Boston type 1 keratoprosthesis: the CHUM experience

Objective: To describe the characteristics, indications, complications, and outcomes of the patients who underwent Boston type 1 keratoprosthesis (KPro) surgery at the Université de Montreal affiliated Notre-Dame Hospital.Design: Retrospective case series.Participants: Forty-seven eyes of 43 patients who underwent KPro surgery.Methods: The charts of all patients who underwent KPro surgery at Notre-Dame Hospital between October 2008 and February 2010 were retrospectively reviewed. Preoperative, intraoperative, and postoperative parameters were collected and analyzed.Results: The indication for Boston type 1 KPro was corneal graft failure in 27 eyes; 20 eyes had KPro as a primary procedure. Preoperative diagnoses included aniridia (34%), mechanical trauma (11%), infections (9%), surgery-related bullous keratopathy (9%), chemical burns (9%), corneal dystrophies (9%), and Stevens-Johnson syndrome (2%). A known history of glaucoma was present in 36 eyes (77%). Median preoperative best-corrected visual acuity (BCVA) was hand motion (range, 20/100 to light perception). The assembly of the KPro and surgery were uneventful in all cases. Mean follow-up was 10 ± 5 months. Median BCVA at last follow-up was 20/150 (range, 20/30 to no light perception). The device retention rate was 100% at the end of the follow-up period. Postoperative complications included retroprosthetic membrane in 12 eyes (26%) and glaucoma progression in 11 eyes (23%).Conclusions: Our study demonstrates an excellent retention rate of the Boston type 1 KPro and an improvement of BCVA in the majority of patients. Many patients undergoing KPro surgery have ocular comorbidities that require ongoing care to prevent further vision loss following KPro surgery.     

Anatomical survival and visual prognosis of Boston type I keratoprosthesis in challenging cases

Purpose

To describe the outcome of patients with Boston type 1 keratoprosthesis, with regard to anatomical and visual success.

Methods

Retrospective case series of patients who underwent Boston type I keratoprosthesis surgery at the Centro de Oftalmología Barraquer in Barcelona and at the University Eye Clinic in Salzburg between May 2006 and December 2011. Sixty-seven eyes were included. Anatomical success, visual acuity, and complication rate were evaluated and correlated with the initial diagnosis.

Results

The mean age of patients was 54 years; 62 % were male and 38 % were female. Eleven patients underwent Type I Boston Kpro implantation as a primary procedure, while the other 52 patients had previous graft failure. The most frequent diagnoses were autoimmune diseases (16 eyes), severe chemical or thermal burn (12 eyes), leukoma post-infectious keratitis (seven eyes) and bullous keratopathy (six eyes). The mean follow-up time was 26 months. Retention of the prosthesis was achieved in 95 % at 1 year and 78 % at 4.5 years. Two eyes suffered extrusion of the KPro, six underwent successful exchange of the prosthesis either due to infection, necrosis or extrusion, three KPro’s had to be explantated, and two eyes ended up in enucleation due to panophthalmitis. The outcome of the autoimmune cases was similar to the group with “other diagnoses” and better than those with chemical/thermal burn. The most frequent complication was development of a retroprosthetic membrane in 21 eyes (34 %). Visual acuity (LogMAR) in the chemical/thermal burn group was 2.30 preoperatively, 0.69 at 1 year, 0.52 at 2 years and 0.39 at 3 years; in the autoimmune group visual acuity was 2.3 preoperatively, 0.65 at 1 year, 0.15 at 2 years, and 1.5 at 3 years.

Conclusions

Boston type 1 keratoprosthesis is a viable option for patients with repeated graft failure, even for those with challenging diagnoses such as ocular burns and autoimmune syndromes.     

羊膜移植治疗眼表烧伤的临床应用分析

目的:评价羊膜移植治疗眼表化学烧伤及热烧伤的临床疗效。方法:收集我院眼部化学及热烧伤24例28眼,行新鲜羊膜移植术治疗,随访6～24mo。术后观察视力,羊膜移植片情况,角膜恢复情况及角膜上皮修复时间,并发症。结果:术后视力提高者22眼(79%),不变者6眼(21%),无视力下降者,术前术后视力差别无统计学意义。羊膜移植片情况:28眼中羊膜覆盖成活24眼,成活率达86%。角膜恢复情况:28眼中角膜最终恢复透明8眼,角膜云翳12眼,角膜斑翳5眼,角膜白斑3眼。角膜上皮愈合时间:22眼角膜上皮1～3wk全部愈合。术前4眼睑球粘连患者,睑球粘连情况均得到改善,3眼完全分离。结论:新鲜羊膜移植术是治疗眼表化学及热烧伤的有效方法。     

