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目的观察和研究双层人新鲜羊膜移植联合自体结膜移位术治疗各种原因引起的睑球粘连的临床效果。方法睑球粘连患者共42例(45眼),其中Ⅰ级14眼,Ⅱ级13眼,Ⅲ级9眼,Ⅳ级9眼。入院后行粘连部位分离及机化瘢痕组织切除,纤维蛋白生物黏合剂及连续锁边缝合固定双层人新鲜羊膜,并用移位的结膜来补充部分巩膜暴露区,以重新形成正常的结膜囊。术后随访6～7个月,包括观察局部反应、结膜上皮的生长情况、羊膜的黏附情况等。结果 45眼术后无一感染,其中32眼(71.1%)手术成功;10眼(22.2%)手术部分成功;3眼(6.7%)手术失败,结膜囊变浅,瘢痕增生粘连。结论双层新鲜人羊膜黏附式及连续交锁缝合能提供平坦光滑的植床,可促进残存的结膜上皮增殖分化,重建结膜表面。同时缺区周围结膜的分离和移位缩小了巩膜暴露区,更有利于在羊膜溶解之前完成结膜上皮化的过程,故此方法可明显提高睑球粘连的治愈率,且降低术后复发率,效果满意。
Objective To observe and study the clinical effect of double-layer fresh amniotic membrane transplantation combined with autologous conjunctival transposition for the treatment of symblepharon caused by various causes. Methods A total of 42 patients (45 eyes) with symblepharon, including 14 eyes of grade Ⅰ, 13 eyes of grade Ⅱ, 9 eyes of grade Ⅲ and 9 eyes of grade Ⅳ. After admission, the adhesion sites were separated and the machine-made scar tissue was excised. Fibrin bio-adhesive and continuous locking suture fixation double-layer fresh human amniotic membrane, and the displaced conjunctiva to supplement part of the scleral exposure area to re-form the normal conjunctival sac. Postoperative follow-up of 6 to 7 months, including the observation of local reactions, the growth of conjunctival epithelium, amniotic adhesions and so on. Results No ophthalmic infection was found in 45 eyes, of which 32 eyes (71.1%) had successful operation. The operation was successful in 10 eyes (22.2%). The operation failed in 3 eyes (6.7%). Conclusion Double fresh human amniotic membrane adhesion and continuous locking can provide a smooth and flat implant bed, which can promote the proliferation and differentiation of conjunctival epithelial remodeling and reconstruct the conjunctival surface. At the same time, the separation and displacement of the surrounding conjunctiva reduce the scleral exposure area, which is more conducive to the completion of amniotic membrane conjunctival epithelialization process before, so this method can significantly improve the healing rate of symblepharon, and reduce postoperative recurrence rate, the effect satisfaction.