急性重度眼烧伤的临床研究
|
摘要
目的 重度烧伤后眼组织受到广泛的损伤, 虽然积极治疗,预后仍差,是临床上常见的难治性眼病之一。本研究旨在通过回顾性分析,获得急性重度眼烧伤的相关临床资料,了解角膜修复情况、致盲情况、并发症发生情况,以明确急性重度眼烧伤治疗后的眼表恢复情况以及并发症的发生率,为临床选择手术方式、改善疗效以及评价重度眼烧伤的预后情况提供参考依据。
方法 在重庆第三军医大学附属西南医院病案室获得1977年1月1日至2002年12月31日共计26年期间,该院急性重度眼烧伤住院病例135例(155眼),分为酸、碱、热3类。设计并逐份填写病例资料调查表。针对相关临床资料、角膜修复情况、致盲情况、并发症发生情况设计2个Excel统计表格;再根据烧伤类型,逐份将调查表中的信息填入表格。最后将Excel文件格式转换成SPSS格式,采用SPSS10.0计算机统计软件作数据处理。
结果
一、急性重度眼烧伤的临床特点:患者以男性为主(86.7%),女性较少(13.3%);中青年(20-40 岁)居多(80.6%)。在3种烧伤类型中,热烧伤最多(50.0%),酸烧伤最少(15.0%)。III、IV度眼烧伤患眼数在1977-1998年的22年间呈逐步增多趋势;自1999年以来,收治的重度眼烧伤总患眼数呈明显增多趋势,且烧伤程度有加重倾向。成年人首要的致伤原因是工伤(81.8%);未成年人首要致伤原因是意外事故(83.3%);未成年人中碱烧伤为首要致伤类型(61.1%)。在成年女性中,酸、热烧伤各占35.7%,与故意伤害及工伤有关。浓硫酸是首要酸性致伤物(75%);石灰是首要碱性致伤物(48%);铝水是首要热烧伤致伤物(53%)。
二、常见致伤物的致伤危害:在本研究中,在酸、碱、热3种不同烧伤类型作用下所致的急性重度眼烧伤,其III度、IV度的频率分布基本相同。
三、角膜修复情况:III度烧伤中,酸、碱、热3种烧伤类型之间的角膜修复时间存在显著性差别(P=0.043)。在眼酸烧伤中,角膜修复时间≤3周占23.0%,4-7周占38.5%,
8-15周占38.5%;在眼碱烧伤中, 角膜修复时间≤3周占22.6%,4-7周占74.2%,8-15周占3.2%,眼酸烧伤的角膜修复时间显著长于眼碱烧伤(P=0.006);眼碱、热烧伤之间以及眼酸、热烧伤之间角膜修复时间无显著性差别。
IV度烧伤中:酸、碱、热3种烧伤类型的角膜修复率分别为:酸:22.2%、碱:72.7%、热:42.9%,有显著性差异(P=0.018);其中眼碱烧伤的角膜修复率分别显著性高于眼酸烧伤(P=0.017)和眼热烧伤(P=0.028);眼酸、热烧伤之间的角膜修复率无显著性差异。眼碱烧伤的角膜修复率分别显著性高于眼酸烧伤和眼热烧伤的原因分析:眼酸烧伤9眼、眼碱烧伤22眼、眼热烧伤35眼中,眼酸烧伤的睑外翻发生率为44.4%,角膜穿孔发生率为66.7%,显著性高于碱烧伤中睑外翻(4.5%) (P=0.017)和角膜穿孔(9.1%) (P=0.003)的发生率;眼碱烧伤和眼热烧伤各种相关并发症的发生率无显著性差别。在IV度烧伤中,3种烧伤类型之间的角膜修复时间无显著性差别。3种烧伤类型之间的角膜未修复原因分布存在显著性差别(P=0.040);在眼酸烧伤角膜未修复患眼中,14.3%由于发生了角膜溶解溃疡,85.7%由于发生了角膜穿孔,在眼碱烧伤角膜未修复患眼中,83.3%由于发生了角膜溶解溃疡,16.7%由于发生了角膜穿孔,即在IV度眼烧伤角膜未修复眼中,酸烧伤角膜穿孔的发生率显著性高于碱烧伤 (P=0.029);眼碱、热烧伤之间以及眼酸、热烧伤之间角膜未修复原因分布无显著性差别。
III、IV度眼烧伤之间修复情况的比较:III度的角膜修复率为:酸:86.7%;碱:96.9%;热:90.5%;总体:92.1%。IV度的角膜修复率为:酸:22.2%;碱:72.7%;热:42.9%;总体:50.0%,在眼酸烧伤(P=0.003)、眼碱烧伤(P=0.029)、眼热烧伤(P<0.001)及重度眼烧伤总体(P<0.001)中,III度烧伤的角膜修复率均显著性高于IV度烧伤。III度眼烧伤的角膜修复时间显著短于IV度(P<0.001),在III度中,角膜修复时间≤3周占22.0%,4-7周占64.6%,8-15周占13.4%,在IV度中,角膜修复时间≤3周占3.0%,4-7周占9.1%,8-15周占87.9%。
四、致盲情况:155只重度烧伤眼的致盲率为75.5%;其中,78只重度化学烧伤眼的致盲率为66.7%, 77只重度热烧伤眼的致盲率为84.4%。“手术”特指以下眼表重建手术方式: LKP、PKP、眼睑缝合术、AMT、口唇粘膜移植术、结膜瓣遮盖术。手术眼平均随访时长为11.88±20.85月,其中III度为11.49±14.18月、IV度为12.04±23.17月;未手术眼平均随访时长为9.16±17.85月,其中III度为7.09±11.10月、IV度为14.16±27.84月。在以上随访时间条件下,未手术眼中,III度眼烧伤的致盲率(54.7%)显著低于IV度(100%)(P<0.001);在手术眼中,III度眼烧伤的致盲率(71.4%)显著低于IV度(100%)(P=0.011)。
五、并发症:IV度眼烧伤的睑球粘连发生率(59.1%)显著性高于III度(36.0%)(P=0.004); IV度眼烧伤的角膜穿孔发生率(27.3%)显著性高于III度(1.1%)(P<0.001);III度眼烧伤的角膜瘢痕发生率(65.2%)显著性高于IV度(28.8%)(P<0.001)。
