组织粘合剂粘合羊膜手术在眼烧伤中的应用

Tissue Adhesive Combined with Amniotic Membrane Adhering in the Treatment of Ocular Burns

目的:评价组织粘合剂粘合羊膜手术在眼烧伤治疗中的疗效。方法:选择2002年9月～2004年6月在中山眼科中心外伤病区住院的眼烧伤患者29例34只眼。其中Ⅱ度烧伤4只眼,Ⅲ度5只眼,Ⅳ度25只眼。Ⅳ度烧伤中角膜缘100%缺血者7只眼,角膜缘缺血小于100%者18只眼;结膜严重坏死累及巩膜者12只眼。全部患者行组织粘合剂粘合羊膜手术前均予常规的药物治疗。术后随访2～6个月,观察角结膜上皮生长情况,羊膜、组织粘合剂贴附情况,炎症及视力等。结果:Ⅱ、Ⅲ度烧伤及部分Ⅳ度烧伤[角膜缘缺血小于100%有27只眼,手术后全部上皮缺损愈合,缺损愈合时间为术后8～42d,(23.9±8.0)d;Ⅳ度烧伤角膜缘100%缺血角膜溃疡溶解的7只眼,除1只眼失访外,6只眼局部溃疡静止。4只眼视力无变化,29只眼视力均有不同程度的提高。结论:组织粘合剂粘合羊膜手术可以迅速恢复烧伤眼表的完整性,有效地防止持续性角膜上皮缺损,角巩膜溃疡穿孔,睑球结膜粘连等并发症的发生;对于严重的Ⅳ度烧伤(角膜缘100%缺血),组织粘合剂粘合羊膜手术有助于阻止角巩膜溃疡穿孔,重建结膜表面,恢复眼前段血供,防止睑球粘连,但由于角膜缘干细胞完全缺陷,恢复角膜表面的完整性,尚需行角膜缘干细胞移植术。

Purpose: To investigate the surgical technique and its usefulness of tissue adhesive combined with amniotic membrane adhering, a new surgical procedure for ocular burns. Methods: Thirty-four eyes from 29 patients with ocular burns participated in the study, grade Ⅱ～Ⅲ 9 eyes, grade Ⅳ 25 eyes .In 25 eyes with burn of grade Ⅳ, 7 eyes experi-enced complete (100%) limbal ischemia, 18 had partial (less than 100%) limbal ischemia, and 12 with severe conjunctival necrosis had sclera involved. Cyanoacrylate tissue adhesive combined with amniotic membrane adhering was applied after standard medical therapies failed in controlling the deterioration of patients′ conditions. Our outcome measures included healing of the epithelial defect, resolution of the ulceration and inflammation, adhering of the tissue adhesive and amniotic membrane, and vision acuity. Results: For a follow-up of 2～6 months, outcome data were available for 33 eyes. All the 27 eyes showed epithelialization within 8～42 days,(23.9±8.0)days,including those with burns of grade Ⅱ～Ⅲ, grade Ⅳ ( partial limbal ischemia). Corneal melting was arrested in 6 eyes with 100% limbal ischemia. Vision acuity was improved signifi-cantly in 29 eyes, had no change in the other 4 eyes. Conclusion: Cyanoacrylate tissue adhesive combined with amniotic membrane adhering can rapidly restore both corneal and conjunctival surfaces, thus preventing effectively scarring sequelae in the late stage. In most severe burns, however, it arrests the cor-neosclera melting and restores the conjunctival surface and blood supply of the anterior segment, but does not restore the integrity of the corneal surface, which requires further limbal stem cell transplantation.