposed smooth sclera and corneal surface were performed by preserved amniotic membrane with limbal autografts gained from health eye. Results:The rate of severe neovascularization after operation was lower (3 eyes of 11 eyes) than that of pre-transplantation(9/11,P<0 05).During follow-up period,3 eyes appeared to be failure with extensive neovascularization on corneal surface.2 eyes with extensive symblepharon showed recovery of ocular movement,preoperative inferior extensive symblepharon were cured and ocular surface were reconstructed successfully.Postoperative rate (7/11) of 0-I degree corneal transparency was more than that of pre-transplantation(1/11,P<0 05).The difference of blind rate of single oculus between pre-operation (4/11) and postoperation (9/11) was significant (P<0 05). Conclusions:Amniotic membrane transplantation with limbal autograft can get better treatment for the patients selected in this study with promoted corneal epithelial heal,inhibited fibrovascularization on ocular surface and improved corneal transparency and vision.

关 键 词：陈旧性眼表烧伤 羊膜移植 自体角膜缘移植术 治疗 

分 类 号：R779.1[医药卫生—眼科]