睑外翻在酸、碱、热3种眼烧伤类型中的发生率分别为:37.5%、11.1%、9.1%,眼酸烧伤的睑外翻发生率显著性高于眼碱烧伤(P=0.016)和眼热烧伤(P=0.003);眼酸烧伤的角膜穿孔发生率(29.2%)显著性高于眼碱烧伤(3.7%)(P=0.004);角膜瘢痕在酸、碱、热3种眼烧伤类型中的发生率分别为:29.2%、70.4%、4
Purpose Even undergo positive treatments in clinic, acute severe injuries of the eye may produce extensive damages to the ocular surface epithelium and anterior segment, resulting in poor prognosis.Our study is to retrospectively analyse acute severe eye burns of 26 years and illuminate outcomes of corneal repairment, blindness and complications, so as to evaluate the prognosis and help to improve curative effect.
Methods From 1977 to 2002, there were totally 135 cases 155 eyes with acute severe ocular chemical and thermal burns admitted to Southwest Hospital of Third Military Medical University, Chongqing. Divided them into acid, alkali, and thermal groups, firstly filled clinical details into designed questionnaires respectively. Secondly, made 2 Excel sheets according to outcomes of corneal repairment, blindness and complications, then transmitted information in those questionnaires into the sheets. Finally transformed Excel tables into SPSS ones and made statistical process.
Results (1) Clinical characteristics of acute severe eye burns: 86.7%were male patients, 13.3% were females, and the greatest at-risk population were the 20-40 year old patients, accounting for 80.6%. Between acid, alkali, and thermal groups, thermal burns were the most usual causes, accounting for 50.0%, acid burns were the rarest causes, accounting for 15.0%. Grade III and IV injuries had gradually increased before 1999. However from 1999, the number of patients admitted have mounted up much more than the past years and the severity of burns tended to be aggravated. The principal cause of injuries for adults was work wounds (81.8%), and for minors it was contretemps(83.3%). Alkali was the principal type of burns among minors(61.1%). In female patients, acid and thermal burns accounted for 35.7% respectively, caused by purposive hurt as well as work wound. Oil of vitriol was the most primary injurants of acid burns(75%).Lime was the most primary injurants of alkali
burns(48%). Melting aluminium was the most primary injurants of thermal burns(53%).
(2) Harmness of common types of injurants in acute severe eye burns: In our study,
acute severe eye burns caused by acid, alkali, or thermal were almost the same in distributing frequency of Grade III and Grade IV burns.
