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單側眼化學性灼傷結膜移植術來治療之兩例經驗報告
Unilateral Chemical Injury Treated by Conjunctival Autograft Transplantation-2 Cases Report
摘要
以自體結膜移植術來治療單眼化學性或熱灼傷最早為Thoft所提出，不但可癒合片眼部缺損，終止繼續（疒貴）瘍下去外，對視力外觀均有助益，Herman持360度環狀自體結膜移植術亦有不錯之效果。本人乃報告兩例單側化學性眼灼傷之病人，第一例化學性眼灼傷，造成輪部缺血壞死，角膜白斑，無菌性（疒貴）瘍，併發性青光眼及虹彩炎，由於缺損無法癒合，最後有角膜小破孔發生，乃行Thoft結膜移植術，術後得以使外眼部缺損癒合，角膜（疒貴）瘍終止，唯因角膜具深部及表屬血管，角膜白斑，併發性青光眼致視力最後失明。第二例單側化學性眼灼傷致全角膜上皮缺損，輪部缺血，角膜些微白斑及水腫，治療後上皮缺損癒合，唯癒合後表屬結膜血管進入，視力僅於100公分處辨指數，是以行修改過的Herman方法，只取180度的健康眼結膜移植至患眼，術後上皮癒合良好，只少許血管入侵至週邊角膜上，視力可矯正至零點陸，唯此法上皮再生是否為輪部的基細胞所來則須再更久時間追踪。
關鍵字
無資料並列摘要
2 cases of unilateral chemical injury treated by conjunctival autogratt transplantation were reported. Case 1 resulted in limbal ischemia, leucoma cornea, sterile ulcer, secondary glaucoma and iritis. Microperforation ocurred despite of aggressive medical treatment. In order to enhance ocular surface healing and stop stromal melting, conjunctival transplantation according to Thoft's method was performed. Surface healing was achieved in 10 days after operation. This patient lost his vision because of secondary glaucoma, leucoma cornea and dense vascularization. Case 2 resulted in limbal ischemia, total epithelial defect and mild corneal opacity. 360 degrees of conjunctival vessel invasion was noted after oculer suface healing. No regression of vascularization for following up to 6 months, modified Herman's method was performed. Instead of 360 degrees of ring graft, 180 degrees of perilimbal conjunctiva was removed from healthy eye to transplant into affectedeye. Re-epithelialization was completed in 1 week after operation. There was only a few vessel invasion over upper peripheral cornea after following up to 12 months. Visual acuity was 20/30. By Thoft's methed, conjunctival epithelium underwent conjunctival transdifferentiation to cornea-like epithelium only when superficial vascularization subsided. Whether the effect of modified Herman's method is comparable to limbal transplantation? It needs more cases and detailed cytologic studies.
延伸閱讀
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