口唇粘膜移植治疗SJS/TEN睑球粘连和睑缘角化的临床疗效
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摘要
目的评价口唇黏膜移植重建眼表和睑缘治疗Stevens-Johnson综合征/中毒性表皮坏死松解症引起的睑球粘连、睑缘角化和眼表瘢痕的疗效。方法回顾性分析Stevens-Johnson综合征/中毒性表皮坏死松解症存在晚期眼部并发症11例(12只眼)患者,应用口唇黏膜移植进行眼表重建和睑缘重建矫正睑球粘连、睑缘角化和眼表瘢痕。手术方案采取切除眼表及睑缘的角化瘢痕组织,彻底松解睑球粘连,应用羊膜移植覆盖角膜和球结膜的缺损,取自体口唇黏膜移植替代缺损的穹隆结膜、睑结膜和睑缘。对比手术前后视力、症状、角膜病变、睑球粘连和睑缘病变的改善情况。结果术后平均随访(41±16. 6)个月,全部12只眼对比术前视力稳定或有提高,异物感、烧灼感和干涩症状得到了明显的改善;术前12只眼都存在着睑缘角化瘢痕、倒睫或乱睫,7只眼引起角膜上皮病变,口唇黏膜移植眼表重建后上皮愈合,1只眼残留少许倒睫但不对角膜产生摩擦;术前9只眼存在着睑球粘连,术后8只眼睑球粘连完全改善,1只眼部分粘连复发。结论口唇黏膜移植进行眼表重建治疗Stevens-Johnson综合征/中毒性表皮坏死松解症的晚期并发症,不仅可以矫正睑球粘连,同时可以矫正睑缘角化瘢痕和倒睫,改善眼表环境,稳定视功能。
Objective To evaluate the clinical efficacy of ocular surface and eyelid reconstruction based on oral mucosa graft on Stevens-Johnson syndrome( SJS)/toxic epidermal necrolysis( TEN) related symblepharon,eyelid keratosis and ocular surface scarring. Methods We retrospectively analyzed 12 eyes of 11 patients with SJS/TEN related severe complications who underwent surgical intervention in our department. After removing the scar tissue and releasing the symblepharon from the ocular surface,amniotic membrane was used to cover the cornea and bulbar conjunctiva,and the oral mucosal graft was used to reconstruct the lid margin,palpebral conjunctiva and fornix conjunctiva. The pre-and post-operative visual acuity,symptoms,keratopathy,symblepharon and lid margin lesions were compared. Results The mean duration of follow up was 41 ± 16. 6 months. In all 12 eyes,visual acuity stabilized or improved following oral mucosa graft. The symptoms of foreign body sensation,burning and dryness were also significantly improved. Eyelid margin keratosis,trichiasis or districhiasis existed in all 12 eyes before the surgery,and 7 eyes had corneal epithelial lesions,which healed after ocular surface reconstruction by oral mucosa graft. One eye still had some trichiasis after the surgery,but would not cause corneal abrasion. Severe symblepharon existed in 9 eyes before the surgery,with 8 eyes significantly improved after the surgery,and 1 eye had recurrence of partial adhesion. Conclusions Oral mucosa graft for ocular surface reconstruction could effectively treat late complications of SJS/TEN,which can not only correct the symblepharon,but also correct the lid margin keratosis and trichiasis,improve the ocular surface and protect visual acuity.
Objective To evaluate the clinical efficacy of ocular surface and eyelid reconstruction based on oral mucosa graft on Stevens-Johnson syndrome( SJS)/toxic epidermal necrolysis( TEN) related symblepharon,eyelid keratosis and ocular surface scarring. Methods We retrospectively analyzed 12 eyes of 11 patients with SJS/TEN related severe complications who underwent surgical intervention in our department. After removing the scar tissue and releasing the symblepharon from the ocular surface,amniotic membrane was used to cover the cornea and bulbar conjunctiva,and the oral mucosal graft was used to reconstruct the lid margin,palpebral conjunctiva and fornix conjunctiva. The pre-and post-operative visual acuity,symptoms,keratopathy,symblepharon and lid margin lesions were compared. Results The mean duration of follow up was 41 ± 16. 6 months. In all 12 eyes,visual acuity stabilized or improved following oral mucosa graft. The symptoms of foreign body sensation,burning and dryness were also significantly improved. Eyelid margin keratosis,trichiasis or districhiasis existed in all 12 eyes before the surgery,and 7 eyes had corneal epithelial lesions,which healed after ocular surface reconstruction by oral mucosa graft. One eye still had some trichiasis after the surgery,but would not cause corneal abrasion. Severe symblepharon existed in 9 eyes before the surgery,with 8 eyes significantly improved after the surgery,and 1 eye had recurrence of partial adhesion. Conclusions Oral mucosa graft for ocular surface reconstruction could effectively treat late complications of SJS/TEN,which can not only correct the symblepharon,but also correct the lid margin keratosis and trichiasis,improve the ocular surface and protect visual acuity.