(3) Corneal repair:In Grade III eye burns, there were significant differences of coreal repair time between acid, alkali, and thermal(P=0.043). In acid burns, the eyes whose corneal repair time≤3 weeks accounted for 23.0%, 4-7 weeks for 38.5%, 8-15 weeks for 38.5%. In alkali burns, ≤3 weeks accounted for 22.6%, 4-7 weeks for 74.2%, 8-15 weeks for 3.2%.That was to say, the corneal repair time of acid burns was significantly longer than alkali(P=0.006). Between not only alkali and thermal burns, but also acid and thermal burns there were no significant differences of corneal repair time.
In Grade IV eye burns, there were significant differences of coreal repair incidence between acid(22.2%), alkali(72.7%), and thermal(42.9%)(P=0.018). The coreal repair incidence of alkali burns was significantly more than acid(P=0.017) and thermal burns(P=0.028).The corneal repair incidence showed no significant differences between acid and thermal burns. The reason why the coreal repair incidence of alkali burns was significantly more than acid and thermal burns was analysed as the following: among the 9 eyes of acid burns, the 22 eyes of alkali burns and the 35 eyes of thermal eyes, incidence of lid ectropion(44.4%) and corneal perforation(66.7%) in acid burns were both significantly more than those of alkali burns(lid ectropion: 4.5%, P=0.017; perforation 9.1%, P=0.003). Between alkali and thermal burns, no significant differences were showed in complications.In Grade IV eye burns, there were no significant differences of coreal repair time between acid, alkali, and thermal burns. There indicated significant differences of causes of coreal unrepair between the 3 groups of burns(P=0.040).In the Grade IV injuried eyes with unrepaired corneas, the incidence of corneal perforation(85.
方法 在重庆第三军医大学附属西南医院病案室获得1977年1月1日至2002年12月31日共计26年期间,该院急性重度眼烧伤住院病例135例(155眼),分为酸、碱、热3类。设计并逐份填写病例资料调查表。针对相关临床资料、角膜修复情况、致盲情况、并发症发生情况设计2个Excel统计表格;再根据烧伤类型,逐份将调查表中的信息填入表格。最后将Excel文件格式转换成SPSS格式,采用SPSS10.0计算机统计软件作数据处理。
结果
一、急性重度眼烧伤的临床特点:患者以男性为主(86.7%),女性较少(13.3%);中青年(20-40 岁)居多(80.6%)。在3种烧伤类型中,热烧伤最多(50.0%),酸烧伤最少(15.0%)。III、IV度眼烧伤患眼数在1977-1998年的22年间呈逐步增多趋势;自1999年以来,收治的重度眼烧伤总患眼数呈明显增多趋势,且烧伤程度有加重倾向。成年人首要的致伤原因是工伤(81.8%);未成年人首要致伤原因是意外事故(83.3%);未成年人中碱烧伤为首要致伤类型(61.1%)。在成年女性中,酸、热烧伤各占35.7%,与故意伤害及工伤有关。浓硫酸是首要酸性致伤物(75%);石灰是首要碱性致伤物(48%);铝水是首要热烧伤致伤物(53%)。
二、常见致伤物的致伤危害:在本研究中,在酸、碱、热3种不同烧伤类型作用下所致的急性重度眼烧伤,其III度、IV度的频率分布基本相同。
三、角膜修复情况:III度烧伤中,酸、碱、热3种烧伤类型之间的角膜修复时间存在显著性差别(P=0.043)。在眼酸烧伤中,角膜修复时间≤3周占23.0%,4-7周占38.5%,
8-15周占38.5%;在眼碱烧伤中, 角膜修复时间≤3周占22.6%,4-7周占74.2%,8-15周占3.2%,眼酸烧伤的角膜修复时间显著长于眼碱烧伤(P=0.006);眼碱、热烧伤之间以及眼酸、热烧伤之间角膜修复时间无显著性差别。