早期新鲜羊膜移植治疗眼部重度碱烧伤临床分析

目的:评价早期新鲜羊膜移植术治疗眼部重度碱烧伤的疗效。方法:对48例67眼重度碱烧伤患者按就诊时间分为A,B两组,烧伤0.5h～7d(包括7d)就诊者26例38眼(A组);烧伤7～20d(不包括7d)就诊者22例29眼(B组)。两组均采用新鲜羊膜移植术,术后均配戴软性角膜接触镜。3mo后观察眼表状况。结果:A组:角膜全透明者28眼,半透明者5眼,全混浊者3眼,角膜白斑者2眼,睑球粘连者2眼,有新生血管者2眼,视力≥0.4者28眼,<0.4者10眼;B组:角膜全透明者12眼,半透明者7眼,全混浊者6眼,角膜白斑者4眼,睑球粘连者13眼,有新生血管者15眼,视力≥0.4者11眼,<0.4者18眼。两组结果比较均有统计学意义(P<0.05)。结论:早期新鲜羊膜移植术可以更好的重建眼表,提高视力,是眼部重度碱烧伤的最佳治疗方法。     

Amniotic membrane extraction solution for ocular chemical burns

Purpose: To evaluate the efficacy of amniotic membrane extract (AME) for ocular chemical burns. Methods: Prospective non‐comparative interventional case series study. Consecutive 14 eyes of 11 patients with acute or chronic chemical burns, being recruited in one referral centre, received AME topically in combination with traditional treatment. Ocular discomfort, visual acuity, ocular surface inflammation, re‐epithelialization, corneal thickness, corneal neovascularization and symblepharon were evaluated. Results: Symptom relieved and ocular surface inflammation reduced dramatically in all eyes. Epithelial defect healed in all eyes with acute burns, in which less than 7 clock hours of limbus was involved, after 16.6 days (1–44 days) AME treatment. AME failed to close the epithelial defect in all eyes with chronic chemical burn coexisting diffuse limbal stem cell deficiency; however, the area of epithelial defect decreased to 58% (11.1%–68.2%) at final visit. During a follow‐up period of 8.2 months (6–11 months), visual acuity improved in 12 eyes (86%). There was mild neovascularization in three eyes with grade III and IV acute burns, and slow progress of neovascularization in chronic burns. Mild symblepharon developed in two eyes with grade III and IV acute burns, whereas there was no significant progress of symblepharon in chronic cases. Conclusions: Although it is a preliminary and uncontrolled study, topical application of AME is effective in reducing inflammation, promoting reepithelization in the treatment of chemical burns, especially for mild to moderate acute cases.     

自体角膜为载体Boston人工角膜治疗复杂性角膜盲

目的评价复杂性角膜混浊患者使用自体角膜做载体的BostonI型人工角膜植入的临床效果。方法回顾性病例研究。10例角膜盲患者（10眼）,术眼病变严重,经至少2名以上国内著名角膜病专家会诊。无法通过角膜移植复明。其中严重碱烧伤7眼,爆炸伤1眼,角膜内皮失代偿多次角膜移植失败1眼．双眼病毒性角膜炎角膜严重血管化1眼。其中9例为双眼盲。术前视力光感或手动。所有病例均一期完成手术,术中使用8．0mm或8．5mm环钻钻取患者角膜,用患者混浊病变的角膜为载体。安装Boston人工角膜。形成患者角膜．人工角膜复合体,复合体作为植片如传统角膜移植实行角膜植床和植片缝合固定,术中常规行晶状体摘除术。结果术后观察1-12个月,平均（5．7±3．8）个月,除1眼视力光感外,其余裸眼视力为0．1～0．8。手术并发症包括角膜植床出血人玻璃体腔2例,继发性青光眼2例,人工角膜后膜4例。所有术眼均无术后漏水并发症发生。结论人工角膜特别适合于穿透性角膜移植难于成功的角膜盲患者,而且是目前对严重角膜瘢痕血管化、眼睑或泪液功能不良患者有效的复明手段。我国角膜供体严重匮乏,用自体角膜为载体可作为部分BostonI型人工角膜植入手术的可行方案。     

