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网络首发:2017-09-16,
纸质出版:2017
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罗益文, 万尚韬. 他克莫司滴眼液治疗眼碱烧伤[J]. 中山大学学报(医学科学版), 2017,38(5).
Tacrolimus Eye Drops in Treatment of Ocular Alkali Burns[J]. Journal of Sun Yat-sen University (Medical Sciences), 2017, 38(5).
【目的】观察质量浓度1 g/L他克莫司滴眼液点眼治疗眼碱烧伤的临床效果。【方法】采用自身前-后对照研究 方法,对2016 年5月23日至 2017 年1月18日就诊于中山大学中山眼科中心用质量浓度1g/L他克莫司滴眼液治疗的眼碱烧 伤12例患者的疗效进行评估。本组患者治疗疗程为1~18周,平均(8.91 ± 5.56)周。按Roper-Hall 眼烧伤分类法评价患者 眼碱烧伤程度。Ⅱ级烧伤2例,Ⅲ级烧伤5例,Ⅳ级烧伤5例。接诊后用质量浓度1g/L他克莫司滴眼液点眼,2次/d。分别于 治疗前、治疗后1周、2周、3周、4周、6周和8周进行裂隙灯显微镜和角膜荧光素钠染色检查,并拍照记录,动态观察角膜上 皮修复及眼前段病变情况,采用Adobe Photoshop CS6图片处理软件计算角膜上皮修复面积。根据角膜上皮修复情况、视力、 有无并发症判断治疗效果,采用SPSS 19.0软件进行统计分析。【结果】本组患者预后良好,角膜上皮愈合,视力大于0.3有 4例,其中Ⅱ级烧伤2例、Ⅲ级烧伤2例;预后欠佳者5例,其中Ⅲ级烧伤3例、Ⅳ级烧伤2例,2例角膜上皮愈合,3例角膜上 皮修复率大于50%,角膜新生血管形成或角膜结膜化,视力<0.3;预后不良3例,均为Ⅳ级烧伤,1例角膜穿孔,1例角膜溃疡 长期不愈,1例继发青光眼。12例病例中,角膜上皮愈合率达到99%的占50%,愈合率>50%的占75%;治疗后视力提高三 行以上者占33.3%;66.6%病例发生并发症。影响预后的因素主要有:角膜及角膜缘烧伤严重程度、并发症发生和角膜上皮 修复率。【结论】质量浓度1g/L他克莫司滴眼液可减轻眼碱烧伤的炎症反应,降低青光眼的发生率,促进角膜溃疡愈合和角 膜上皮修复,减少因角膜缘烧伤所导致的并发症的发生。
【Objective】To evaluate the efficacy of topical use of 1 g/L tacrolimus eye drops in the treatment of ocular alkali burns.【Methods】A prospective study was performed to evaluate the efficacy of 1 g/L tacrolimus eye drops in the treatment of 12 patients with ocular alkali burns admittedin Zhongshan Ophthalmic Center of Sun Yat-sen University between May 23,2016 and Jan? uary 18,2017. The patients were treated for 1 ~ 18 weeks,with an average of 8.91 ± 5.56 weeks.The degree of ocular alkali burns was evaluated according to Roper-Hall classification system. In this group of patients,there were 2 cases of grade Ⅱ burns,5 cases of grade Ⅲ burns and 5 cases of grade Ⅳ burns. Each patient was given 1 g/L tacrolimus eye drops 2 times a day after admission. The slit lamp microscope and corneal fluorescein sodium staining examination were performed before and 1th week,2nd week,3rd week, 4th week,6th week,8th week respectively after performing topical tacrolimus treatment. Photos were taken to keep records to dynami? cally observe the epithelial repair and anterior segment lesions. Adobe Photoshop CS6 image processing software was used to calculate the area of corneal epithelium repair. The therapeutic effect was evaluated according to the corneal epithelial repair,visual acuity and complications. The statistical analysis was carried out by SPSS 19.0 software.【Results】4 cases reached good prognosis,including 2 cases of gradeⅡ and 2 cases of gradeⅢ burns,the corneal epithelium healed and the visual acuity was greater than 0.3. 5 cases had guarded prognosis,including 3 cases of gradeⅢ and 2 cases of gradeⅣ burns,corneal epithelium healed in 2 cases,corneal epi?thelial repair rate was greater than 50% in 3 cases,in which corneal neovascularization or corneal conjunctiva occurred,and the visu? al acuity was less than 0.3. 3 cases of gradeⅣ burns had poor prognosis:1 had corneal perforation,1 had long term corneal ulcer, and 1 had secondary glaucoma. In 12 cases,the corneal epithelial healing rate reached 99% in 50% patients,and the healing rate was greater than 50% in 75% patients. The visual acuity of 33.3% patients increased by more than three lines,and 66.6% cases had complications. The main factors affecting the prognosis are:The degree of corneal and corneal limbal burns,complication and corneal epithelial repair rate.【Conclusion】1 g/L tacrolimus eye drops can reduce the inflammatory reaction of ocular alkali burns,reduce the incidence of glaucoma,promote corneal ulcer healing and corneal epithelial repair,and reduce complications caused by corneal lim? bal burns.
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