IV度烧伤中:酸、碱、热3种烧伤类型的角膜修复率分别为:酸:22.2%、碱:72.7%、热:42.9%,有显著性差异(P=0.018);其中眼碱烧伤的角膜修复率分别显著性高于眼酸烧伤(P=0.017)和眼热烧伤(P=0.028);眼酸、热烧伤之间的角膜修复率无显著性差异。眼碱烧伤的角膜修复率分别显著性高于眼酸烧伤和眼热烧伤的原因分析:眼酸烧伤9眼、眼碱烧伤22眼、眼热烧伤35眼中,眼酸烧伤的睑外翻发生率为44.4%,角膜穿孔发生率为66.7%,显著性高于碱烧伤中睑外翻(4.5%) (P=0.017)和角膜穿孔(9.1%) (P=0.003)的发生率;眼碱烧伤和眼热烧伤各种相关并发症的发生率无显著性差别。在IV度烧伤中,3种烧伤类型之间的角膜修复时间无显著性差别。3种烧伤类型之间的角膜未修复原因分布存在显著性差别(P=0.040);在眼酸烧伤角膜未修复患眼中,14.3%由于发生了角膜溶解溃疡,85.7%由于发生了角膜穿孔,在眼碱烧伤角膜未修复患眼中,83.3%由于发生了角膜溶解溃疡,16.7%由于发生了角膜穿孔,即在IV度眼烧伤角膜未修复眼中,酸烧伤角膜穿孔的发生率显著性高于碱烧伤 (P=0.029);眼碱、热烧伤之间以及眼酸、热烧伤之间角膜未修复原因分布无显著性差别。
III、IV度眼烧伤之间修复情况的比较:III度的角膜修复率为:酸:86.7%;碱:96.9%;热:90.5%;总体:92.1%。IV度的角膜修复率为:酸:22.2%;碱:72.7%;热:42.9%;总体:50.0%,在眼酸烧伤(P=0.003)、眼碱烧伤(P=0.029)、眼热烧伤(P<0.001)及重度眼烧伤总体(P<0.001)中,III度烧伤的角膜修复率均显著性高于IV度烧伤。III度眼烧伤的角膜修复时间显著短于IV度(P<0.001),在III度中,角膜修复时间≤3周占22.0%,4-7周占64.6%,8-15周占13.4%,在IV度中,角膜修复时间≤3周占3.0%,4-7周占9.1%,8-15周占87.9%。
四、致盲情况:155只重度烧伤眼的致盲率为75.5%;其中,78只重度化学烧伤眼的致盲率为66.7%, 77只重度热烧伤眼的致盲率为84.4%。“手术”特指以下眼表重建手术方式: LKP、PKP、眼睑缝合术、AMT、口唇粘膜移植术、结膜瓣遮盖术。手术眼平均随访时长为11.88±20.85月,其中III度为11.49±14.18月、IV度为12.04±23.17月;未手术眼平均随访时长为9.16±17.85月,其中III度为7.09±11.10月、IV度为14.16±27.84月。在以上随访时间条件下,未手术眼中,III度眼烧伤的致盲率(54.7%)显著低于IV度(100%)(P<0.001);在手术眼中,III度眼烧伤的致盲率(71.4%)显著低于IV度(100%)(P=0.011)。
五、并发症:IV度眼烧伤的睑球粘连发生率(59.1%)显著性高于III度(36.0%)(P=0.004); IV度眼烧伤的角膜穿孔发生率(27.3%)显著性高于III度(1.1%)(P<0.001);III度眼烧伤的角膜瘢痕发生率(65.2%)显著性高于IV度(28.8%)(P<0.001)。
睑外翻在酸、碱、热3种眼烧伤类型中的发生率分别为:37.5%、11.1%、9.1%,眼酸烧伤的睑外翻发生率显著性高于眼碱烧伤(P=0.016)和眼热烧伤(P=0.003);眼酸烧伤的角膜穿孔发生率(29.2%)显著性高于眼碱烧伤(3.7%)(P=0.004);角膜瘢痕在酸、碱、热3种眼烧伤类型中的发生率分别为:29.2%、70.4%、4
Purpose Even undergo positive treatments in clinic, acute severe injuries of the eye may produce extensive damages to the ocular surface epithelium and anterior segment, resulting in poor prognosis.Our study is to retrospectively analyse acute severe eye burns of 26 years and illuminate outcomes of corneal repairment, blindness and complications, so as to evaluate the prognosis and help to improve curative effect.
Methods From 1977 to 2002, there were totally 135 cases 155 eyes with acute severe ocular chemical and thermal burns admitted to Southwest Hospital of Third Military Medical University, Chongqing. Divided them into acid, alkali, and thermal groups, firstly filled clinical details into designed questionnaires respectively. Secondly, made 2 Excel sheets according to outcomes of corneal repairment, blindness and complications, then transmitted information in those questionnaires into the sheets. Finally transformed Excel tables into SPSS ones and made statistical process.
