早期板层角巩膜移植治疗眼部严重碱烧伤的临床观察

The clinical observations of severe alkali burned eyes with early lamellar corneoscleral transplantation

目的 :评价早期板层角巩膜移植术对重度眼部碱烧伤的疗效。方法 :将符合 Roper- Hall诊断标准 、 级的患者根据初诊时间是受伤二周内还是二周后分为手术组与对照组。手术组依据巩膜有无坏死而行板层角巩膜移植或板层角膜移植。对照组不手术。药物治疗两组相同。结果 :随访 6～ 2 4个月 ,手术组 16例 19眼 ,多数术后视力显著提高 ,充血时间缩短 ,角膜溃疡发生率降低 ,溃疡持续时间缩短 ,无溃疡穿孔发生 ,新生血管密度较对照组低。对照组 6例 10眼 ,6眼角膜溃疡穿孔 ,6眼角膜大白斑伴严重血管翳 ,5眼发生不同程度的睑球粘连。结论 :清除失活的角巩膜组织合并早期板层角巩膜移植治疗严重眼部碱烧伤可有效减少角膜溃疡穿孔、防止睑球粘连、缩短炎症充血时间和增进视力。

Objective:To evaluate the effectiveness of early lamellar corneoscleral transplantation in the management of sevene alkali burned eye.Patients and Methods:The patients compatible with the Ⅲ or Ⅳ grades of Roper Halls standards were divided into operating group and control group according to the post burning interval which was less than 2 weeks or more.Depending on the presence or absence of scleral nacrosis,the patients in operating group were given a lamellar corneoscleral transplantation or a lamellar keratoplasty.The patients in control group did not receive any operation.The medication was the same in the two groups.Results:During the following up of 6 to 24 months,most cases in operating group had significantly improved vision postoperatively,less inflammatory congestion,lower incidence of corneal ulcer formation,and less neovasculerization.No perforation occurred in any case of the operating group.Whilst in the control group,ulcerative perforation occurred in 6 of 10 eyes,leucoma accompanied by severe panus in 6 eyes,symblepharon in 5 eyes.Conclusion:Debridement with early lamellar corneoscleral transplantation can effectively decrease the occurrence of corneal perforation,prevent symblepharon,shorten the time of inflammation,and improve visual acuity.