Boston type 1 keratoprosthesis outcomes in ocular burns

Purpose: To report the outcomes of Boston type I keratoprosthesis (BKPro) in the management of ocular burn injuries. Methods: This was a prospective study including all cases of BKPro implantation for ocular burns at the External Diseases and Cornea Service of the Federal University of São Paulo, between February 2008 and February 2010. Ten patients (10 eyes) were enrolled. Procedures performed to manage ocular injury were identified, and data were collected regarding patients’ ocular history, surgical procedure(s) performed, and postoperative outcomes, including visual acuity, retention, complications and required surgical procedures. Results: A total of 11 Type 1 BKPro were implanted in 10 eyes of 10 patients. The mean follow‐up period was 25.7 ± 10.8 months. Preoperative best‐corrected visual acuity (BCVA) ranged from count fingers to light perception. Postoperative BCVA was better than 20/200 in 90% of the patients and better than 20/60 in 60% of the patients. The overall BKPro retention rate was 90%. The most common complications were retroprosthetic membrane formation (50%) and persistent corneal epithelial defect evolving to corneal melting (40%). Patients who underwent ocular surface procedures such as limbal transplantation prior to BKPRo implantation had a lower incidence of corneal melting/thinning (p = 0.07), although this was not statistically significant. Conclusion: The anatomical and functional results identified in this study support the use of BKPro in managing bilateral limbal stem cell deficiency secondary to ocular burns.     

The Boston keratoprosthesis in Stevens-Johnson syndrome

PURPOSE: To evaluate the use of the Boston keratoprosthesis (KPro) in patients with Stevens-Johnson syndrome (SJS). DESIGN: Retrospective, noncomparative, interventional case series. METHODS: Sixteen eyes of 15 patients with SJS underwent KPro surgery at the Massachusetts Eye and Ear Infirmary from January 2000 through December 2005. The preoperative, operative, and postoperative findings were recorded. All patients underwent either the type I or type II Boston KPro surgery by one surgeon (C.H.D.). Retention of the prosthesis, best-corrected visual acuity, the need for surgical revision, and postoperative complications were recorded. The outcomes were compared with those of an earlier group of patients from the 1990s. RESULTS: The mean age of patients was 50+/-18 years (range, 23 to 74 years), and the mean duration of their disease was 10+/-6.6 years. The mean follow-up period was 3.6+/-1.5 years (range, 10.2 months to 5.6 years). Ten eyes underwent type II KPro surgery, whereas six eyes underwent type I KPro surgery. Twelve eyes (75%) achieved a visual acuity of 20/200 or better after surgery, with eight eyes (50%) achieving excellent vision of 20/40 or better. Visual acuity was maintained at 20/200 or better over a mean period of 2.5+/-2.0 years. Preexisting glaucoma was found to be a significant risk factor for visual loss. There were no cases of KPro extrusion or endophthalmitis. CONCLUSIONS: KPro in SJS has improved, largely because of the introduction of vancomycin prophylaxis and better glaucoma treatment. It seems to be superior to standard penetrating keratoplasty, with or without allografted stem cell transplantation, as judged from the literature. However, the outcome of the KPro in SJS is still substantially less favorable than in nonautoimmune diseases.     

Treatment of the sequelae of ocular burns using limbal transplantation

PURPOSE: To report the results of limbal transplantation in patients with severe ocular burns and limbal stem cell deficiency. PATIENTS AND METHODS: This series includes six autografts (unilateral ocular burns) and five allografts (bilateral ocular burns) performed in ten eyes of ten males with an average age of 43 years. The origin of the ocular burn was chemical in eight cases and thermal in the remaining two cases. The average time between the initial trauma and limbal transplantation was 79 months. The average size of limbal grafts was 190 degrees (range: 80-20 degrees for autografts and 120-360 degrees for allografts). Patients with allografts received oral cyclosporine in three cases, topical cyclosporine in one case, and intravenous methylprednisolone in one case. Eight patients underwent penetrating keratoplasty an average of 11 months after limbal transplantation (range: 5-24 months). RESULTS: The average follow-up time was 36 months (range: 7-77 months). The overall success rate of limbal transplantation (ocular surface improvement) was 73% (8/11). The success rate of penetrating keratoplasty was 63% (5/8). The average initial visual acuity was 0.4/10 and the average final visual acuity was 1.6/10. Visual acuity improved by two lines or more in seven cases. DISCUSSION: Limbal transplantation is a useful surgical technique in patients with severe ocular burns. However, results remain insufficient and new techniques such as limbal stem cell culture and transplantation are needed to improve the visual prognosis of these patients.     

