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。

Efficacy observation of sealing the gap between conjunctiva and Tenon capsule combined with amniotic membrane transplantation and fibrin glue in the treatment of symblepharon

Objective　To investigate the clinical effects of sealing the gap between conjunctiva and Tenon capsule combined with amniotic membrane transplantation and fibrin glue in the treatment of symblepharon.Methods　Thirty-one patients （34 eyes） with symblepharon were treated with symblepharon lysis and abnormal fibrovascular tissue excision，then running sutures were used to seal the gap between conjunctiva and Tenon capsule combined with amniotic membrane transplantation.In the operation，amniotic membrane was fixed with fibrin glue.For severe symblepharon where there was conjunctival shortening，autologous oral mucosa graft was added to seal the gap.Observed indicators included ocular surface reconstruction，inflammation activity，ocular motility，visual acuity，development of grafts and complication.Results　For a follow-up of 12 months，25 eyes （73.5%） achieved complete success，6 eyes （17.6%） achieved partial success，and 3 eyes （8.8%） had failure.The outcome was closely related to the preoperative symblepharon length，width and inflammation activity （all P＜0.05）.After surgery，the ocular motility and inflammation activity were significantly improved （P＜0.05）.6 eyes （17.6%） had improved visual acuity.Conclusion　The clinical effects of sealing the gap between conjunctiva and Tenon capsule with amniotic membrane transplantation and fibrin glue in treating symblepharon is remarkable.Among them，the use of running suture to seal the gap between conjunctiva and Tenon capsule is an important step in the surgical treatment of symblepharon.