羊膜移植治疗早期角膜溶解

目的评价羊膜移植治疗眼热烧伤（化学伤）早期角膜溶解（伤后10～20d）的效果。方法回顾性研究。选择2004年6月至2006年6月在唐山市眼科医院就诊的眼热烧伤（化学伤）早期角膜溶解施行冰冻羊膜移植手术患者30例（30眼）作为手术组,2004年之前30例（30眼）眼热烧伤（化学伤）早期角膜溶解保守治疗病例作为对照组。比较两组中角膜上皮修复程度、基质水肿状态、视力变化及角膜新生血管生长等情况。结果手术组中28例手术后7～15d角膜溶解区修复,角膜上皮完全愈合,基质水肿减轻,视力有不同程度的提高;2例术后角膜继续溶解,采用保守治疗效果不佳,再次行羊膜移植治疗后,角膜上皮完全愈合。对照组中10例在保守治疗7～15d后角膜溶解区修复,基质水肿减轻,视力不同程度提高;10例角膜溶解区部分修复,基质水肿状态与视力变化不明显;10例溶解范围继续加深、扩大,基质水肿无减轻,视力下降。两组比较差异有统计学意义（P＆lt;0.05）。所有病例均有新生血管生长,手术组新生血管较对照组少且较细小。结论羊膜移植手术有利于早期溶解角膜的修复,对于结膜及角膜缘损伤较严重的患者需多次予羊膜移植手术治疗。该手术步骤简单,效果显著,值得推广。

Amniotic membrane transplantation for treatment of early corneal dissolution

Objective To evaluate the effect of treating early corneal dissolution from environmental burns（chemical injury） with amniotic membrane transplantation 10 to 20 days after injury.Methods This was a retrospective study.Thirty cases of early corneal dissolution caused by environmental burns（chemical injury） between June 2004 and June 2006 who were treated with amniotic membrane transplantation（the surgery group） were included in the study.Records from another 30 cases treated with traditional methods before 2004 were collected as the control group.The differences in the repair of the corneal epithelium and stromal edema,improvement of visual acuity and growth of corneal neovascularization between the two groups were compared.Results The corneal epithelium completely healed in 28 cases in the surgery group,stromal edema was reduced,and visual acuity was improved.The corneal epithelium continued to dissolve in 2 cases and amniotic membrane transplantation was repeated,resulting in a complete healing of the corneal epithelium.In 10 cases in the control group,the corneal epithelium completely healed,stromal edema was reduced,and visual acuity was improved.In 10 cases,corneal dissolution was partly restored but there was no obvious improvement in stromal edema or visual acuity.There was deterioration in 10 cases.Differences between the two groups were statistically significant（P〈0.05）.Neovascular growth was found in all of the cases,but neovascularity was less frequent and more restricted in the surgery group.Conclusion Amniotic membrane transplantation is an effective treatment for early corneal dissolution.Patients whose conjunctiva and corneal limbus are seriously injured can repeatedly undergo surgery with amniotic membrane transplantation.The surgery is simple,effective,and information about this technique should be disseminated widely.