中国实用眼科杂志
中國實用眼科雜誌
중국실용안과잡지
CHINESE JOURNAL OF PRACTICAL OPHTHALMOLOGY
2012年
8期
908-912
,共5页
高妍%王效武%李春晖%李冰%赵矩伟
高妍%王效武%李春暉%李冰%趙矩偉
고연%왕효무%리춘휘%리빙%조구위
碱烧伤%眼表%生物羊膜%移植%疗效
堿燒傷%眼錶%生物羊膜%移植%療效
감소상%안표%생물양막%이식%료효
Ocular surface%Alkali burns%Biological amnion%Transplantation%Effect
目的 应用共焦激光显微镜观察生物羊膜移植术对早期、中期中度的眼表碱烧伤的临床效果.方法 临床病例自身对照研究.对2008年9月至2010年12月在山西省眼科医院就诊的病人选择45例(62只眼)Roper-Hall分度为Ⅱ度或Ⅲ度的患者,根据眼部受伤时间分组,A组(36只眼)为受伤24 h至2 w,B组(26只眼)为受伤2 w至30 d.对所有眼表碱烧伤患者生物羊膜移植术,术前术后分别行眼表共焦激光显微镜观察,统计各组角膜缘炎性细胞与杯状细胞密度；并进行临床观察及评分,内容包括:视力、裂隙灯检查,角膜荧光染色,睑球粘连分级,角膜新生血管评分.采用配对设计的两样本均数t检验,以P＜0.05为差异有统计学意义.结果 A组碱烧伤患者角膜上皮细胞形态不规则,上皮细胞下可见较多炎性细胞浸润,基底层细胞高亮的核减少；内皮层细胞边界模糊不清,难以分辨细胞形态；偶见结膜杯状细胞.B组碱烧伤患者角膜上皮细胞依旧形态不规则,细胞边界较模糊；表层细胞下炎性细胞减少,可见高亮反光的结模样细胞生长；可见结膜杯状细胞.术后两组患者角膜上皮细胞形态均有改善,炎性细胞减少,结膜杯状细胞增多.术前A、B组角膜上皮细胞下炎性细胞密度每视野分别为(5409.38±302.59)个、(4614.22±386.29)个,术后A、B组角膜上皮细胞下炎性细胞密度每视野分别为(2854.12±307.41)个、(2218.34±198.69)个,两组间术前术后自身比较差异有统计学意义(P＜0.05).术前A、B组杯状细胞密度分别每视野为(5.38±3.12)个、(9.42±6.51)个,术后A、B组杯细胞密度分别每视野为(13.50±4.93)个、(15.63±3.78)个,两组间术前术后比较差异有统计学意义(P＜0.05).角膜荧光染色积分两组间术前后比较差异无统计学意义(P＞0.05),术前术后新生血管评分、术后中度睑球粘连发生率两组间比较差异具有统计学意义(P＜0.05).结论 早期进行生物羊膜移植术是Ⅱ～Ⅲ度早期眼表碱烧伤简单有效的治疗方法,术后恢复好于疾病中期接受手术的患者.共焦激光显微镜是观察碱烧伤患者眼表形态、评价手术效果的有效工具.
目的 應用共焦激光顯微鏡觀察生物羊膜移植術對早期、中期中度的眼錶堿燒傷的臨床效果.方法 臨床病例自身對照研究.對2008年9月至2010年12月在山西省眼科醫院就診的病人選擇45例(62隻眼)Roper-Hall分度為Ⅱ度或Ⅲ度的患者,根據眼部受傷時間分組,A組(36隻眼)為受傷24 h至2 w,B組(26隻眼)為受傷2 w至30 d.對所有眼錶堿燒傷患者生物羊膜移植術,術前術後分彆行眼錶共焦激光顯微鏡觀察,統計各組角膜緣炎性細胞與杯狀細胞密度；併進行臨床觀察及評分,內容包括:視力、裂隙燈檢查,角膜熒光染色,瞼毬粘連分級,角膜新生血管評分.採用配對設計的兩樣本均數t檢驗,以P＜0.05為差異有統計學意義.結果 A組堿燒傷患者角膜上皮細胞形態不規則,上皮細胞下可見較多炎性細胞浸潤,基底層細胞高亮的覈減少；內皮層細胞邊界模糊不清,難以分辨細胞形態；偶見結膜杯狀細胞.B組堿燒傷患者角膜上皮細胞依舊形態不規則,細胞邊界較模糊；錶層細胞下炎性細胞減少,可見高亮反光的結模樣細胞生長；可見結膜杯狀細胞.術後兩組患者角膜上皮細胞形態均有改善,炎性細胞減少,結膜杯狀細胞增多.術前A、B組角膜上皮細胞下炎性細胞密度每視野分彆為(5409.38±302.59)箇、(4614.22±386.29)箇,術後A、B組角膜上皮細胞下炎性細胞密度每視野分彆為(2854.12±307.41)箇、(2218.34±198.69)箇,兩組間術前術後自身比較差異有統計學意義(P＜0.05).術前A、B組杯狀細胞密度分彆每視野為(5.38±3.12)箇、(9.42±6.51)箇,術後A、B組杯細胞密度分彆每視野為(13.50±4.93)箇、(15.63±3.78)箇,兩組間術前術後比較差異有統計學意義(P＜0.05).角膜熒光染色積分兩組間術前後比較差異無統計學意義(P＞0.05),術前術後新生血管評分、術後中度瞼毬粘連髮生率兩組間比較差異具有統計學意義(P＜0.05).結論 早期進行生物羊膜移植術是Ⅱ～Ⅲ度早期眼錶堿燒傷簡單有效的治療方法,術後恢複好于疾病中期接受手術的患者.共焦激光顯微鏡是觀察堿燒傷患者眼錶形態、評價手術效果的有效工具.
