羊膜移植术在碱烧伤急性期重建结膜表面的实验研究

目的:(1)研究羊膜移植在治疗兔眼大面积结膜碱烧伤,重建健康结膜表面中的作用.(2)探讨碱烧伤急性期施行羊膜移植术的可行性.方法:选用30只家兔,制作角膜缘上方球结膜至穹隆部的碱烧伤的动物模型.实验组于碱烧伤后1wk时(急性期)行保存的人羊膜移植术及穹隆成形术.术后1,2,3,4,8,12wk时做光镜观察移植部位的结膜上皮生长情况,并于术后1,4,8wk时取移植区结膜做电镜观察其超微结构,同时与碱烧伤后行结膜下注射维生素C及应用抗生素眼药水点眼治疗的对照组结膜作对照观察.并在上述相应时期摄眼外观像、做上角膜缘至上方穹隆部宽度的测量.结果:(1)羊膜移植术后1wk时,光镜、电镜可见羊膜上有结膜上皮细胞长入,4wk时,含有杯状细胞的结膜上皮完全覆盖羊膜,接近于正常的结膜组织,12wk时,羊膜上结膜上皮细胞排列整齐,穹隆部结膜上皮下纤维结缔组织较为疏松,无增生.而对照组1wk时见结膜上皮细胞坏死脱落,未见有含杯状细胞的结膜上皮长入,4～8 wk时所见为大量纤维结缔组织增生,伴炎性细胞浸润.12wk时,穹隆部纤维结缔组织增生明显,未见有正常结膜上皮覆盖.(2)外观眼表可见,12wk时实验组移植区结膜光滑无瘢痕,上穹隆形成良好,穹隆深达7.6～8.2 mm,接近正常穹隆深度8.0～8.5 mm.而对照组结膜表面不光滑,有结膜肉芽肿形成,瘢痕增生明显,上方穹隆明显变浅,穹隆深度为1.0～4.5 mm.结论:以甘油保存的羊膜可作为一种底物载体,提供健康的基底膜,有利于周围正常结膜上皮的粘附、移行和分化,进而重建正常结膜表面.结膜碱烧伤后早期行羊膜移植可重建正常结膜表面,有效地防止睑球粘连的发生.     

深低温保存羊膜治疗严重睑球粘连的临床观察

目的:探讨深低温保存羊膜移植治疗严重睑球粘连的临床价值。方法:对43例46眼有严重睑球粘连及假性胬肉的患者,进行睑球粘连松解后,应用羊膜移植重建球结膜和角膜表面,观察其临床效果。结果:在随访期内(平均13±3.5mo),24例患者疗效为优,眼睑球粘连均得到明显改善,眼表基本恢复正常;15例疗效为良,睑球粘连部分复发,但较术前有所改善;7例因上下睑球全粘连、结膜囊闭锁愈后效果较差。结论:对于严重的睑球粘连,深低温保存羊膜移植重建眼表是较理想的治疗方法。     

Effect of amniotic membrane transplantation on rabbit conjunctival surface reconstruction at the recovering stage of alkali burn

AIM: To investigate the effect of amniotic membrane transplantation(AMT) on rabbit conjunctival surface recon- struction with severe alkali burns.(2) To evaluate the possibility of AMT treatment for ocular alkali burns during recovering stage. METHODS: Animal models were established on 30 eyes of rabbits by creating severe alkali burns on the conjunctiva from the upper corneal limbus to the upper conjunctival fornix. Preserved human amniotic membrane transplantations and reconstruction of conjunctival fornix were performed at one week after injury (recovering stage). Epithelium growth of burned area after transplantation was observed using light microscope at 1, 2, 3, 4, and 8 weeks. Conjunctival tissue in transplantation area was collected at 1, 4 and 8 weeks. The ultrastructure of the collected tissue was studied by electron microscope. The results were compared with control group, which received only vitamin C subconjunctival injection and antibiotic eye drops as treatment for alkali burn. Exterior eye pictures were also taken at the end of the observation, the width from upper corneal limbus to the edge of upper fornix was measured. Data were analyzed statistically. · RESULTS:(1) In the transplant group, conjunctival epithelium growth was observed in the area of AMT under both light and electron microscope 1 week after surgery. At the 4th week, conjunctival epithelium with goblet cells that resembled normal conjunctival tissues was observed in the whole amniotic membrane area. At the 12th week, the conjunctival epithelium on the amniotic membrane was well formed, and the connective tissue under the epithelium was loose at the fornix. No fibrosis was identified. In contrast, conjunctival epithelium necrosis was observed in the control group at 2 weeks after alkali burns. Reepithelization did not occur through the 12-week observation. Severe fibrosis with inflammatory cells infiltration was observed between 4 to 8 weeks. At the 12th week, fibrosis of the connective tissue at the fornix developed and there were no conjunctival epithelium covering the burned area.(2) In the transplant group, the conjunctiva in transplanted area had no scarring and appeared smooth at the 12th week. Upper fornix was reconstructed. The depth of fornix was 7.9±0.3mm (7.6- 8.2mm), which was approximate to the normal depth 8.2±0.2mm (8.0-8.4mm, P >0.05). While in the control group, the burned area appeared rough with granuloma formation and severe scarring. Upper fornix became shallow. The depth of fornix was 3.1±1.7mm (1.0 - 4.5mm.), and significant difference was found between control and transplant group (P <0.01). CONCLUSION: Human amniotic membrane preserved in glycerin can promote cell adhering, migrating and differenti- ating of normal conjunctival epithelium. Reconstruction of conjunctival surface in early stage of alkali burn can be achieved by AMT. AMT can effectively prevent symblepharon formation.     