引文
[1] Bastuji-Garin S,Rzany B,Stern RS,et al. Clinical classification of cases of toxic epidermal necrolysis,Stevens-Johnson syndrome,and erythema multiforme[J]. Arch Dermatol,1993,129(1):92-96.
[2] Sotozono C,Ang LP,Koizumi N,et al. New grading system for the evaluation of chronic ocular manifestations in patients with StevensJohnson syndrome[J]. Ophthalmology,2007,114(7):1294-1302.
[3] Pascuale MA D,Espana EM,Liu T S,et al. Correlation of corneal complications with eyelid cicatricial pathologies in patients with stevens-johnson syndrome and toxic epidermal necrolysis Syndrome[J]. Ophthalmology,2005,112(5):904-912.
[4]曾国燕,张远平,赵学英,等.累及眼部的Stevens-Johnson综合征14例[J].实用医学杂志,2016,32(9):1500-1502.
[5] Fu Y,Gregory DG,Sippel KC,et al. The ophthalmologist's role in the management of acute Stevens-Johnson syndrome and toxic epidermal necrolysis[J]. Ocul Surf,2010,8(4):193-203.
[6] Mai C Bertelmann E. Oral Mucosal Grafts:Old Technique in New Light[J]. Ophthalmic Research,2013,50(2):91-98.
[7] Kheirkhah A,Blanco G,Casas V,et al. Surgical strategies for fornix reconstruction based on symblepharon severity[J]. Am J Ophthalmol,2008,146(2):266-275.
[8] Iyer G,Pillai V S,Srinivasan B,et al. Mucous membrane grafting for lid margin keratinization in stevens-johnson syndrome:Results[J]. Cornea,2010,29(2):146-151.
[9] Fu Y,Liu J,Tseng SC. Oral mucosal graft to correct lid margin pathologic features in cicatricial ocular surface diseases. Am J Ophthalmology,2011,152(4):600-608. e601.
[10]何彦,张爱雪,王智群,等. 45例Stevens-Johnson综合征眼部并发症的临床分析[J].眼科,2016,25(6):382-386.
[11] Iyer G,Srinivasan B,Agarwal S,et al. Comprehensive approach to ocular consequences of Stevens Johnson Syndrome-the aftermath of a systemic condition[J]. Graefes Arch Clin Exp Ophthalmol,2014,252(3):457-467.
[12] Iyer G,Srinivasan B,Agarwal S,et al. Treatment modalities and clinical outcomes in ocular sequelae of stevens-johnson syndrome over 25 years-a paradigm shift[J]. Cornea,2016,35(1):46-50.
[2] Sotozono C,Ang LP,Koizumi N,et al. New grading system for the evaluation of chronic ocular manifestations in patients with StevensJohnson syndrome[J]. Ophthalmology,2007,114(7):1294-1302.
[3] Pascuale MA D,Espana EM,Liu T S,et al. Correlation of corneal complications with eyelid cicatricial pathologies in patients with stevens-johnson syndrome and toxic epidermal necrolysis Syndrome[J]. Ophthalmology,2005,112(5):904-912.
[4]曾国燕,张远平,赵学英,等.累及眼部的Stevens-Johnson综合征14例[J].实用医学杂志,2016,32(9):1500-1502.
[5] Fu Y,Gregory DG,Sippel KC,et al. The ophthalmologist's role in the management of acute Stevens-Johnson syndrome and toxic epidermal necrolysis[J]. Ocul Surf,2010,8(4):193-203.
[6] Mai C Bertelmann E. Oral Mucosal Grafts:Old Technique in New Light[J]. Ophthalmic Research,2013,50(2):91-98.
[7] Kheirkhah A,Blanco G,Casas V,et al. Surgical strategies for fornix reconstruction based on symblepharon severity[J]. Am J Ophthalmol,2008,146(2):266-275.
[8] Iyer G,Pillai V S,Srinivasan B,et al. Mucous membrane grafting for lid margin keratinization in stevens-johnson syndrome:Results[J]. Cornea,2010,29(2):146-151.
[9] Fu Y,Liu J,Tseng SC. Oral mucosal graft to correct lid margin pathologic features in cicatricial ocular surface diseases. Am J Ophthalmology,2011,152(4):600-608. e601.
[10]何彦,张爱雪,王智群,等. 45例Stevens-Johnson综合征眼部并发症的临床分析[J].眼科,2016,25(6):382-386.
[11] Iyer G,Srinivasan B,Agarwal S,et al. Comprehensive approach to ocular consequences of Stevens Johnson Syndrome-the aftermath of a systemic condition[J]. Graefes Arch Clin Exp Ophthalmol,2014,252(3):457-467.
[12] Iyer G,Srinivasan B,Agarwal S,et al. Treatment modalities and clinical outcomes in ocular sequelae of stevens-johnson syndrome over 25 years-a paradigm shift[J]. Cornea,2016,35(1):46-50.
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