목적 응용공초격광현미경관찰생물양막이식술대조기、중기중도적안표감소상적림상효과.방법 림상병례자신대조연구.대2008년9월지2010년12월재산서성안과의원취진적병인선택45례(62지안)Roper-Hall분도위Ⅱ도혹Ⅲ도적환자,근거안부수상시간분조,A조(36지안)위수상24 h지2 w,B조(26지안)위수상2 w지30 d.대소유안표감소상환자생물양막이식술,술전술후분별행안표공초격광현미경관찰,통계각조각막연염성세포여배상세포밀도；병진행림상관찰급평분,내용포괄:시력、렬극등검사,각막형광염색,검구점련분급,각막신생혈관평분.채용배대설계적량양본균수t검험,이P＜0.05위차이유통계학의의.결과 A조감소상환자각막상피세포형태불규칙,상피세포하가견교다염성세포침윤,기저층세포고량적핵감소；내피층세포변계모호불청,난이분변세포형태；우견결막배상세포.B조감소상환자각막상피세포의구형태불규칙,세포변계교모호；표층세포하염성세포감소,가견고량반광적결모양세포생장；가견결막배상세포.술후량조환자각막상피세포형태균유개선,염성세포감소,결막배상세포증다.술전A、B조각막상피세포하염성세포밀도매시야분별위(5409.38±302.59)개、(4614.22±386.29)개,술후A、B조각막상피세포하염성세포밀도매시야분별위(2854.12±307.41)개、(2218.34±198.69)개,량조간술전술후자신비교차이유통계학의의(P＜0.05).술전A、B조배상세포밀도분별매시야위(5.38±3.12)개、(9.42±6.51)개,술후A、B조배세포밀도분별매시야위(13.50±4.93)개、(15.63±3.78)개,량조간술전술후비교차이유통계학의의(P＜0.05).각막형광염색적분량조간술전후비교차이무통계학의의(P＞0.05),술전술후신생혈관평분、술후중도검구점련발생솔량조간비교차이구유통계학의의(P＜0.05).결론 조기진행생물양막이식술시Ⅱ～Ⅲ도조기안표감소상간단유효적치료방법,술후회복호우질병중기접수수술적환자.공초격광현미경시관찰감소상환자안표형태、평개수술효과적유효공구.
Objective To investigate the clinical effect of biological amnion transplantation on moderate ocular surface alkali burns.To evaluate the possibility of biological amnion treatment for ocular alkali bums during early stage. Methods Thirty-two alkali bums patients who classified as Ⅱ ～Ⅲ degree according to Roper-Hall classification were enrolled in this study.They were divided into two groups to the course of disease:group A had 24 eyes (24 hours-2 weeks),group B had 18 eyes (2 weeks-1 month).All patients underwent biological amnion transplantation by the same surgeon.The limbus and bulbar conjunctiva were observed by laser scanning confocal microscope before and after the surgery,and the densities of the inflammatory cells and goblet cells were calculated.All patients were given clinical exam and value the scores of acuity vision,corneal fluorescent staining,degree of symblepharon and corneal neovascularization.Matching t test was used to compare the changes between two groups. Results The corneal epithelia of the patients in group A manifested irregular features.There were numerous small inflammatory cells beneath the superficial epithelia and very few goblet cells.The images of the endothelial layer were unclear,and it was hard to discriminate the morphology of each cell.In group B,it was still hard to discriminate the morphology of the corneal epithelia.The inflammatory cells beneath the superficial epithelia decreased,and there were few goblet cells.The morphology of the corneal epithelia was improved,and the inflammatory cells decreased with the goblet cells increasing in both groups.The densities of inflammatory cells beneath the superficial epithelia were (5409±302) cell/field,(3814±286) cell/field in group A and B respectively before operation,that were (2854±307) cell/field,(2018±198) cell/field in group A and B respectively after operation.The P value was ＜0.05 by matching t test.The densities of goblet cells were (5±2) cell/field,(10±6) cell/field in group A and B respectively before operation,that were (15±4) cell/field,(17±3) cell/field in group A and B respectively after operation.The P value was ＜0.05 by matching t test.There wasn't a significant difference in the scores of corneal fluorescent staining between the two groups; however,there were significant changes in the degree of moderate symblepharon and score of corneal neovascularization. Conclusions Early amniotic membrane transplantation is effective for reconstruction of ocular surface and decreasing the related complications.The laser scanning confocal microscopy is a useful tool to clearly show that the morphology of the ocular surface of moderate alkali burns patients among and evaluated the effect of the operation.