Results (1) Clinical characteristics of acute severe eye burns: 86.7%were male patients, 13.3% were females, and the greatest at-risk population were the 20-40 year old patients, accounting for 80.6%. Between acid, alkali, and thermal groups, thermal burns were the most usual causes, accounting for 50.0%, acid burns were the rarest causes, accounting for 15.0%. Grade III and IV injuries had gradually increased before 1999. However from 1999, the number of patients admitted have mounted up much more than the past years and the severity of burns tended to be aggravated. The principal cause of injuries for adults was work wounds (81.8%), and for minors it was contretemps(83.3%). Alkali was the principal type of burns among minors(61.1%). In female patients, acid and thermal burns accounted for 35.7% respectively, caused by purposive hurt as well as work wound. Oil of vitriol was the most primary injurants of acid burns(75%).Lime was the most primary injurants of alkali
burns(48%). Melting aluminium was the most primary injurants of thermal burns(53%).
(2) Harmness of common types of injurants in acute severe eye burns: In our study,
acute severe eye burns caused by acid, alkali, or thermal were almost the same in distributing frequency of Grade III and Grade IV burns.
(3) Corneal repair:In Grade III eye burns, there were significant differences of coreal repair time between acid, alkali, and thermal(P=0.043). In acid burns, the eyes whose corneal repair time≤3 weeks accounted for 23.0%, 4-7 weeks for 38.5%, 8-15 weeks for 38.5%. In alkali burns, ≤3 weeks accounted for 22.6%, 4-7 weeks for 74.2%, 8-15 weeks for 3.2%.That was to say, the corneal repair time of acid burns was significantly longer than alkali(P=0.006). Between not only alkali and thermal burns, but also acid and thermal burns there were no significant differences of corneal repair time.
In Grade IV eye burns, there were significant differences of coreal repair incidence between acid(22.2%), alkali(72.7%), and thermal(42.9%)(P=0.018). The coreal repair incidence of alkali burns was significantly more than acid(P=0.017) and thermal burns(P=0.028).The corneal repair incidence showed no significant differences between acid and thermal burns. The reason why the coreal repair incidence of alkali burns was significantly more than acid and thermal burns was analysed as the following: among the 9 eyes of acid burns, the 22 eyes of alkali burns and the 35 eyes of thermal eyes, incidence of lid ectropion(44.4%) and corneal perforation(66.7%) in acid burns were both significantly more than those of alkali burns(lid ectropion: 4.5%, P=0.017; perforation 9.1%, P=0.003). Between alkali and thermal burns, no significant differences were showed in complications.In Grade IV eye burns, there were no significant differences of coreal repair time between acid, alkali, and thermal burns. There indicated significant differences of causes of coreal unrepair between the 3 groups of burns(P=0.040).In the Grade IV injuried eyes with unrepaired corneas, the incidence of corneal perforation(85.
引文
李凤鸣。眼科全书,第1版,北京。人民卫生出版社,3361-3369
Roper-Hall MJ.Thermal and chemical burns.Trans Ophthalmo Soc UK 1965;85:631-640
Kuckelkorn R, Makropoulos W, Kotteck A, Reim M: Retrospective study of severe alkali burns of the eyes. Klin Monatsbl Augenheikd 1993;203:397-402
MichaelD,Wagoner MD.Chemical injuries of the eye:current concepts in pathophysiology and therapy. Surv Ophthalmol 1997; 41(4): 275-313
陈家祺,陈晓明等。眼科学,第5版,北京。人民卫生出版社,224
郑大文,李光玲。碱性烧伤后眼表异常的角膜缘移植术治疗。眼外伤职业性眼病杂志2000,22:603～604
McCulley JP,Chemical injuries,in smolin G and Thoft RA(eds).The cornea:scientific foundation and clinical practice.Boston,Little,Brown and Co,1987,edz,pp527-542.
