严重眼部烧伤急性期处理及组织工程角膜上皮移植的效果分析

目的：通过对严重眼部烧伤急性期处理及组织工程角膜上皮移植治疗眼角膜烧伤的效果分析,探讨治疗眼部烧伤的行之有效的途径.方法：对2005年1月-2009年12月收治的32例43眼（年龄1～43岁）严重急性期眼部烧伤患者,按致伤原因不同,分别进行急性期处理及对角膜创面进行羊膜和/或行自体/同种异体组织工程角膜上皮移植,观察视力、角膜创面愈合及新生血管生成情况.结果：43只眼中有11只在1周内角膜上皮愈合,矫正视力0.5以上,12只在行单纯羊膜覆盖后伤后2周上皮愈合,矫正视力＜0.5;12只在行单纯羊膜覆盖＋角膜缘干细胞组织工程角膜移植后于伤后3周上皮愈合,角膜血管翳（＋）（新生血管P1）,矫正视力0.02;8只在行羊膜覆盖＋角膜缘干细胞人工角膜移植后于伤后4周上皮愈合,角膜血管翳（＋＋）（新生血管P2）,矫正视力＜0.02.结论：化学伤明显重于单纯热烧伤,而碱烧伤及其复合灼伤则后果更为严重.早期处理极为重要,其中对碱烧伤的24 h持续冲洗,甚至结膜下冲洗、前房穿刺等措施十分必要.羊膜覆盖可有效地保护创面,而自体角膜缘干细胞体外培养后的组织工程角膜上皮移植可有效地促进角膜创面愈合,减少新生血管的产生.

Effect of acute stage treatment and transplantation of tissue-engineered corneal epithelium in severe burn injury of eye

Objective：To probe an effective approach by analyzing the effect of acute stage management and engineering corneal epithelium transplantation in treating severe corneal burn. Methods： Forty-three eyes （32 cases, aged from 1 to 43 years old） with severe acute corneal burn were treated in our hospital from January 2005 to December 2009, and they were given acute stage management and covered with amnion and/or autologous or allogenic tissue engineering corneal epithelium over raw corneal surface. The conditions of corneal surface and neovascular- ization were observed. Results：The integrity of corneal surface was recovered in 11 eyes within 1 week, with corrected vision ≥0.5; 12 eyes were covered with amniotic membrane and the corneal epithelium healed 2 weeks after the operation, resulting in a corrected vision〈0.5; 12 eyes were covered with amniotic membrane and tissue engineering corneal epithelial transplants, and the corneal epithelium of 12 eyes healed 3 weeks after the operation, with neovascularization P1 , and corrected vision 0.02. In other 8 eyes corneal defect healed 4 weeks after the operation, with neovascularization P2, and corrected vision〈0.02. Conclusions：The prognosis of thermal burn is bet- ter than that of chemical injury, and alkaline burn is most serious. It is of great significance to given early management, and covering the injured cornea with amniotic membrane could protect the raw coneal surface. Cultivated au- tologous or allogenic tissue engineering corneal epithelium transplantation could both facilitate recovery of integrity of ocular surface and also inhibit corneal neovascularization, thus it creates an opportunity for further corneal transplantation.