Shimazaki Jun, Shimmura Shigeto, Tsubota Kazuo
Department of Ophthalmology, Tokyo Dental College, Chiba, Japan.
Ophthalmology. 2004 Jan;111(1):38-44. doi: 10.1016/j.ophtha.2003.02.003.
To study the association between surgical approach and postoperative results in chemical and thermal burns of the cornea.
Retrospective, interventional, noncomparable case series.
Thirty-two eyes of 32 patients with chemical (n = 27) or thermal (n = 5) burns of the cornea that were associated with total limbal dysfunction. Eight eyes had a history of previous keratoplasty.
Patients were treated by amniotic membrane transplantation combined with either conjunctivolimbal autograft transplantation (autograft group, n = 11) or keratolimbal allograft transplantation (allograft group, n = 21). Fifteen eyes had simultaneous penetrating keratoplasty (simultaneous group), and 6 had keratoplasty several months after ocular surface reconstruction (2-step group).
Reconstruction of the corneal surface by corneal epithelium, clarity of the cornea, and incidence of postoperative complications. The outcome was compared between the autograft and allograft groups and also between the simultaneous and 2-step groups.
At final examination, 17 eyes (53.1%) showed stable corneal epithelialization. Preoperative conditions were similar in the autograft and allograft groups and also in the simultaneous and 2-step groups. The autograft group showed significantly better results than the allograft group in both corneal epithelialization (Kaplan-Meier analysis, P = 0.003) and clear cornea (P = 0.010). Although the incidences of corneal epithelialization and clear corneas did not significantly differ between the simultaneous and 2-step groups, the former had a higher rate of endothelial rejection in the central graft (P = 0.019).
In chemical or thermal burns of the cornea with monocular involvement, autografting should be considered as a first choice of surgery. Even in eyes with opaque corneal stroma, it may be safer to perform ocular surface reconstruction first, followed by keratoplasty as a secondary procedure.
研究角膜化学伤和热烧伤的手术方式与术后结果之间的关联。
回顾性、干预性、非可比性病例系列。
32例角膜化学伤（n = 27）或热烧伤（n = 5）且伴有全角膜缘功能障碍的患者的32只眼。8只眼有过角膜移植手术史。
患者接受羊膜移植联合结膜角膜缘自体移植（自体移植组，n = 11）或角膜缘同种异体移植（同种异体移植组，n = 21）治疗。15只眼同期行穿透性角膜移植术（同期组），6只眼在眼表重建数月后行角膜移植术（两步组）。
角膜上皮重建角膜表面情况、角膜透明度及术后并发症发生率。比较自体移植组与同种异体移植组以及同期组与两步组的结果。
末次检查时，17只眼（53.1%）角膜上皮化稳定。自体移植组与同种异体移植组以及同期组与两步组术前情况相似。自体移植组在角膜上皮化（Kaplan-Meier分析，P = 0.003）和角膜透明（P = 0.010）方面均显著优于同种异体移植组。虽然同期组与两步组角膜上皮化和角膜透明的发生率无显著差异，但前者中央植片内皮排斥率更高（P = 0.019）。
在单眼受累的角膜化学伤或热烧伤中，自体移植应作为首选手术方式。即使在角膜基质混浊的眼中，先进行眼表重建，随后二期行角膜移植术可能更安全。