人羊膜移植治疗翼状胬肉等眼表疾病的临床观察

目的：观察用人羊膜移植术治疗翼新诗胬肉、角膜热灼伤、化学伤、睑球粘连等眼表疾病的临床疗效。方法：用人羊膜移植术治疗翼状胬肉46例65只眼，其中复发性胬肉16只眼，假性翼状胬肉1只眼，角膜热灼伤、化学伤3例4只眼，睑球粘连2例2只眼，手术均在显微镜下完成。结果：随访3-11个月，羊膜移植手术均一次成功，无免疫排斥反应。翼状胬肉组，角膜透明，无新生血管，巩膜面结膜覆盖良好，充血消失；2只眼复发，复发率为3.1％，成功率96.9％。3例（4只眼）角膜热灼伤、化学伤者，术后均未见继续溶解、穿孔。睑球粘连者，结膜囊形成，睑球粘连者，结膜囊形成，睑球粘连松解，眼球活动基本正常。结论：人羊膜移植是治疗翼状胬肉等眼表疾病较有效方法，它可抑制结膜下及角膜纤维化，促进结膜、角膜的上皮化。     

Fornix and conjunctiva reconstruction by amniotic membrane in a patient with conjunctival mucosa-associated lymphoid tissue lymphoma

BACKGROUND: Conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma is a rare, low-grade, non-Hodgkin's B-cell lymphoma. Herein, we report our successful management of the large conjunctival defect caused by resection of conjunctival MALT lymphoma by covering it with transplanted amniotic membrane. CASE: A 28-year-old Japanese man, who had been diagnosed histologically as having conjunctival MALT lymphoma in his left eye, was referred to us for treatment. The tumor was located on the lower bulbar and palpebral conjunctiva, and involved the fornix. Extensive resection of the conjunctival lesion was performed. Two pieces of amniotic membrane were used to reconstruct the fornix, bulbar, and palpebral conjunctival defect. OBSERVATIONS: Epithelialization over the transplantation was completed within 3 weeks when all sutures were removed. During the 6 months of follow-up, there was no recurrence or any postoperative complication, such as graft rejection, symblepharon, or chronic inflammation. CONCLUSIONS: We demonstrated for the first time that amniotic membrane can be used to cover a large defect on both bulbar and palpebral conjunctiva when such a low-grade malignancy as MALT lymphoma is extensively excised. Amniotic membrane transplantation was quite effective for the fornix and conjunctival reconstruction.     

深低温保存羊膜在結膜重建中的臨床應用

目的評價深低温保存羊膜移植進行結膜重建的手術療效,并分析羊膜移植結膜重建手術成功的基本條件和具體手術方法與操作要點.方法用深低温保存的羊膜治療43例結膜整形患者.無眼球結膜囊狹窄10例,大面積結膜腫瘤13例,瞼球粘連9例,復發性胬肉7例,并嘗試對少數病例(4例)義眼座暴露,進行羊膜修補.結果隨診6～18個月,總治愈率達88.64%,無眼球結膜囊狹窄的治愈率為80%,瞼球粘連的治愈率達88.89%,大面積結膜腫瘤和復發性胬肉的治愈率皆為100%,而應用深低温保存羊膜修補羲眼座暴露,治愈率祗有50%.結論深低温保存的羊膜是一種有良好發展前景的生物材料,羊膜移植結膜重建術後整形外觀良好.在具體實踐中,結膜重建的手術效果不僅與羊膜的制備和保存有關,而且受手術方式的選擇,手術操作技巧以及術後處理的强烈影響.     

