Long-term outcome of allogeneic cultivated limbal epithelial transplantation for symblepharon caused by severe ocular burns.
Long-term outcome of allogeneic cultivated limbal epithelial transplantation for symblepharon caused by severe ocular burns.
复制标题
同种异体培养式角膜缘上皮移植治疗严重眼部烧伤引起的睑缘联合的远期疗效
DOI：
10.1186/s12886-017-0403-9
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发表时间：
2017-01-31
影响因子：
2
通讯作者：
Zhou Q
中科院分区：
文献类型：
--
作者：
Cheng J;Zhai H;Wang J;Duan H;Zhou Q
目的评价同种异体培养角膜缘上皮移植(CLET)治疗眼烧伤后不同程度上睑粘连的疗效。对80例(80只眼)睑粘连患者行准分子激光原位角膜磨镶术，分析手术成功率、角膜状况及复发的危险因素。结果患者年龄4~60岁，平均(32.4 ± )13.7岁。平均随访时间26.4 ± 13.6个月(12~60个月)。其中化学烧伤36眼，热烧伤44眼。首次手术完全成功40眼(50%)，部分成功25眼(31.3%)，失败15眼(18.8%)。I/II级睑粘连完全成功率为85.0%，III级为51.5%，IV级为22.2%(P= 0.001)。术前炎症反应中重度者占23.1%，轻度或无炎症者占63.0%(P= 0.000)。43只眼(53.8%)角膜状况改善，其中21只眼视力提高。术后睑粘连复发与眼球粘连长度(P= 0.003)、术前炎症活动度(P= 0.016)、术后瘢痕内翻及倒睫(P= 0.038)呈正相关。结论CLET能有效地恢复眼球粘连所致的解剖深穹隆，同时可改善角膜表面状况。手术治疗的成功依赖于炎症的有效控制和眼睑异常的及时处理。
BackgroundThe therapeutic effects of allogeneic cultivated limbal epithelial transplantation (CLET) for symblephara at different degrees caused by ocular burns were evaluated in this study.MethodsA series of interventional cases were involved in this retrospective study. Eighty eyes (80 patients) with symblephara underwent CLET and the success rates of surgical treatment as well as corneal conditions and risk factors for recurrent symblepharon were analyzed.ResultsThe average age of patients was 32.4 ± 13.7 years (ranged from 4 to 60 years). The average follow-up time was 26.4 ± 13.6 months (ranged from 12 to 60 months). Symblepharon cases were caused by chemical burns (36 eyes) or thermal burns (44 eyes). The first surgical intervention achieved complete success in 40 eyes (50%), partial success in 25 eyes (31.3%), and failure in 15 eyes (18.8%). The rate of complete success was 85.0% in eyes with grade I/II symblephara, 51.5% in eyes with grade III eyes and 22.2% in eyes grade IV symblephara (P= 0.001). The treatment was completely successful in 23.1% of eyes with moderate or severe preoperative inflammatory action and 63.0% of eyes with mild or no inflammation (P= 0.000). The corneal conditions were improved in 43 eyes (53.8%), of which 21 eyes had improved visual acuity. The recurrence of symblepharon after the first CLET was positively correlated with symblepharon length (P= 0.003), preoperative inflammatory activity (P= 0.016) as well as postoperative cicatricial entropion and trichiasis (P= 0.038).ConclusionsCLET was effective on the recovery of anatomically deep fornixes in eyes caused by symblephara and corneal surface condition could be improved simultaneously. The success of surgical treatment was dependent on the effective control of inflammation and timely management of eyelid abnormalities.