Multidisciplinary Treatment to Restore Vision in Ocular Burns
Multidisciplinary Treatment to Restore Vision in Ocular Burns
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DOI：
10.1093/jbcr/irz201
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发表时间：
2020-07-01
影响因子：
1.4
通讯作者：
Ehrlichman, Richard J.
中科院分区：
文献类型：
--
作者：
Christensen, Joani M.;Shanbhag, Swapna S.;Ehrlichman, Richard J.
眶周烧伤引起眶周软组织收缩和变形，引起眼睑功能障碍，进一步导致角膜瘢痕或穿孔导致视力丧失。我们提出了我们的多学科算法，以恢复患者的视力烧伤相关的双侧角膜失明与光感知。对连续4例需要眼周重建和角膜假体的烧伤患者进行图表回顾。最初的治疗包括眼睑释放和移植物覆盖全球。角膜置换的策略取决于眼睑的位置、功能和泪液产生的充分性。所有患者均为角膜盲，仅有光感和瘢痕性外翻。重建视力预后较好的眼。眼睑重建手术包括全层皮肤移植（FTSG）或裂层皮肤移植（STSG）。两名患者恢复了足够的眼睑功能，并接受了标准的角膜假体植入。2例行粘膜移植后角膜假体。所有患者术后重建眼视力均有改善。眼周烧伤引起的角膜损伤可导致失明。早期介入眼科，采取保护措施，尽早解除外翻是至关重要的。对于严重的烧伤，多学科的治疗方法，在适当的球体保护之后植入角膜假体，可以有效地恢复烧伤相关性角膜失明患者的视力。
Periorbital burns generate contraction and distortion of periorbital soft tissue, causing eyelid malfunction, further contributing to loss of vision from corneal scarring or perforation. We present our multidisciplinary algorithm to restore vision in patients with burn-related bilateral corneal blindness with light perception. Chart review was performed for four consecutive burn patients requiring periocular reconstruction and keratoprosthesis. Initial treatment included globe coverage with eyelid releases and grafts. Strategy of corneal replacement was determined by eyelid position and function and sufficiency of tear production. All patients were corneal blind with light perception only and cicatricial ectropion. The eye with better visual prognosis was reconstructed. Eyelid reconstruction procedures consisted of lid releases with full-thickness skin graft (FTSG) or split-thickness skin graft (STSG). Two patients regained adequate lid function and underwent standard keratoprosthesis placement. Two underwent mucous membrane grafts followed by keratoprosthesis. All patients experienced improved postoperative vision in their reconstructed eye. Corneal injury due to periocular burns can lead to blindness. Early involvement of ophthalmology, protective measures, and early ectropion release arc critical. For severe burns, a multidisciplinary approach, where adequate globe protection is followed by keratoprosthesis placement, can effectively restore vision in patients with burn-related corneal blindness.