羊膜移植治疗早期重度眼表碱烧伤

Treatment of early and severe ocular alkali burns by amniotic membrane transplantation

纳入重度眼表碱烧伤患者16例,符合国内1982年眼外伤与职业性眼病协作小组通过的重度眼表碱烧伤的分度标准,均知情同意,共16只眼。对患者行羊膜移植术覆盖伤眼角结膜表面,观察术后羊膜转归、角膜透明度及纤维增殖情况。术后3～6个月复查发现,14例患者羊膜贴附佳,均未进行2次手术,眼表稳定,视力在指数/眼前～4.5之间,其中10例角膜遗留不同程度的斑翳。剩余2例患者进行3次羊膜移植未控制住无菌性炎症,角膜表面全周纤维血管增殖,分别行两次对侧健眼角膜缘干细胞移植才控制住炎症,视力恢复差。结果提示羊膜移植可有效应用于早期重度眼表碱烧伤的重建治疗,但对于全周干细胞缺损的患者,则需联合角膜缘干细胞移植治疗。

Sixteen patients （16 eyes） suffering from early and severe ocular alkali burns were selected, who were in accordance with the classification standard provided by the consortium of Ocular Trauma and Occupational Eye Disease in 1982, and all subjects signed the informed consent. AMT was performed to cover the corneal and conjunctival surface, and all the patients were followed up to observe the visual acuity, corneal transparency and fiber proliferation. In the follow-up of 3-6 months post-operation, 14 patients got better attachment of AM without secondary surgery, and they acquired stable ocular surface with he visual acuity ranged CF/BE-4.5, of which 10 cases suffered from different degree of corneal macula, while another 2 patients suffered from uncontrolled aseptic inflammation even after three times of AMT, and the fiber and vascular proliferation covered the entire cornea. Not until twice contralateral limbal stem cell transplantations, the inflammation was controlled, but the prognosis of visual acuity was very poor. The result showed that the AMT could be effectively used in the reconstruction of early and severe ocular alkali burns, but for the patients with whole limbal stem cell deficiency, it should be performed by being combined with limbal stem cell transplantation.