CAJ | 학술논문

目的介绍结膜瓣移植治疗眼部烧伤和眼科手术后巩膜缺血坏死的手术方法,观察其临床疗效.方法回顾性病例研究.2007年1月至2012年3月,共13例眼部烧伤和眼科手术后巩膜缺血坏死、溶解的患者在山东省眼科医院接受了结膜瓣移植,其中碱烧伤4例,热烧伤6例,翼状胬肉切除手术后巩膜坏死3例.对所有患者行带蒂结膜瓣转位或游离结膜瓣移植术治疗,其中4例行单纯结膜瓣移植,2例联合部分板层角膜移植(LK)术,6例联合羊膜移植(AMT)术,1例联合LK和AMT术.随诊3～24个月,对手术后巩膜坏死和结膜瓣存活等情况进行观察.结果移植的结膜瓣1周内血运差、色苍白,1周后逐渐出现充血表现,2周拆除结膜瓣缝线后充血症状逐渐减轻.13例患者结膜瓣均愈合良好,巩膜坏死控制.至最后一次随访,2例角膜透明,3例角膜植片透明,l例角膜斑翳,7例角膜血管化.结论结膜瓣移植(或联合LK和AMT)治疗眼部烧伤和眼科手术后巩膜坏死在临床上安全有效,能够较好地解决巩膜穿孔的风险,为后续治疗提供一个相对稳定的眼部环境.
목적 개소결막판이식치료안부소상화안과수술후공막결혈배사적수술방법,관찰기림상료효.방법 회고성병례연구.2007년1월지2012년3월,공13례안부소상화안과수술후공막결혈배사、용해적환자재산동성안과의원접수료결막판이식,기중감소상4례,열소상6례,익상노육절제수술후공막배사3례.대소유환자행대체결막판전위혹유리결막판이식술치료,기중4례행단순결막판이식,2례연합부분판층각막이식(LK)술,6례연합양막이식(AMT)술,1례연합LK화AMT술.수진3～24개월,대수술후공막배사화결막판존활등정황진행관찰.결과 이식적결막판1주내혈운차、색창백,1주후축점출현충혈표현,2주탁제결막판봉선후충혈증상축점감경.13례환자결막판균유합량호,공막배사공제.지최후일차수방,2례각막투명,3례각막식편투명,l례각막반예,7례각막혈관화.결론 결막판이식(혹연합LK화AMT)치료안부소상화안과수술후공막배사재림상상안전유효,능구교호지해결공막천공적풍험,위후속치료제공일개상대은정적안부배경.
Objective To evaluate the clinical efficacy of conjunctival flap transplantation for the treatment of scleral necrosis after eye burns or ocular surgeries.Methods It was a retrospective case series study.A total of 13 cases of scleral necrosis, including 10 patients with eye burns and 3 cases with post-pterygium excision,received conjunctival flap transplants in Shandong Eye Hospital from January 2007 to March 2012.Four patients received conjunctival flap transplants only,2 patients had combined lamellar keratoplasty (LK),6 patients received combined amniotic membrane transplants (AMT),and 1 patient had combined LK and AMT.The follow-up period ranged from 3 to 24 months after the surgery and during this time scleral necrosis status, conjunctival flap survival, et al,were monitored. Results The transplanted conjunctival flap appeared pale within 1 week after the surgery, and congestion developed after 1 week with conjunctival flap healing. The congestion gradually disappeared when the suture was removed after 2 weeks.The conjunctival flaps hcaled with the sclera and necrosis was controlled in all patients. At the final follow-up evaluation, corneal transparency was observed in 2 patients,clear graft in 3 patients,corneal macula in 1 patient,and corneal vascularization in 7 patients.Conclusion Conjunctival flap transplantation (or combined LK and/or AMT) is a safe and effective method for the clinical treatment of scleral necrosis.This method can prevent the risk of scleral necrosis and perforation and establishes a stable ocular surface for further treatment.