新鲜羊膜联合带活性角膜缘的全板层角膜移植治疗早期严重眼烧伤

目的：探讨新鲜羊膜联合带活性角膜缘的全板层角膜移植治疗早期严重眼烧伤疗效。方法：对早期严重眼烧伤14例15眼施行新鲜羊膜联合带活性角膜缘的全板层角膜移植术,术后观察移植物贴附、生长及眼表情况,监测重建的穹窿深度,了解是否有睑球粘连的发生。结果：移植的羊膜、角膜缘及角膜全部成活,重建的眼表面很快上皮化并保持基本稳定。除6眼因白内障及角膜持续水肿外,余视力均有提高。4眼发生睑球粘连,余形成足够的穹窿深度,眼球运动基本正常。术后3眼移植角膜缘发生排斥反应,局部用药控制。结论：治疗早期严重眼烧伤,新鲜羊膜移植能够有效防止睑球粘连,异体角膜缘及全板层角膜移植可恢复角膜结构并提供足够的干细胞,获得稳定眼表面。积极防治移植角膜缘排斥反应十分重要。     

玻璃体切割联合手术治疗严重眼外伤的临床观察

目的：探讨玻璃体切割联合手术治疗严重眼外伤的临床疗效。方法：回顾性分析我院自2011-01以来收治的经玻璃体切割联合手术治疗的严重眼外伤患者30例31眼。结果：患者31眼中术后视力提高24眼,术前无光感12眼中术后视力不变2眼,光感2眼,手动3眼,指数4眼,1眼恢复为0.1;6眼球内异物的异物取出率为100%,炎症控制好;18眼复杂视网膜脱离,15眼成功复位,视网膜复位率为83%;14眼外伤性白内障或晶状体脱位,玻璃体手术后12眼行人工晶状体植入术,晶状体植入率为86%。结论：严重眼外伤包括术前无光感眼,经过恰当的玻璃体手术联合相应的治疗措施,可以最大限度保留患者的眼球及挽救患者的视功能。     

早期生物羊膜移植联合自体血清治疗眼碱烧伤的临床观察

目的 观察生物羊膜移植联合自体血清治疗眼碱烧伤的临床疗效.方法 回顾分析2011年8月至2013年4月收治眼表碱烧伤22例（40眼）.观察早期行生物羊膜移植联合自体血清的治疗后视力、角膜混浊及并发症情况.结果 所有病例术后眼表迅速稳定,术后视力提高、角膜透明性均明显好于术前、并发症少.结论 生物羊膜移植术联合自体血清不失为治疗眼部碱烧伤的一种简单可行、实用有效的方法.     

眼外伤玻璃体切除术前ERG及VEP检查对术后视力预测价值

目的 观察闪光视网膜电图（flicker electroretinogram,F-ERG）及闪光视诱发电位（flicker visual evoked potential,F-VEP）测定对眼后段外伤玻璃体切除术后视力预测价值。方法 对42例（42只眼）眼后段外伤伴玻璃体混浊或积血的患者在玻璃体切除术前两周内行F-VEP及F-ERG检查,并分析其与术后1个月最佳矫正视力的关系。结果 F-ERG检查正常或轻度异常25只眼,术后视力提高23只眼（92．0％）,中度异常或重度异常和记录不到波形17只眼,术后视力提高7只眼（41．2％）。F-VEP检查正常或轻度异常27只眼,术后视力提高24只眼（88．9％）,中度异常或重度异常和记录不到波形15只眼,术后视力提高5只眼（33．3％）。F-VEP及F-ERG均正常或轻度异常的18只眼,术后视力均提高,且术后视力均恢复至0．1以上。F-VEP及F-ERG均重度异常或记录不到波形的2只眼,术后视力1只眼下降,1只眼不变。结论 眼外伤玻璃体切除术前联合检测F-VEP及F-ERG对术后视力预测有重要意义。     

角膜缘上皮移植联合穿透性角膜移植治疗陈旧性眼化学伤与热烧伤

目的:通过角膜缘上皮移植,改善化学伤与热烧伤穿透性角膜移植片的预后。方法:严重陈旧性眼化学伤与热烧伤26例28眼,12眼施行角膜缘移植联合部分穿透性角膜移植术,与16眼单纯施行部分穿透性角膜移植术作对照。结果:联合手术组,追踪5～28个月,植片透明率75％,9眼有效地阻止了植片新生血管和假性胬肉的复发,排斥反应发生率33.3％。对照组角膜植片血管新生较多,植片透明率为25％,持续性角膜上皮缺损发生率为50％,排斥反应发生率50％。结论:对严重陈旧性眼部化学伤与热烧伤,施行角膜缘移植联合部分穿透性角膜移植术,有预防术后合并症和改善植片预后的作用。眼科学报1997;13:213—216。     

