组织粘合剂粘合羊膜手术在眼表重建术中的应用

Tissue adhesive combined with amniotic membrane adhering for ocular surface reconstruction

目的:评价组织粘合剂粘合羊膜手术在眼表重建术中的疗效。方法:对16例17眼由于各种原因造成的角膜上皮持久不愈合的患者实施羊膜手术,术中用组织粘合剂固定羊膜。其中Ⅳ度以下眼化学烧伤4例5眼,外伤或异物剔除术后持续性角膜溃疡4例4眼,局限性蚕蚀性角膜溃疡3例3眼,神经麻痹性角膜溃疡和暴露性角膜溃疡各2例2眼,绝对期青光眼合并大泡性角膜病变1例1眼。全部患者在术前给予常规的药物治疗,术后予加压包扎、局部抗炎等处理。随访2～12mo,观察视力及局部反应、角膜上皮的生长情况、羊膜的贴附情况等。结果:手术后88%的患眼上皮缺损愈合,愈合时间为9～48(26.7±7.8)d,羊膜贴附的时间约为1mo,83%的患眼视力有不同程度的提高。结论:对于有角膜缘干细胞残存的眼表,组织粘合剂粘合羊膜手术可以恢复眼表的完整性,有效地防止持续性角膜上皮缺损,改善患者局部刺激症状。

AIM： To investigate the usage of tissue adhesive combined with amniotic membrane adhering for ocular surface reconstruction. METHODS： Human amniotic membrane transplantation using tissue adhesive was performed on 17 eyes of 16 patients with ocular surface disorders, including 5 eyes （4 patients） of chemical burns （undergrade Ⅳ ）, 4 eyes （4 patients） of corneal ulcer after ocular trauma, 3 eyes （3 patients） of limited Mooren＇s ulcer, 2 eyes （2 patients） of corneal ulcer after neuroparalytic keratitis, 2 eyes （2 patients） of exposure keratitis, and 1 eye （1 patient） of absolute glaucoma with bullous keratopathy. All patients received standard medical therapies before surgery. The follow-up time ranged from 2 to 12 months. Our outcome measures included the local reactions, vision acuity, healing of the epithelial defection, adhering of the tissue adhesive and amniotic membrane. RESULTS： Epithelialization occurred in 88% of the eyes in 9-48 days （mean 26.7 ±7.8 days）. Amniotic membrane attached at about 1 month. Vision acuity was improved in 83% of the eyes. CONCLUSION： Tissue adhesive combined with amniotic membrane adhering can restore the integrity of the ocular surface in cases which have enough corneal limbus stem calls. It can avoid persistent defect of corneal epithelium and improve the local stimulative symptom.