全眼表羊膜移植治疗百草枯致化学眼外伤临床观察

Total ocular surface amniotic membrane transplantation for treatment of paraquat-induced chemical ocular surface injury

目的观察百草枯致急性重度化学性眼外伤的临床特征及应用全眼表羊膜移植手术的疗效。方法收集2011年3月至2012年8月于山东省眼科医院就诊的8例（8只眼）百草枯致化学性眼外伤的患者并详细询问病史；利用裂隙灯观察患眼睑缘、结膜及角膜的损伤特征；对上述患者给予全眼表（包括睑结膜、球结膜、穹窿结膜和角膜）羊膜移植术，术后全身及局部应用糖皮质激素等治疗3天；记录手术后视力、眼表恢复情况及泪液。结果损伤特征：（1）睑缘水肿、充血，睑板腺口模糊不清。（2）睑球结膜重度充血、水肿，全结膜（包括睑结膜、球结膜及穹窿结膜）均可见灰白色伪膜被覆，去除伪膜后可见大片鲜红色出血创面，2例病史大于10d患者伪膜均有不同程度脱落，自穹窿部开始逐渐发生睑球结膜粘连。（3）角膜弥漫水肿、雾状混浊，严重者可伴有角膜上皮缺损。治疗后8例患者视力均恢复至受伤前水平。羊膜组织术后7-14d自行溶解吸收或脱落，无睑球粘连，结膜组织光滑，平整，角膜恢复透明，上皮缺损愈合，荧光素染色阴性，随访至术后3月未发生睑球结膜粘连。睑缘留有大量瘢痕，睑板腺口阻塞，患者均出现不同程度的泪液分泌量减少。结论百草枯致化学性眼外伤急性期以全结膜伪膜为主要临床特征，可造成严重的眼表损害，及时行全眼表羊膜移植术可有效减少睑球粘连等并发症。

Objective To investigate the clinical cal ocular surface injury and the therapeutic efficacy feature of paraquat-induced acute severe chemi- of total ocular surface amniotic membrane transplantation for treatment of ocular surface damage. Methods Eight patients （8 eyes） with paraquat-induced ocular surface injury who were treated in shandong eye hospital from march 2011 to August 2012 were studied and asked for details of the medical history. Slit lamp were used to observe the characteristics of palpebral margin, conjunctiva and corneal damage. The patients underwent total ocu- lar surface （Including palpebral conjunctiva, bulbar conjunctiva, fornical conjunctiva and cornea） amni- otic membrane transplantation combined with systemic and local glucocorticoid treatment for 3 days after the surgery. Visual acuity, recovery of ocular surface after surgery and tear was record. Re- suits Damage features： （1） Palpebral margin was characterized by edema and hyperaemia. Meibomian gland orifices were hard to see clearly. （2） Palpebral conjunctiva and bulbar conjunctiva manifested as edema and hyperaemia. All conjunctiva （including palpebral conjunctiva, bulbar conjunctiva and fornical conjunctival） were covered by grayish pseuclomemoran~. ^-,~,~＇- wound can be seen when the pseudomembrane had been removed. Two patients whose medical history was more than 10 days with different extent of pseudomembrane detachment gradually began to produce symblepharon from fornix. （3） Cornea was characterized by diffuse edema, corneal opacity, or may be associated with corneal epithelium defect. Treatment outcome： All of patients＇ visual acuity restored to preoperative levels. Anmiotic membrane dissolved in 7 to 14 days with no symblepharon. Conjunctival appeared smooth and fiat. Corneal transparency gradually restored. The corneal epithelization process was completed with negative fluorescence staining. Follow-up to 3 months, there was no symblepharon. Lots of meibomian gland orifices jamed in order to the scar formation of Pal- pebral margin. The patients presented with different degree of tear secretion decrease. Conclusions Paraquat-induced chemical ocular surface injury is characterized by pseudomembrane of all conjunctiva and can cause serious ocular surface damage. Complications, such as symbIepharon, will be effectively reduced by having total ocular surface amniotic membrane transplantation timely.