羊膜移植重建静止期眼结膜表面的远期疗效分析

目的研究羊膜移植重建睑球粘连分离后缺损结膜表面的远期疗效,探讨其相关的影响因素.方法对51例(55只眼)因陈旧性化学伤、热烧伤或Stevens-Johnson综合征而发生睑球粘连的患者进行睑球粘连分离联合羊膜移植手术.陈旧性化学伤33只眼中,10只眼为烧伤后5.0～11.0个月接受手术,23只眼为烧伤后1.0～8.0年接受手术.结果 51例患者术后随访26.0～30.0个月,平均(27.4±2.6)个月 .术后早期所有移植在眼结膜表面的羊膜植片均未见溃烂和溶解,周边对合良好.31只眼(56.4%)形成了足够深的穹窿部且恢复了眼球运动功能.9只眼(16.4%)发生部分睑球粘连,眼球运动轻度受限,但其面积远较术前为小.15只眼(27.3%)术后发生中度以上的睑球粘连,其中8只眼因睑闭锁而行全结膜囊成形的患眼术后1个月内结膜囊再次发生重度的睑球粘连.因Stevens-Johnson综合征而发生中度睑球粘连的4只眼术后均彻底解除了粘连.不同程度睑球粘连的患者于羊膜移植术后的效果不同,粘连程度越重,效果越差(P=0.000).眼表化学烧伤后(7.2±1.4)个月所行的手术与烧伤后1年以上行羊膜移植术的预后效果比较,差异有显著意义(P=0.039).不同泪液分泌组间预后效果比较,差异有显著意义(P=0.000),干眼症越严重,效果越差.结论羊膜可有效重建睑球粘连分离后缺损的结膜表面,部分患眼可能需要多次手术才能获得较好效果.患眼术前睑球粘连和干眼程度以及是否残存部分结膜上皮等移植微环境将影响羊膜移植重建眼结膜表面的远期疗效.     

义眼座植入同期利用羊膜移植结膜囊重建术的临床观察

目的 探讨结膜囊狭窄患者义眼座植入同期利用羊膜移植重建结膜囊的临床效果。方法 对23例结膜囊狭窄患者行义眼座植入同时行结膜囊重建术。术中下穹隆采用埋线法固定在眶下壁骨膜,保存羊膜移植于结膜缺损区,上下睑缘褥式缝合。每周打开眼睑并用荧光素试纸染色,观察结膜上皮生长情况。术后2个月拆除上下眼睑缝线,定制合适的义眼。结果 术后第4周20只术眼羊膜表面全部被结膜上皮覆盖,其余3只术眼发生羊膜融解,结膜上皮未愈。术后2个月4只Ⅰ度结膜囊狭窄患眼全部治愈;10只Ⅱ度结膜囊狭窄患眼中8只治愈,2只好转;9只Ⅲ度结膜囊狭窄患眼中3只术眼痊愈、3只术眼好转,余3只术眼无效,其中1只术眼半年后重新行结膜囊成形术。完成治疗的21例患者无义眼座暴露、感染及睑球粘连等并发症,对术后眼座的活动度和外观比较满意。结论 对于Ⅰ和Ⅱ度的结膜囊狭窄采用保存羊膜移植同期行眼座植入术是安全可行的。对于Ⅲ度结膜囊狭窄采用保存羊膜移植疗效欠佳。（     

Role of amniotic membrane transplantation for conjunctival reconstruction in ocular-cicatricial pemphigoid

