| Objective: To evaluate the clinical curative effect of amniotic membrane grafting for ocular chemical burn and thermal burn.Methods: document:We collected 24 patients(28 eyes) with ocular chemical and thermal burn,including 9 alkali burn patients(10 eyes), 6 acid burn patients(8 eyes), 9 thermal burn patients(8 eyes). 21 cases were males and 3 cases females. The age was from 4 years old to 65 years old and the average was 34.2years old. according to interna-tional allpurpose Roper-Hall[3]standard :13 cases (15eyes)was III degree adustum,11 cases (13eyes)was IV degree adustum .method s:They had been treated for amniotic membrane grafting in our hospital from February 2000 to October 2008. The follow-up ranged from 6-24 months. months.The postoperative visual acuity, the condition of amniotic membrane transplant and ophthalmo- surface renovation were documented.Result: Postoperative corrected visual acuity : 2eyes were light perception; 3eyes were from hand movement to exponent; 10 eyes were 0.01-0.05; 7 eyes were 0.05-0.1; 4 eyes were 0.1-0.3; 2 eyes were more than 0.3. The visual acuity was improved to various extent in 22 eyes(78.6%)and was not altered in 6 eyes(21.4%)after amniotic membrane grafting . No visual acuity appearances degression. Status of amniotic membrane implant: amniotic membrane fell off in 3 cases. amniotic membrane took in 24 eyes . inflammation, solution and absorption were not observated. Ambitus annealed and well healed.amniotic membrane was gray and slight dropsy in Postoperative 4 to 5 days. amniotic membrane became transparent gradually and had normal thickness.3 eyes appeared amniotic membrane partial defluxion on Postoperative 5 to 7 days. Patients undergone amniotic membrane grafting again. amniotic membrane survived and eye surface was stable. 1case failed that amniotic membrane fell off on Postoperative 5 days before inflammation was controlled . cornea dissolved and became thin. raw surface of cornea healed after lamellar keratoplasty. Conditions of cornea : 6 eyes recovered to transparent; caligo corneae emerged in 12 eyes eventually; corneal macula emerged in 3 eyes. diverse extent new vessels of cornea emerged one after another in 4 eyes after operation, which spreaded toward to pupil area. Time of corneal epithelium healing :corneal epithelium of 28eyes recovered entirely,22 eyes of which recovered within 3 weeks. Complication and management: 1. infection: infection emerge on 1case of serious alkali burn on Postoperative 5days. Infection controlled by anti-infective drug treatment. corneal macula formed ultimatly and was cured by lamellar keratoplasty. 2. haematocele between layers: haematocele emerged between cornea and amniotic membrane in 1 eye on Postoperative 1day. Haematocele diminished and disappeared gradually in one week by pressurized bandaging and anastaltic treatment.Complications of rejection, implant necrosis and corneal perforation were not observated.Conclusion: (1) amniotic membrane possess organismal character- istics as follows : antiinflammatory and inhibiting the growth of new vessels;low antigenicity; excreting many kinds of cell growth factors; favourable ability of anti-sticking; inhibiting fibrosis; diminishing cicatrization. (2)operation skill①Cleaning necrotic conjunctiva and cornea tissue carefully,which can decrease bacterium multiplication and inflammatory cell infiltrating. Partial severe inflammatory reaction and immune reaction diminished. Complications of corneal perforation was also avoided.②thorough haemostasis: haematocele under amniotic membrane which may lead to implants late healed, dissolved , necrosis was prevented.③amniotic membrane grafting is modus operandi that healing eye surface adustum.④amniotic membrane implant sticked to eye surface sufficiently, which avoided haematocele, fluidify and guaranteed amniotic membrane alive and producing a marked effect. Pressing planting bed gently with cotton bud after operation, so that fluidify between amniotic membrane and cornea could be discarded. Postoperative eyes were wrapped with pressurize , which was benefit for amniotic membrane sticking.⑤fixing and sewing up tightly.⑥paying attention to medication after operation.⑦estimating injury condition correctly.⑧spongy layer and fibroblast layer should be scraped carefully when dealed with fresh amniotic membrane.⑨serious eyes adustum were companyed by eyelid coloboma , dacryma discarding blocking and eye lash growing in disorder.All of the factors mentioned obove could destroy lacrimal film or damage amniotic membrane directly. Eyelids should be repaired as far as possible during or after operation and applying artificial tears frequently. (3). opportunity of operation:①amniotic memb- rane grafting should be done as soon as possible on alkali burn and adustum that were serious thanⅢdegree. The earlyer amniotic membrane grafting opration was done the better therapeutic efficacy was. Complications were prevented and diminished conspicuously when operation was done within one week.②opportunity of amniotic membrane grafting operation for the second time: amniotic membrane grafting operation should be done promptly for another time when amniotic membrane was shedding or dissolving, because conjunctiva and cornea was repaired slowly. We believe that amniotic membrane grafting should be done repeated when the follpwing condition : defect area of epithelium was more than 2mm;the extent of limbus corneae metabolic effect was more than 1/4 quadrant; eye surface has serious congestion; epithelium was unrecovered; amniotic membrane shedding and autolysis fairly early; cornea was bedewing and clouding.③. opportunity of amniotic membrane grafting operation for acute stage adustum eye surface re-establishment: we believe that amniotic membrane grafting operation for acute stage adustum eye surface re-establishment should be carried out after medical treatment was carried out for some time which had better more than 2 to 3 weeks. Meanwhile , operator decided practicing amniotic membrane grafting or combining limbus corneae transplant operation according to destroyed condition of limbus corneae.④it is hazardous to do segregating atretoblepharia combining amniotic membrane grafting operation on atretoblepharia that caused by pristine adustum , which increase the possibility of corneal perforation. 4. amniotic membrane grafting is modus operandi that healing eye surface adustum:irritations ,such as soreness ,phengophobia,lachrymation and spasm of eyelid were soothed notably on Postoperative 4 to 5 days.the patients could open the eyes on Postoperative 7 days. The visual acuity was improved to various extent in 22 eyes(78.6%)and eye surface was stable . complications of corneal perforation and implant exclusion were not observated. amniotic membrane grafting is the modus operandi to deal with the complications of eyeburn damage,such as corneal epithelium defect, conjunctiva and atretoblepharia.5. prognosis of operation: prognosis of alkali burn was worse than that of thermal burn; prognosis of operation during convalescence stage was worse than that of operation during acute stage ; eyeburn damage of IV degree had the worst prognosis. |
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