Barnes MJ: Function of ascorbic acid in collagen metabolism. Ann NY Acad Sci 1975;258:264-277
Wagoner MD,Kenyon KR:Chemical injuries of the eye, in Albert DM, Jakobice FA (eds): Principles and practice of ophthalmology: clinical practice. Philadephia, WB Saunders 1994;Vol 1:234-245
陈良君,于晓莉。.碱性眼化学灼伤并发症及其处理。眼外伤职业眼病杂志2000,22:221～222
赵敏,陈家祺等.。鼠角膜碱烧伤的免疫学研究.。中华眼科杂志,2000, 36:40～42
马伯俐,王莹、王敬钦等。职业中毒病例研究。化工工业出版社,4
赵敏。眼球热烧伤。中国实用眼科杂志,1997,15:194～197
Buck RC. Cell migration in repair of mouse corneal epithelium. Invest Ophthalmol Vis Sci 1979;18:767-784
Buck RC. Measurement of centripetal migration of normal corneal epithelium cells in the mouse. Invest Ophthalmol Vis Sci 1985;26:1296-1299
Thoft RA, Friend J. The X,Y,Z hypothesis of corneal epithelial maintenance. Invest Ophthalmol Vis Sci 1983;24:1442-1443
Friedenwald JS.Growth pressure and metaplasia of conjunctival and corneal epithelium.Doc Ophthalmol 1951;5-6:184-192
Friedenwald JS, Buschke W. Some factors concerned in the mitotic and wound-healing activities of the corneal epithelium.Trans Am Ophthalmol Soc 1944;42:371-383
Kaye DB.Epithelial response in penetrating keratoplasty. Am J Ophthalmol 1980;89: 381-387
Kinoshita S, Friend J, Thoft RA. Sex chromatin of donor corneal epithelium in rabbits. Inv Ophthalmol Vis Sci 1981;21:434-441
Hanna C, Bicknell DS, O Brien JE. Cell turnover in the adult human eye.Arch Ophthalmol 1961:65:695-698
Bron AJ.Vortex patterns of the corneal epithelium. Trans Am Ophthalmol Soc UK 1973;93:455-472
Spigelman AW, Vernot AJ, Deutsch TA, et al. Fibronectin in alkali burns of the rabbit cornea.Cornea 1985:4:169-173
Sharma A, Coles WH. Kinetics of corneal epithelial maintenance and graft loss. Invest Ophthalmol Vis Sci 1989;30:1962-1971
Zieske JD, Bukusoglu G, Yankauckas MA.Characterization of a potential marker of corneal epithelial stem cells. Invest Ophthalmol Vis Sci 1992;33:143-152
Zieske JD, Bukusoglu G, Yankauckas MA, Wasson ME, Keutmann HT.Alpha-enolase is restricted to basal cells of stratified squamous epithelium. Dev Biol 1992;151:18-26
Friedenwald JS. Hughes WF, Hermann H. Acid burns of the eye.Arch Ophthalmol 1946;35:98-108
Huang AJW, Tseng SCG. Corneal epithelium healing in the absence of limbal epithelium. Invest Ophthalmol Vis Sci 1991;32:96-105
Shapiro MS, Friend J, Thoft RA. Corneal re-epithelialization from the conjunctiva. Invest Ophthalmol Vis Sci 1981;21:135-142
Gartaganis SP, Margaritis LH, Koliopoulous JX. The corneal epithelium basement membrane complexes after alkali burns: an ultrastructuralstudy. Ann Ophthalmol 1987;19:263-268
Hirst LW, Fogle JA, Kenyon KR, Stark WJ.Corneal epithelial regeneration and adhesion following acid burns in the rhesus monkey. Invest Ophthalmol Vis Sci 1982;23:764-773
Friend J, Thoft RA. Functional competence of regenerating ocular surface epithelium. Invest Ophthalmol Vis Sci 1978;17:134-139
HarrisTM, Berry ER, Pakurar AS, Sheppard LB.Biochemical transformation of bulbar conjunctiva into corneal epithelium:an electrophoretic analysis. Exp Eye Res 1985;11: 597-606
Huang AJW, Tseng SCG,et al. Modulation of paracellular permeability during corneal epithelial wound healing. Invest Ophthalmol Vis Sci 1986;27(Suppl):51
Kinoshita S, Friend J. et al. Keratin-like proteins in corneal and conjunctival epithelium are different. Invest Ophthalmol Vis Sci 1983;24:577-581
Saika S, Kobata S, Hashizume N, et al. Epithelial basement membrane in alkali-burned corneas in rats. Immunohistochemical study. Cornea 1993;12:383-390
Thoft RA, Friend J. Biochemical transformation of regenerating ocular surface epithelium. Invest Ophthalmol Vis Sci 1977;16:14-20
Tseng SCG.Concepts and application of limbal stem cells. Eye 1989;3:141-157
