板层角膜联合羊膜移植治疗早期严重角结膜碱性化学伤

Corneal combined amniotic membrane transplantation for early severe alkali chemical injury of the eye

目的 :观察板层角膜联合新鲜羊膜移植治疗各种早期严重角、结膜碱性化学伤的临床疗效。方法 :对2 3例 (2 3眼 )因各种碱性化学物质所致 ,Roper Hall分级II度以上 ,病程在 2周内的早期严重角、结膜化学伤患者 ,施行板层角膜联合羊膜移植术 ,并结合皮质激素等治疗 ,术后随访 6～ 12 (平均 8.3)月。结果 :2 3眼中角膜植片透明 7眼 ,半透明 10眼 ,混浊 6眼 ;有 2眼术后发生排斥反应 ,经 1%环孢素A和皮质激素治疗后角膜水肿消退 ,但植片混浊。术后视力≥ 0 .3者 3眼 ,0 .2 5～ 0 .1者 5眼 ,0 .0 1～ 0 .1者 9眼 ,指数以下者 6眼。无 1眼因角膜溶解穿孔而摘除眼球者。结论 :对严重角、结膜碱性化学伤眼早期进行板层角膜联合羊膜移植 ,可有效地清除坏死的角、结膜组织和炎症细胞 ,减少和防止并发症发生 。

Objective To investigate the effect of lamella corneal transplantation combined amniotic membrane transplantation for the early severe alkali burns of eyes. Methods Twenty-three eyes with an over second-degree acute corneal alkali injury in 2 weeks were treated by lamella corneal transplantation combined amniotic membrane transplantation. After the operation the patients were treated with an intense and prolonged regimen of topical steroids and topical and systemic vitamin C. All patients were followed up for 6～12 months. Results Seven eyes were cornea transparent, 10 semi-transparent, and 6 opaque in the 23 eyes, respectively. The visual acuity of 3 eyes was better than 0.3,that of 5 eyes was between 0.25 to 0.1, and that of the other 15 eyes was below 0.1. No eye was enucleated due to the corneoscleral melting. Conclusion Lamella corneal transplantation combined amniotic membrane transplantation may clear away the necrotic tissues and cells of corneal or conjunctiva, prevent and reduce the complication, and improve the prognosis of the patients.