Thoft R A
Ophthalmology. 1979 Jun;86(6):1084-92. doi: 10.1016/s0161-6420(79)35433-1.
Rehabilitation of the ocular surface is frequently desired following severe chemical and thermal injury. While keratoplasty, both lamellar and penetrating, has been the usual mode of therapy, chronic healing deficits and graft rejections as a result of heavy vascularization often lead to an unsatisfactory result. In unilateral injury, conjunctival transplantation from the opposite, uninvolved eye offers an alternative therapy which avoids both intraocular surgery and the introduction of immunologically foreign tissue. Seven of ten cases of unilateral chemical or thermal injury showed marked reduction in vascularization and scarring following conjunctival transplantation. The characteristic early vascularization of the peripheral conjunctival grafts showed marked regression one to four months postoperatively. At the same time, the central cornea, whose superficial vessels and scarring were removed by keratectomy, showed reepithelialization and smoothing, without attendant vascularization. Three cases were optical failures partially as a result of deep scarring that could not be adequately excised with keratectomy. Preoperative evaluation must be directed primarily toward evaluation of the corneal thickness and the extent of deep vascularization to select those patients most likely to be improved by conjunctival transplantation.
严重化学和热烧伤后，眼部表面的修复常常是人们所期望的。虽然板层角膜移植和穿透性角膜移植一直是常用的治疗方式，但由于严重血管化导致的慢性愈合缺陷和移植排斥反应常常导致不理想的结果。在单侧损伤中，从对侧未受累眼进行结膜移植提供了一种替代疗法，该疗法既避免了眼内手术，又避免了引入免疫异源组织。十例单侧化学或热烧伤病例中有七例在结膜移植后血管化和瘢痕形成明显减轻。周边结膜移植特有的早期血管化在术后一至四个月明显消退。与此同时，通过角膜切除术去除了浅表血管和瘢痕的中央角膜显示出上皮再生和平滑，且没有伴随血管化。三例患者手术效果不佳，部分原因是存在无法通过角膜切除术充分切除的深层瘢痕。术前评估必须主要针对角膜厚度和深层血管化程度进行评估，以选择那些最有可能通过结膜移植得到改善的患者。