Tseng SCG, Hirst LW, Farazdaghi M, Green WR. Goblet cell density and vascularization during conjunctival transdifferentiation. Invest Ophthalmol Vis Sci 1984;25:1168-1176
Zhu G, Ishizaki M, Heseba T, et al. Expression of K12 keratin in alkali-burned rabbit corneas. Curr Eye Res 1992;11:875-887
Chen JJ, Tseng SCG, Corneal epithelial wound healing in partial limbal deficiency. Invest Ophthalmol Vis Sci 1990;31:1301-1314
Kinoshita S, Kiorpes TC, Friend J, Thoft RA, Limbal epithelium in ocular surface wound healing. Invest Ophthalmol Vis Sci 1982;23:73-80
Maumenee AE, Repair in cornea. Adv Biol Skin. 1964;5:208-215
Srinivasan BD, Worgul BV, Iwamoto T, Eakins KE, The re-epithelialization of rabbit cornea following partial and complete epithelial denudation. Exp Eye Res.1977; 25:343-351
Tseng SCG, Farazdaghi M. Reversal of conjunctival trans-differentiation by topical tretinoin. Cornea 1988;7:273-279
Tseng SCG, Farazdaghi M, Rider AA. Conjunctival trans-differentiation induced by systemic Vitamin A deficiency in vascularized rabbit corneas. Invest Ophthalmol Vis Sci 1987;28:1497-1504
Tseng SCG, Hatchell D, Tierney N, et al. Expression of specific keratin markers by rabbit corneal, conjunctival ,and esophageal epithelium during Vitamin A deficiency. J Cell Biol 1984;99:2279-2286
Tseng SCG, Hirst LW, Farazdaghi M., Green WR. Inhibition of conjunctival trans -differentiation by topical retinoids. Invest Ophthalmol Vis Sci 1987;28:538-542
Tseng SCG, Maumenee AE, Stark WF. et al. Topical retinoid therapy for various eye disorders. Ophthalmology 1985;92:717-727
Geggel HS, Thoft RA, Friend J, Histology of human conjunctival transplantation.. Cornea 1984;3:11-15
Gross J. An essay on biological degradation of collagen, in Hay ED(ed): Cell biology of the extracellular matrix. New York, Plenum 1982;pp217-258
Foster CS, Zelt R, Kenyon KR, et al. Ascorbate therapy for experimental chemical burns. Invest Ophthalmol Vis Sci 1980;19(suppl):227
Levinson RA, Paterson CA, Pfister RR. Ascorbic acid prevents corneal ulcerationation and perforation follwing experimental alkali burns. Invest Ophthalmol Vis Sci 1976;15:986-993
Pfister RR, Haddox JL, Lank KM. Citrate or ascorbatecitrate treatment of established corneal ulcerations in the alkali injuried rabbit eye. Invest Ophthalmol Vis Sci 1988; 29:1110-1115
Pfister RR, Haddox JL,Yuille-Barr D. The combined effect of citrate/ascorbate treantment in alkali-injuried rabbit eyes. Cornea 1991;10:100-101
Pfister RR, Nicolearo ML, Pterson CA. Sodium citrate reduces the incidenceof corneal ulcerationation and perforation in extreme alkali-burned eyes-acetylcysteine and ascorbate have no favorable effect. Invest Ophthalmol Vis Sci 1989;21:186-190
Pfister RR, Pterson CA. Ascorbic acid in the treatment of alkali burns of the eye.Ophthalmology 1980;87:1050-1057
Pfister RR, Pterson CA. Additional clinical and morphological observation on the favorable effect of ascorbate in experimental ocular alkali burns. Invest Ophthalmol Vis Sci 1977;16:478-487
Pfister RR, Pterson CA, Spiers JW, et al. The efficacy of ascorbate treatment after severe experimental alkali burns depends upon the route of administration. Invest Ophthalmol
Vis Sci 1980;19:1526-1529
Phan TM, Zelt RP, Kenyon KR,et al. Ascorbic acid therapy in a thermal burn model of corneal ulcerationation in rabbit. Am J Ophthalmol 1985;99:74-82
Rehany U, Lahav M, Shoshan S. Collagenolytic activity in keratoconus.Ann Ophthalmol 1982;14:751-753
Grant WM. Toxicology of the eye.Drugs ,chemicals, plants, venoms. Springfield,Charles C, Thomaas 1974; ed 2:pp5-22
Kao WWY, Ebert J, Kao CWC, et al. Development of monoclonal antibodies recongnizing collagenase from rabbit PMN:the presenceof the enzyme in ulcerationating corneas.Curr Eye Res 1986;5:801-805