组织工程上皮移植治疗烧伤后部分角膜结膜化的初步观察

目的 探讨组织工程上皮移植治疗眼表烧伤后因角膜缘干细胞功能障碍导致角膜结膜化的临床疗效.方法 系列病例研究.选择2007年12月至2008年5月期间,在首都医科大学附属北京同仁医院、北京同仁眼科中心收治的6例(6只眼)因化学烧伤、热烧伤所致的角膜结膜化患者,采用组织工程上皮移植治疗,术后随访观察6～12个月,对患者的视力、角膜新生血管及角膜透明度进行评估.结果 在随访期内,术后6例患者中有5例视力轻度提高,1例视力无变化.6例患者术后角膜新生血管较术前改善,但是在随访末期有1例患者术后新生血管再次长入角膜并大于1/2象限.5例患者的角膜透明度较术前提高.4例患者角膜基本透明,2例患者角膜轻度混浊.结论 组织工程上皮移植治疗眼烧伤后角膜结膜化可改善眼表损伤程度.     

Combined penetrating keratoplasty and keratolimbal allograft transplantation in comparison with corneoscleral transplantation in the treatment of severe eye burns

Purpose: The aim of this study is to compare the therapeutic outcomes between penetrating keratoplasty (PK) combined with keratolimbal allograft (KLAL) transplantation and corneoscleral transplantation in patients with severe corneal burns. Methods: Thirty‐eight patients (39 eyes) diagnosed severe corneal burns in stable status with vascularization and corneal opacity were included. We performed combined PK with KLAL transplantation in 23 eyes (group A) and corneoscleral transplantation in 16 eyes (group B). The main outcome measures were postoperative complications and long‐term visual acuity and rejection. Results: The incidence of postoperative complications (corneal epithelium defect, hyphaema and hypotony) in group A were obviously less than those in group B. Fifteen eyes (65%) in group A and four eyes (25%) in group B had best‐corrected visual acuity of >0.05 at 24 months (P = 0.022). Limbal stem cell rejection occurred in eleven grafts (48%) in group A and eight grafts (50%) in group B (P = 1.000). Nine grafts (39%) in group A and 12 grafts (54%) in group B had endothelial rejection (P = 0.049). Conclusions: PK combined with KLAL transplantation may reduce the risk of postoperative complications. Long‐term prognosis appears better than corneoscleral transplantation in the treatment of severe eye burns.     

Amniotic membrane transplantation for partial and total limbal stem cell deficiency secondary to chemical burn

PURPOSE: To evaluate the surgical outcome of preserved amniotic membrane transplantation (AMT) for ocular surface reconstruction in chemical burn with limbal stem cell deficiency. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Twenty eyes of 20 consecutive patients with limbal stem cell deficiency secondary to ocular chemical injury. INTERVENTION: AMT with or without adjunctive limbal transplantation using limbal tissue from either the healthy contralateral eye (CLAU) or a living related donor (lr-CLAL). MAIN OUTCOME MEASURES: Reconstruction of corneal epithelium (clear appearance without epithelial defect, normal fluorescein permeability and the absence of conjunctiva-derived goblet cells on impression cytology), decrease in corneal vascularization and improvement in visual acuity. RESULTS: With a mean follow-up time of 19 months (range, 8-27 months), satisfactory ocular surface reconstruction was obtained in 15 eyes (75%), with reduced inflammation and vascularization of the ocular surface and a mean epithelialization time of 3.3 weeks. Success was observed in all cases of partial limbal stem cell deficiency (PLD) and in 68.75% (11 eyes) of cases of total limbal stem cell deficiency (TLD). Surgical failure was observed in five severe cases (31.25%). A significant visual improvement was observed in all cases after surgery, except for 2 eyes that maintained preoperative visual acuity. CONCLUSIONS: AMT seems to be an efficient adjunct for ocular surface reconstruction in chemical burns with PLD. When performed in conjunction with limbal stem cell transplantation, it is also effective in most cases of TLD.     