PURPOSE: To evaluate the role and the effectiveness over time of amniotic membrane transplantation (AMT) as a first-step procedure to treat conjunctival reconstruction in late-stage ocular-cicatricial pemphigoid (OCP). DESIGN: Prospective interventional noncomparative case series. PARTICIPANTS: Nine eyes (9 patients) with advanced OCP. METHODS: Preoperatively, the ocular surface conditions were evaluated by immunohistochemistry of conjunctival biopsy and impression cytology specimens. The amniotic membrane was obtained during cesarean section from women who were 39 weeks pregnant and seronegative for human immunodeficiency virus, hepatitis B and C, and syphilis; it was processed, histologically tested, and stored at -80 degrees C. After scar tissue was removed, the preserved amniotic membrane was placed over the cornea, the bulbar, and tarsal conjunctiva, and was secured with 8-0 Vicryl sutures to the conjunctival edges and the deep fornices with double-armed 6-0 silk sutures. In 2 cases a double layer of amniotic membrane was transplanted. All patients received immunosuppressive systemic therapy and preservative-free tear substitutes and steroids topically for at least 6 months. During follow-up (average, 48 weeks; range, 28-96 weeks), a new standardized method was used to evaluate the fornix depth, and impression cytology testing was performed and conjunctival inflammation recorded and used as parameters for monitoring disease activity. MAIN OUTCOME MEASURES: Symblepharon, increased inferior fornix depth, presence of conjunctival goblet cells, and the degree of conjunctival inflammation. RESULTS: The conjunctival surface was free from symblepharon in all subjects for the first 16 weeks. At the week 28 examination, a small area of symblepharon was present in four eyes (44.4%). The depth of the fornix was significantly (P < 0.0001, analysis of variance) improved at weeks 4, 16, and 28. The normal conjunctival epithelium with goblet cells was restored in 6 of 9 eyes (66.7%) at the week 4 examination and in 4 eyes (44.4%) at the week 28 examination. Conjunctival inflammation was clinically but not statistically reduced. The visual acuity improved in 5 subjects. CONCLUSIONS: AMT can be a first-step procedure for ocular surface reconstruction in OCP, but its effectiveness deteriorates slightly over time.     

眼烧伤后重度睑球粘连眼表重建的临床研究

目的探讨新鲜供体带角膜缘板层角膜移植（LKP）联合带角膜缘干细胞自体球结膜移植和羊膜移植治疗眼烧伤后重度睑球粘连的眼表重建效果。方法选择1998年2月至2003年2月我院收治的眼烧伤后重度睑球粘连患者26例（26只眼）。根据视功能受损程度将睑球粘连分为4度．其中Ⅲ度19只眼、Ⅳ度7只眼。手术方法：（1）分离睑球粘连,保留假性胬肉;（2）利用新鲜供体行带角巩膜缘的部分LKP（19只眼）或全LKP（7只眼）;（3）取带角膜缘组织自体球结膜瓣移植于粘连最重的创面;（4）假性胬肉后徙,部分替代球结膜,联合羊膜移植重建结膜囊。术后随访8～36个月,观察结膜囊情况、眼球活动、角膜植片免疫排斥反应情况以及羊膜和假性胬肉的转归。结果除1只眼因睑裂闭合不全行永久性睑裂缝合术外,其余25只眼的眼表情况均得到不同程度改善。（1）睑球粘连：17只眼（65％）第一次手术后粘连完全分离,复视消失;8只眼（31％）在单纯羊膜覆盖的创面区复发条带状睑球粘连,其中5只眼经再次手术粘连完全解除,3只眼残余Ⅰ度粘连。（2）羊膜在术后1周开始自溶,3个月时完全消失;保留的假性胬肉术后1～3个月充血消退,逐渐变薄,相应区域无睑球粘连复发。（3）角膜情况：6只眼角膜植片发生免疫排斥反应,其中3只眼治疗后植片恢复透明,2只眼因植片混浊行二次LKP。结论新鲜供体带角膜缘LKP联合带角膜缘干细胞自体球结膜移植和羊膜移植是治疗眼烧伤后重度睑球粘连的有效方法,假性胬肉可部分替代球结膜重建结膜囊,羊膜移植在重度睑球粘连的治疗中仅发挥暂时支持创面促进眼表恢复的作用。（中华眼科杂志,2005,41：791-795）     

新鲜羊膜移植在重建健康眼表面中的应用

目的：探讨新鲜羊膜移植在治疗严重的急、慢性眼表疾病中重建健康眼表的可行性，评价其疗效。方法：本院住院的眼表疾病患者21例（22只眼）分别进行单纯羊膜移植术13例（14只眼）、羊膜移植结膜囊成形术2例（2只眼）和羊膜移植联合自体角膜缘干细胞移植术6例（6只眼）。术后随访6-12个月，平均8.5个月。结果：所有移植的羊膜植片均未出现溶解和排斥，21例术后视力均提高。角膜溃疡患者未见角膜继续溶解，睑球粘连患者恢复眼球运动功能，翼状胬肉未见复发。结论：新鲜羊膜移植可有效应用于重建眼表面，有一定的临床推广价值。     

