Shan Fengmei, Feng Xueying, Li Jie, Yang Sha, Wang Fuhua, Shi Weiyun, Zhao Long, Zhou Qingjun
Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Jinan 250012, China.
Shandong Provincial Key Laboratory of Ophthalmology, State Key Laboratory Cultivation Base, Eye Institute of Shandong First Medical University, Qingdao 266071, China.
J Funct Biomater. 2023 Jun 8;14(6):318. doi: 10.3390/jfb14060318.
This prospective study aimed to evaluate the effectiveness of decellularized porcine conjunctiva (DPC) in the management of severe symblepharon. Sixteen patients with severe symblepharon were enrolled in this study. After symblepharon lysis and Mitomycin C (MMC) application, tarsus defects were covered with residual autologous conjunctiva (AC), autologous oral mucosa (AOM), or DPC throughout the fornix, and DPC was used for all the exposed sclera. The outcomes were classified as complete success, partial success, or failure. Six symblepharon patients had chemical burns and ten had thermal burns. Tarsus defects were covered with DPC, AC, and AOM in two, three, and eleven cases, respectively. After an average follow-up of 20.0 ± 6 months, the anatomical outcomes observed were complete successes in twelve (three with AC+DPC, four with AC+AOM+DPC, and five with AOM+DPC) (75%) cases, partial successes in three (one with AOM+DPC and two with DPC+DPC) (18.75%) cases, and failure in one (with AOM+DPC) (6.25%) case. Before surgery, the depth of the narrowest part of the conjunctival sac was 0.59 ± 0.76 mm (range, 0-2 mm), tear fluid quantity (Schirmer II tests) was 12.5 ± 2.26 mm (range, 10-16 mm), and the distance of the eye rotation toward the opposite direction of the symblepharon was 3.75 ± 1.39 mm (range, 2-7 mm). The fornix depths increased to 7.53 ± 1.64 mm (range, 3-9 mm), eye movement was significantly improved, and the distance of eye movement reaching 6.56 ± 1.24 mm (range, 4-8 mm) 1 month after the operation; the postoperative Schirmer II test (12.06 ± 2.90 mm, range, 6-17 mm) was similar to that before surgery. Goblet cells were finally found in fifteen patients by conjunctival impression cytology in the transplantation area of DPC, except for one patient who failed. DPC could be considered an alternative for ocular surface reconstruction of severe symblepharon. Covering tarsal defects with autologous mucosa is necessary for extensive reconstruction of the ocular surface.
这项前瞻性研究旨在评估脱细胞猪结膜（DPC）在治疗严重睑球粘连中的有效性。16例严重睑球粘连患者纳入本研究。睑球粘连松解并应用丝裂霉素C（MMC）后，用残余自体结膜（AC）、自体口腔黏膜（AOM）或DPC覆盖整个穹窿部的睑板缺损，所有暴露的巩膜均使用DPC。结果分为完全成功、部分成功或失败。6例睑球粘连患者为化学伤，10例为热烧伤。睑板缺损分别用DPC、AC和AOM覆盖2例、3例和11例。平均随访20.0±6个月后，观察到的解剖学结果为12例（3例采用AC+DPC，4例采用AC+AOM+DPC，5例采用AOM+DPC）（75%）完全成功，3例（1例采用AOM+DPC，2例采用DPC+DPC）（18.75%）部分成功，1例（采用AOM+DPC）（6.25%）失败。术前，结膜囊最窄处深度为0.59±0.76mm（范围0-2mm），泪液量（Schirmer II试验）为12.5±2.26mm（范围10-16mm），眼球向睑球粘连相反方向转动的距离为3.75±1.39mm（范围2-7mm）。术后1个月，穹窿深度增加至7.53±1.64mm（范围3-9mm），眼球运动明显改善，眼球运动距离达到6.56±1.24mm（范围4-8mm）；术后Schirmer II试验（12.06±2.90mm，范围6-17mm）与术前相似。除1例失败患者外，15例患者通过DPC移植区结膜印片细胞学检查最终发现杯状细胞。DPC可被视为严重睑球粘连眼表重建的一种替代方法。用自体黏膜覆盖睑板缺损对于眼表的广泛重建是必要的。
