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目的探讨结膜囊狭窄患者义眼座植入同期利用羊膜移植重建结膜囊的临床效果。方法对23例结膜囊狭窄患者行义眼座植入同时行结膜囊重建术。术中下穹隆采用埋线法固定在眶下壁骨膜,保存羊膜移植于结膜缺损区,上下睑缘褥式缝合。每周打开眼睑并用荧光素试纸染色,观察结膜上皮生长情况。术后2个月拆除上下眼睑缝线,定制合适的义眼。结果术后第4周20只术眼羊膜表面全部被结膜上皮覆盖,其余3只术眼发生羊膜融解,结膜上皮未愈。术后2个月4只Ⅰ度结膜囊狭窄患眼全部治愈;10只Ⅱ度结膜囊狭窄患眼中8只治愈,2只好转;9只Ⅲ度结膜囊狭窄患眼中3只术眼痊愈、3只术眼好转,余3只术眼无效,其中1只术眼半年后重新行结膜囊成形术。完成治疗的21例患者无义眼座暴露、感染及睑球粘连等并发症,对术后眼座的活动度和外观比较满意。结论对于Ⅰ和Ⅱ度的结膜囊狭窄采用保存羊膜移植同期行眼座植入术是安全可行的。对于Ⅲ度结膜囊狭窄采用保存羊膜移植疗效欠佳。(中华眼科杂志,2005,41:1005-1008)
Objective To investigate the clinical effect of implantation of amniotic membrane transplantation for conjunctival sac in patients with conjunctival stenosis. Methods Twenty - three patients with conjunctival stenosis underwent ocular balloon reconstruction simultaneously with ocular prosthesis implantation. Intraoperative lower dome was fixed by embedding method in the periosteum of the infraorbital wall, the preservation of amniotic membrane transplantation in the conjunctival defect area, upper and lower eyelid mattress suture. Open the eyelids weekly and stain with fluorescein test strips to observe the conjunctival epithelial growth. Remove the upper and lower eyelid suture 2 months after surgery, customize the appropriate sense of the eye. Results All four eyes were covered with conjunctival epithelium in the fourth week after operation, and amniotic membrane was dissolved in the other three eyes, conjunctival epithelium did not heal. Three patients with grade Ⅰ conjunctival stenosis were cured at 2 months after surgery. Eight patients with grade Ⅱ conjunctival stenosis were cured and 2 patients improved. Three patients with grade Ⅲ conjunctival stenosis were cured in 3 eyes. 3 Only the eye surgery improved, more than 3 eyes ineffective, of which one eye after six months to re-conjunctival sacoplasty. The complete treatment of 21 patients with non-nocturnal exposure, infection and symblepharon and other complications, postoperative ocular motility and appearance more satisfied. Conclusions It is safe and feasible to use the preserved amniotic membrane transplantation in the same period for ophthalmic stenosis of Ⅰ and Ⅱ degree conjunctival stenosis. Third-degree conjunctival stenosis preservation of amniotic membrane transplantation with poor efficacy. (Chinese Journal of Ophthalmology, 2005,41: 1005-1008)