Amniotic membrane transplantation for reconstruction of the conjunctival fornices

PURPOSE: To describe the clinical outcome of amniotic membrane transplantation (AMT) for fornix reconstruction in a variety of ocular surface disorders. DESIGN: Noncomparative interventional case series. PARTICIPANTS: Seventeen eyes in 15 patients with symblepharon. Four eyes had ocular-cicatricial pemphigoid, two eyes had symblepharon after pterygium excision, four eyes had chemical or mechanical trauma, two eyes had strabismus surgery, two eyes (one patient) had Stevens-Johnson syndrome, one eye had toxic epidermal necrolysis, and two eyes (one patient) had chronic allergic conjunctivitis. INTERVENTION: The subconjunctival scar tissue was dissected from the episclera, and the freed conjunctival flap was recessed to the fornix. A layer of amniotic membrane (AM) was applied to cover the exposed episclera. The fornical edge of the membrane was anchored with sutures passing through the full thickness of the lid. MAIN OUTCOME MEASURES: A deep conjunctival fornix, lack of motility restriction. RESULTS: The mean follow-up period was 37 +/- 24 months (range, 9-84 months). Complete fornix reconstruction was demonstrated in 12 of 17 eyes (70.6%), whereas 2 eyes had a partial success, and 3 eyes (3 patients) had recurrence of symblepharon with restricted motility. In eyes that demonstrated partial success or failure, the underlying etiology was either an autoimmune disorder or a recurrent pterygium. The most successful outcome was observed in eyes with symblepharon associated with trauma. CONCLUSIONS: AMT is an effective method of fornix reconstruction for the repair of symblepharon in a variety of ocular surface disorders. Future modifications, including an epithelial cellular component on the AM (conjunctival autograft or ex vivo expanded epithelial stem cells) may improve the outcome of this surgical procedure.     

新鲜和保存羊膜移植重建结膜眼表的临床对比研究

目的：比较新鲜羊膜和保存羊膜治疗睑球粘连的疗效差异，分析影响疗效的因素。方法：共51例55只眼因陈旧性化学伤、热烧伤或Stevens—Johnson综合征而发生睑球粘连的临床连续病例接受睑球粘连分离联合新鲜羊膜移植（22只眼）或保存羊膜移植（33只眼）。其中男30例32只眼．女21例23只眼。年龄4～51岁．平均（34．2±4.3）岁。其中11只眼在烧伤后5～11个月，平均（7．4±1．6）个月时接受手术，40只眼在烧伤后1～8年，平均（2．0±0．7）年进行手术。结果：术后随访12-32个月，平均（19．3±4．1）个月。所有移植存结膜眼表面的羊膜（包括新鲜羊膜）植片在术后早期均未见溃烂和溶解，周边对合良好。31／55（56．4％）只眼形成了足够深的穹窿部且恢复了眼球运动功能。9／55（16．4％）只眼发生部分睑球粘连，眼球运动轻度受限，但其面积远较术前为小。15／55（27.3％）眼术后发生中度以上的睑球粘连。新鲜羊膜和保存羊膜重建眼结膜表面的效果相似（X2=0．466，P=0．797）；不同程度睑球粘连的患者其羊膜移植术后的效果不同（新鲜羊膜．X2=27．995，P=0．000；保存羊膜，X2=33．610，P=0．000）；在眼表烧伤后1年内手术比1年以上进行羊膜移植的效果也不同（X2=4、243，P=0．039）。结论：新鲜羊膜和保存羊膜一样可以有效地用于重建睑球粘连解除后的结膜眼表。患眼术前睑球粘连程度以及烧伤后其眼表炎症是否处于安静状态等因素都会直接影响羊膜移植重建眼结膜表面的远期疗效。     

封闭结膜和Tenon囊间隙联合羊膜移植及纤维蛋白胶治疗睑球粘连的疗效观察

目的　研究封闭结膜和Tenon囊间隙技术联合羊膜移植及纤维蛋白胶治疗睑球粘连的临床疗效。方法　对31例（34眼）睑球粘连患者进行睑球粘连松解并切除异常纤维血管组织后，采用连续缝线封闭结膜和Tenon囊间隙技术联合羊膜移植进行治疗，术中辅以纤维蛋白胶固定羊膜。对结膜不足的重度睑球粘连病例使用自体唇黏膜移植封闭间隙。观察眼表重建效果、眼表炎症、眼球活动度、视力、移植材料情况及并发症等。结果　术后12个月34眼中完全成功25眼、部分成功6眼、失败3眼。术后疗效和术前睑球粘连的长度、宽度以及炎症活动度均有相关性（均为P＜0.05）。术后眼球活动度及炎症活动度得到显著改善（P＜0.05），6眼视力提高。结论　封闭结膜和Tenon囊间隙联合羊膜移植及纤维蛋白胶治疗睑球粘连疗效显著，其中使用连续缝线封闭结膜和Tenon囊技术是手术治疗睑球粘连的一个重要步骤。     

