带角膜缘干细胞的大植片深板层角膜移植联合自体结膜移植治疗严重眼表烧伤

Conjunctival autotransplantation-combined large-diameter deep lamellar keratoplasty with corneal limbal stem cells for severe ocular surface burn

目的观察带角膜缘干细胞的大植片深板层角膜移植联合自体结膜移植治疗严重眼表烧伤的疗效。方法11例11眼严重眼表烧伤患者行带角膜缘干细胞的大植片深板层角膜移植联合自体结膜移植患者的回顾性分析，其中碱烧伤3眼、酸烧伤2眼、热烧伤6眼，全部病例均伴有角膜新生血管翳。术后随访16～24个月，观察视力、上皮修复情况、角膜透明性、移植物的贴附生长、有无睑球粘连复发及排斥反应出现。结果术后2眼出现双前房，予以加压包扎，1眼第10天消失，1眼予以前房气体置换，术后3d双前房消失。术后1a植片透明率为63．6％，4眼植片混浊；11例患者术后1a恢复正常角膜缘结构；术后最佳矫正视力1眼0．6，5眼≥0．1，5眼〈0．1，但较术前均有提高。结论利用新鲜健康的角巩膜材料进行大植片深板层角膜移植联合结膜移植是一种安全、有效的治疗重症眼部化学伤及热烧伤的手术方法。

Objective To investigate the efficacy of conjunctival autotransplanta- tion-combined large-diameter deep lamellar keratoplasty with corneal limbal stem cells on severe ocular surface burn. Methods Retrospective analyses were conducted on 11 patients （ 11 eyes） with severe ocular surface burn who had received conjunctival au- totransplantation-combined large-diameter deep lamellar keratoplasty with corneal lim- bal stem cells. Of all the subject eyes, 3 eyes were with alkali burn, 2 eyes with acid burn,5 eyes with thermal burn; Newly-formed corneal pannus was found in all eyes. Follow-ups of 16 -24 months were carried out ,postoperative visual acuity, corneal epi- thelial recovery, corneal transparency, attached growth of grafts, symblepharon recur- rence and rejection action were monitored. Results Postoperative double anterior chamber was observed in 2 eyes ,the symptom in 1 eye disappeared at the 10th day after the eye was given pressure dressing;The symptom in the other disappeared at the 3th day after the eye was given anterior chamber gas replacement. Graft transparency was 63.6% after the operation 1 year; Graft opacification was observed in 4 eyes. All patients had normal corneal limbal structure after the operation 1 year. The postoperative bestcorrected visual aculty：O. 5（ 1 eye）, ≥0. 1 （5 eyes）, 〈0. 1 （5 eyes） ; Postoperative best corrected visual acuity of all eyes were better than preoperative ones. Conclusion Conjunctival autotransplantation-combined large-diameter deep lamellar keratoplasty with fresh and healthy corneal and scleral material is a safe and effective way in treating severe ocular surface chemical or thermal burn.