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目的 研究和评估羊膜贴敷对重症眼表烧伤的确切疗效和影响手术疗效的相关因素。方法 通过对15例2 0眼Ⅲ～Ⅳ度眼表烧伤眼手术前后视力、角膜上皮化、角膜缘和瞳孔区角膜血管化程度和是否睑球粘连四项指标的系统观察结果,对羊膜贴敷术的临床疗效作回顾性总结,并分析影响临床疗效的相关因素。结果 术后平均随访6m (2m～12m) ,所有术眼均获得上皮化痊愈,无一例发生角膜溃疡;10例12眼一次手术成功,5例8眼Ⅳ烧伤患者一次术后残留部分上皮缺损,经再次手术完成上皮化。视力方面14眼获得有用视力,其中达到0 .1～0. 4者10眼(5 0 % ) ,≥0. 5者4眼(2 0 % ) ;<0. 1者仅6例6眼(30 % ) ,均为严重的Ⅳ烧伤,手术使患眼免于失明。导致视力低下的原因是角膜缘和瞳孔区角膜瘢痕血管化,但手术为今后的增视性眼表移植术奠定了基础。结论 对于重症眼表烧伤如能及时行羊膜贴敷术,可望取得比较满意的治疗效果。总体疗效显示,受伤后越早接受手术,并于术后坚持应用0 . 5 %环孢素A滴眼,均能获得比较满意的疗效。羊膜贴敷术能有效地促进上皮细胞的分化移行、抑制局部的炎症反应、阻止新生血管和疤痕的形成、阻止烧伤的病理发展。本系列临床观察提示,羊膜贴敷对重症眼表烧伤是一种比较理想的应急治疗措施
Objective To study and evaluate the exact effect of amniotic membrane sticking on severe ocular surface burns and related factors that affect the surgical efficacy. Methods The visual acuity, corneal epithelialization, degree of corneal limbal and corneal vascularization in the pupil area and whether or not the symblepharon were observed before and after operation in 15 eyes of 20 eyes of Ⅲ ~ Ⅳ ocular surface were studied systematically. The clinical effect of surgery was retrospectively reviewed and the related factors influencing clinical efficacy were analyzed. Results All patients were followed up for 6m (2m ~ 12m) after operation. All the eyes were well epithelized, and none had corneal ulcer. One case of 12 cases was successful in one operation, and the remaining part of epithelial defect was found in 5 cases of 8 cases of Ⅳ burn. After surgery to complete epithelialization. Visual acuity in 14 eyes to obtain useful vision, which reached 0 .1 ~ 0. 4 of 10 eyes (50%), ≥ 0 5 of 4 eyes (20%); <0 1 only 6 cases of 6 eyes ( 30%), are severe IV burns, the surgery so that the affected eyes from blindness. The reason for low vision is corneal limbal and pupil corneal scar vascularization, but the surgery for the future of enhanced ocular surface transplantation has laid the foundation. Conclusion Severe ocular surface burns, if timely amniotic membrane sticking, is expected to obtain a more satisfactory treatment. The overall efficacy showed that the sooner the injury was treated, and the 0.5% cyclosporin A eye drops were used after the operation to obtain satisfactory results. Amniotic membrane sticking can effectively promote epithelial differentiation and migration, inhibit the local inflammatory response, prevent the formation of new blood vessels and scars, prevent the pathological development of burns. This series of clinical observations suggest that amniotic membrane on the ocular surface burns is an ideal emergency treatment measures