保存人羊膜联合自体角膜缘移植治疗陈旧性眼部烧伤

观察羊膜移植在重建眼表面,治疗陈旧性眼部烧伤中的应用价值。方法采用保存入羊膜联合自体角膜缘移植治疗１５例。结果１５只眼中,１２只眼眼表面重建成功,１０只眼角膜透明或半透明,８只眼脱盲。     

眼外伤睑球粘连的羊膜移植治疗

目的 评价羊膜移植治疗眼化学伤及热烧伤所致睑球粘连的效果。方法 我院眼部化学伤及热烧伤后睑球粘连病例34例（36眼）行睑球粘连分离联合保存人羊膜移植术。结果 术后随访半年以上，睑球粘连被彻底分开，眼球恢复自由活动者28例（30眼）占83．3％；6例（6眼）术后复发，占16．6％。结论 保存人羊膜移植治疗眼部化学伤及热烧伤后睑球粘连取材方便，效果显著。     

Amniotic membrane transplantation elicits goblet cell repopulation after conjunctival reconstruction in a case of severe ocular cicatricial pemphigoid

PURPOSE: The surgical procedures used until now to rebuild the conjunctiva in patients affected by ocular cicatricial pemphigoid (OCP) have not demonstrated appreciable anatomical and functional success. This study reports the postoperative clinical and cytological outcomes of a human amniotic membrane transplantation (AMT) to rebuild the conjunctiva in a case of late stage OCP. METHODS: We present a 75-year-old woman with a severe form of pemphigoid with entropion, trichiasis, symblepharon and blunting of the fornices, who underwent excision of the scarred and inflamed tissue covering the ocular surface and AMT. RESULTS: Our data show an improvement of the ocular surface condition, with reacquired fornix depth, reduced inflammation and presence of goblet cells at each follow-up. CONCLUSION: Amniotic membrane transplantation was successful as a first step procedure to reduce inflammation and to rebuild a physiological conjunctival epithelium in late stage OCP.     

羊膜移植在翼状胬肉术中的应用

目的观察保存人胎盘羊膜移植在翼状胬肉切除术后结膜重建及防止翼状胬肉复发中的疗效。方法对117例（143眼）翼状胬肉行广泛切除后，用保存人羊膜移植修补。结果术后2～3天角膜上皮修复，2～3周结膜血管化完成，与正常结膜不易区分。随访观察2～24月，治愈率91％。结论翼状胬肉切除联合羊膜移植术可有效地降低复发率。     

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。     

Management of severe ocular burns with symblepharon

Background  To evaluate the effect of lamellar keratoplasty combined with limbal stem cells, using amniotic membrane, autologous conjunctiva, and pseudopterygium to reconstruct external eyes for severe ocular burns with symblepharon. Methods  Thirty eyes of 29 patients had severe symblephara resulting from eye burns. According to the range of the symblepharon and the loss of limbal stem cells, partial lamellar keratoplasty combined with partial limbal stem cell treatment was performed in 19 eyes, and total lamellar keratoplasty with total limbus was performed in 11 eyes. All patients had amniotic membrane and autologous conjunctival transplantation, and the pseudopterygium was preserved to reconstruct the fornix. Results  Symblephara were completely relieved in 19 eyes. They remained partially in ten eyes in strip-like form, but seven of these were completely relieved after further autologous conjunctival transplantation. One eye was treated with tarsorrhaphy for eyelid malformation. The remaining pseudopterygium became thinner after the operation and showed no symblepharon. Immune rejection occurred in eight corneal grafts; clarity was restored in four of these, while there was graft neovascularization in the remaining four. Conclusions  Depending on the area of symblepharon and the loss of limbal stem cells, partial or total lamellar keratoplasty combined with limbal stem cells, using amniotic membrane, autologous conjunctiva and pseudopterygium to reconstruct external eyes appears to be effective in treating severe ocular burns with symblepharon. Pseudopterygium can partly substitute autologous conjunctiva in ocular surface reconstruction.