Joseph A, Dua H S, King A J
Division of Ophthalmology and Visual Sciences, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH, UK.
Br J Ophthalmol. 2001 Sep;85(9):1065-9. doi: 10.1136/bjo.85.9.1065.
To report the failure of amniotic membrane transplantation (AMT) for ocular surface reconstruction in patients with severe acute chemical and thermal burns.
Four eyes of three patients who suffered severe chemical (n=3) and thermal (n=1) burns were studied. The aim of AMT was to prevent symblepharon formation, promote conjunctival regeneration, inhibit corneal melting by promoting epithelialisation, and to protect the ocular surface while associated lid burns were treated. AMT was used to cover the entire ocular surface of all the severely burnt and ischaemic eyes, 2-3 weeks after the injury. Where indicated, AMT was repeated by itself or in combination with other procedures in all patients.
Three of the four eyes developed symblepharon and progressive corneal melt requiring urgent tectonic keratoplasty. All four eyes had persistent epithelial defects. Less than 25% of conjunctival regeneration occurred in three eyes. Two eyes autoeviscerated, one patient underwent lid sparing exenteration for a painful blind eye and one eye became phthysical.
AMT did not help to restore the ocular surface or preserve the integrity of the eye in all our patients with severe acute burns, when used by itself or in combination with other surgical procedures. This reflects the extreme severity of the ocular burns in these patients and, in turn, draws attention to the fact that the current classification system does not adequately reflect such severity. In the current system such burns would be grouped under grade IV injuries to the eye (more than 50% limbal ischaemia). The prognosis of patients with 100% limbal ischaemia is much worse than patients with just over 50% limbal ischaemia. This inadequacy of the classification system probably also explains the difference between outcomes of management of grade IV burns (with AMT) in this series, compared with others.
报告羊膜移植术（AMT）用于严重急性化学性和热性眼烧伤患者眼表重建失败的情况。
对3例严重化学性烧伤（n = 3）和1例热性烧伤患者的4只眼进行研究。AMT的目的是预防睑球粘连形成，促进结膜再生，通过促进上皮化抑制角膜溶解，并在治疗相关眼睑烧伤时保护眼表。在受伤后2 - 3周，AMT用于覆盖所有严重烧伤和缺血眼的整个眼表。在有指征的情况下，所有患者单独或联合其他手术重复进行AMT。
4只眼中有3只发生睑球粘连和进行性角膜溶解，需要紧急进行结构性角膜移植术。所有4只眼均存在持续性上皮缺损。3只眼中结膜再生少于25%。2只眼眼球内容摘除，1例患者因疼痛性盲眼接受了保留眼睑的眶内容剜除术，1只眼眼球痨。
对于我们所有严重急性烧伤患者，单独或联合其他外科手术使用AMT无助于恢复眼表或保持眼球完整性。这反映了这些患者眼烧伤的极端严重性，进而引起人们对当前分类系统未充分反映这种严重性这一事实的关注。在当前系统中，此类烧伤将被归类为眼部IV级损伤（角膜缘缺血超过50%）。角膜缘100%缺血患者的预后比角膜缘缺血略超过50%的患者差得多。该分类系统的这种不足可能也解释了本系列中IV级烧伤（采用AMT）与其他系列治疗结果之间的差异。
