组织工程角膜上皮联合羊膜移植治疗眼表化学伤效果观察

目的：探讨组织工程角膜上皮联合羊膜移植治疗眼表化学烧伤的临床效果.方法：34例（41只眼）跟表化学烧伤患者按来院先后顺序编号,随机分为两组.观察组18例（22只眼）行组织工程角膜上皮联合新鲜羊膜移植,对照组16例（19只眼）行结膜囊冲洗、前房冲洗和促角膜上皮生长药物点眼等治疗,观察两组临床疗效.术后随访观察角膜上皮化情况和视力恢复情况.结果：全部患者保存了眼球,观察组患者在术后1周内角膜植片水肿明显减轻,术后2～3周角膜缘植片基本透明,未见感染或排斥反应;术后4～6周内,眼表上皮重新上皮化,无瘢痕增生和新生血管化,角膜上皮修复好;术后视力较术前视力明显提高,差异有统计学意义（P〈0.05）;术后随访2～10个月,无假性胬肉及睑球粘连并发症发生.对照组3周内6例眼部炎症基本控制,3例眼部炎症持续超过21 d,4例角膜血管化,3例角膜持续性上皮缺损;治疗后视力较入院时视力变化差异无统计学意义（P〉0.05）.结论：组织工程角膜上皮联合羊膜移植是一种有效的治疗眼表化学烧伤的方法.

Combined tissue-engineered corneal epithelium and preserved human amniotic membrane transplantation for the treatment of chemical burn of eyes

Objective：To investigate the clinical effect of combined tissue engineered corneal epithelium and preserved human amniotic membrane transplantation for the treatment of chemical burn of eyes. Methods： Forty-one eyes in 34 cases suffered from ocular chemical burns, and according to the order number to the hospital, they were randomly divided into two groups： observation group （18 cases, 22 eyes） were treated with tissue engineered corneal epithelium and preserved human amniotic membrane transplantation, control group （16 cases, 19 eyes） were treated with conjunctival sac washing, anterior chamber irrigation and eye drops to promote the growth of corneal epithelium. All patients were followed-up for 2-10 months to observe epithelization and the restoration of vision. Results： In all 34 cases eyeballs were preserved,without the signs of acute rejective reaction. In observation group, postoperative corneal edema was significantly decreased in 1 week, corneal grafts appeared almost transparent, and no infection or rejection occurred in 2-3 weeks postoperatively. Re-epithelialization of ocular surface epithelium, neovascularization and no scar were observed in reconstructed ocular surfaces in 4-6 weeks postoperatively. Visual acuity was significantly improved compared with the preoperative visual acuity, and the difference was statistically significant（P〈0.05）. Pseudopterygium and symblepharon complications were also not found after 2-10 months. In control group inflammation was under control in 3 weeks in 6 cases, and ocular inflammation lasted longer than 21 days in 3 cases, corneal vascularization was found in 4 cases, and persistent corneal epithelial defect was observed in 3 cases. There was no significant difference in visual acuity after treatment compared with that on admission （P~0.05）. Conclusions： In ocular chemical burn , tissue engineered corneal epithelium combined with preserved human amniotic membrane transplantation can effectively improve corneal reconstruction.