折叠式人工玻璃体球囊植入术与外伤眼睫状体功能关系的初步分析

目的：探讨折叠式人工玻璃体球囊(FCVB)植入术治疗重度眼外伤患者的有效性和安全性,初步分析睫状体功能对FCVB植入手术的影响。

方法：回顾性分析。纳入2018-01/2020-07在南方医科大学附属小榄人民医院接受FCVB植入手术的重度眼外伤患者10例10眼。根据患者术前检查结果进行睫状体功能评分,评分≤5分者判定睫状体功能衰竭：其中评分>5分者8眼,评分≤5分者2眼。术后随访1～31mo,检查患者BCVA、眼压,观察前房、视网膜复位情况、球囊位置及术后不良反应。

结果：纳入9眼无晶状体眼患者FCVB植入过程顺利,术中无并发症; 1眼有晶状体眼患者在FCVB植入过程中出现上方部分虹膜根部离断。至末次随访,所有患者FCVB位置良好,视网膜复位率100%。无严重不良事件发生。术前和末次随访的BCVA和眼压比较均无差异(P>0.05)。术前睫状体评分>5分组(8眼)中,有2眼各补充手术1次,1眼补充手术2次。睫状体功能评分≤5分组(2眼),1眼补充手术1次,1眼补充手术5次。

结论：FCVB可用于治疗重度眼外伤患者,但不能有效提高患者视力。患者术前的睫状体功能状态可能与FCVB植入术后持续性低眼压、浅前房相关。     

Autologous limbal grafting combined with deep lamellar keratoplasty in unilateral eye with severe chemical or thermal burn at late stage

PURPOSE: To evaluate the efficacy of autologous limbal transplantation (ALT) combined with deep lamellar keratoplasty (DLK) for ocular surface reconstruction and corneal clarity recovery in eyes with severe late-stage chemical or thermal burns. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Thirty-nine eyes of 39 patients with a history of severe chemical or thermal burns over 6 months (mean, 47 +/- 28.7 months) exhibiting corneal vascularization, conjunctivalization, and heavy corneal scarring were treated at two university hospitals. METHODS: Surgical procedures included excising epibulbar fibrous tissue, clearing the fibrovascular membrane over the cornea, deep removal of corneal stroma 7.5 to 8.0 mm in diameter, exposing Descemet's membrane in the pupillary area, grafting a corneal button, transplanting autologous limbal and conjunctival epithelial grafts, and making a temporary tarsorrhaphy. MAIN OUTCOME MEASURES: Integrity of ocular surface recovery, postoperative corneal epithelial stability, optical corneal clarity, and best-corrected visual acuity were the outcome measurements. RESULTS: Thirty-four of 39 eyes that received ALT combined with DLK met the criteria of the study. Of 34 operated eyes, full corneal epithelialization was achieved in 19 eyes (55.9%) within 5 days and in 32 eyes (94.1%) within 7 days after surgery. Delayed epithelial healing occurred in two eyes (5.9%). The reconstructed corneal surface remained stable, and the renewed epithelium was characterized cytologically by nonkeratinized squamous cells without goblet cells. After surgery in 11 of 34 eyes, fluid was identified between Descemet's membrane and the donor corneal graft, resulting in a pseudochamber that completely resolved in 10 eyes within 30 days. In one patient, a persistent pseudochamber was present for 28 months. After surgery, transparent cornea especially in the pupillary area was accomplished in 29 eyes, whereas mild cornea clouding, nebulomacular corneal opacity, and heavy corneal scarring were observed, respectively, in three eyes. In addition, corneal endothelial decompensation was identified in two eyes and demonstrated persistent corneal epithelial and stromal edema. Remarkable improvement of postoperative vision was achieved in 30 eyes. Four eyes without postoperative improvement in vision were regrafted by penetrating keratoplasty at least 6 months after the original ALT and DLK surgery. CONCLUSIONS: Autologous limbal grafting combined with DLK simultaneously can restore a normal and stable ocular surface, create clear central cornea, and remarkably enhance visual acuity after severe chemical or thermal burns.     

羊膜移植治疗早期严重眼部烧伤疗效观察

目的 :探讨羊膜移植治疗早期严重眼部烧伤的疗效。方法 :采用我院眼库提供的保存人羊膜移植治疗碱烧伤 10例 (11只眼 ) ,酸烧伤 7例 (8只眼 ) ,热烧伤 9例 (9只眼 )。结果 :18只眼脱盲 ,其中 12只眼视力 >0 1,12只眼角膜恢复透明 ,14只眼角膜无新生血管 ,2只眼轻度睑球粘连 ,羊膜无免疫排斥、继发感染 ,眼表稳定。结论 :羊膜移植治疗早期严重眼部烧伤获得良好的治疗效果。