带角膜缘干细胞全板层角膜移植联合泪道栓塞术治疗严重陈旧性眼表烧伤分析

Clinical study of large-diameter lamellar keratoplasty combined with punctal occlusion in the treatment of severe ocular burns

目的探讨带角膜缘干细胞的全板层角膜移植联合泪道栓塞术治疗严重陈旧性眼表烧伤的临床疗效。方法非随机回顾性研究。收集自2010年1月至2012年1月在厦门眼科中心住院的严重陈旧性眼表烧伤16例行全板层角膜移植术患者资料，并术后随访6。20个月，观察术前术后泪膜破裂时间（TFBUT）、泪液分泌（SchirmerI试验）、角膜植片透明度、贴附及生长情况，并对手术前后的视力进行比较。结果16例严重陈旧性眼表烧伤患者术后11只眼角膜基本透明，5只眼角膜有不同程度细小新生血管侵入层间。13例患者术后最佳矫正视力有不同程度的提高。Schirmer I试验和TFBUT术后6个月较术前显著延长，差异均有统计学意义（P〈0．05）。随访过程有2例发生免疫排斥反应，未见有溢泪、感染、泪点处异物感和肉芽组织增生等不良反应。结论带角膜缘干细胞的全板层角膜移植联合泪道栓塞术治疗严重陈旧性眼表烧伤，具有较好地临床应用价值。

Objective To investigate the efficacy of large-diameter lamellar keratoplasty com- bined with punctal occlusion in cases of severe ocular burns. Methods In the prospective consecu- tive case series, 16 patients （16 eyes） with severe ocular burn at Affiliated Xiamen Eye Center of Xiamen University from January 2010 to January 2012 underwent limbal allograft with large-diame- ter lamellar transplantation and punctal occlusion. All patients were followed up for 6-20 months, pre- and postoperative best corrected visual acuity （BCVA） was compared, the operative status of grafts was monitored during the follow-up period. Graft clearance was observed, too. Results All surgical procedures were performed successfully. A stable transparent corneal epithelium was restored in 16 patients with severe ocular burn. In 5 cases, gradual recurrence of peripheral corneal vascular- ization occurred during the follow-up period. Features of graft rejection developed in 2 （25%） of these 16 eyes. The ll grafts remained transparent until the latest follow-up. Thirteen patients had im- proved BCVA while 2 patients had the same BCVA. The Schirmer I test was significantly increased post surgery compared to pre-surgery （P 〈0.05）. Conclusions The advent of large-diameter lamellar keratoplasty combined with punctal occlusion techniques seems to be effective in reconstructing an ocular surface with long-term stability.