Lazarus GS, Brown RS, Daniel JR, et al. Human granulocyte collagenase. Science 1968;159;1483-1485
Lazarus GS, Daniel JR, Brown RS, et al. Degradation of collagen by a human granulocyte collagenolytic system. J Clin Invest 1968;47:2622-2629
Macartney A,Tschesche H. latent and active human polymorphonuclear leukocyte collagenase. J Biochem 1983;130:71-78
Ogloblina OG, Platonova LV, Paskhina TS, et al. On the identity of the kininogenase and plasminogen activators of human granulocytes. Biokhimiia 1984;49:302-309
Pfister RR. Chemical injuries of the eye. Ophthalmology 1983;90:619-633
Paterson CA, Williams RN. Sodium citrate inhibits PMN accumulation in aqueous humor and iris-ciliary body following endotoxin-induced inflammation. Invest Ophthalmol Vis Sci 1983;24(suppl):199
Paterson CA, Williams RN, Parker AW. Characteristics of polymorphonuclear leukocyte infiltration into alkali burned eyeand influence of sodium citrate. Exp Eye Res 1984; 39:701-708
Reim M,.The results of ischaemia in chemical injuries. Eye 1992;6:376-380
Reim M, A new treatment concept in severe caustic injuries and thermal burns of the eye. Fortschr Ophthalmol 1989;86:722-726
Reim M, Teping C. Surgical procedures in the treatment of most severe eye burns. Revival of the artificial epithelium. Acta Ophthalmol 1989;192(suppl):47-54
Wagoner MD, Kenyon KR, Gipson IK, et al. Polymorphonuclear neutrophils delay corneal epithelial wound healing in vitro. Invest Ophthalmol Vis Sci 1984;25:1217-1220
Berman MB, Barber JG, Talamo RC, Langley CE. Corneal ulcerationation and the serum antiproteases.I. alpha-1-antitrypsin. Invest Ophthalmol Vis Sci 1973;12:759-770
Cooper TW, Eisen AZ, Stricklin GP, Welgus HG. Platelet derived collagenase inhibitor: characterization and subcellular localization.Proc Natl Acad Sci USA 1985;82:2779-2783
Gunderson T. Conjunctival flaps in the treatment of corneal disease with reference to a new technique of application. Arch Ophthalmol 1958;60:880-888
Teping C, Reim M,.Tenoplasty as a new surgical principle in the early treatment of the mose severe chemical eye burns. Klin Monatsbl Augenheilkd 1989;194:1-5
Kuckelkorn R, Wenzel M, Lamprecht J, et al.Autologous transplantation of nasal mucosa after severe chemical and thermal eye burn. Klin Monatsbl Augenheilkd 1994;204: 155-161
Naumann GOH, Lang GK,Rummelt V, Wigand ME.Autologous nasal mucosa transplantation in severe bilateral conjunctival mucus deficiency syndrome. Ophthalmology 1990;97:1011-1017
Shore JW, Foster JS, Westfall CT, Rubin PAD.Results of buccal mucosal grafting for patients with medically controlled ocular cicatrical pemphigoid. Ophthalmology 1990;99:383-395
Kuckelkorn R,Kottek A, Reim M. Intraocular complications after severe chemical burns-incidence and surgical treatment. Klin Monatsbl Augenheilkd 1994;205:86-92
Pfister RR,Friend J, Dohlman CH. The anterior segments of rabbits after alkali burns. Arch Ophthalmol 1971;86:189-193
Pfister RR, Paterson CA, Hayes SA. Topical ascorbate descreases the incidence of corneal ulcerationation after experimental alkali burns. Invest Ophthalmol Vis Sci 1978;17:1019-1024
Roper-Hall MJ.Thermal and chemical burns.Trans Ophthalmo Soc UK 1965;85:631-640
Kuckelkorn R, Makropoulos W, Kotteck A, Reim M: Retrospective study of severe alkali burns of the eyes. Klin Monatsbl Augenheikd 1993;203:397-402
MichaelD,Wagoner MD.Chemical injuries of the eye:current concepts in pathophysiology and therapy. Surv Ophthalmol 1997; 41(4): 275-313
陈家祺,陈晓明等。眼科学,第5版,北京。人民卫生出版社,224
郑大文,李光玲。碱性烧伤后眼表异常的角膜缘移植术治疗。眼外伤职业性眼病杂志2000,22:603～604
McCulley JP,Chemical injuries,in smolin G and Thoft RA(eds).The cornea:scientific foundation and clinical practice.Boston,Little,Brown and Co,1987,edz,pp527-542.
Barnes MJ: Function of ascorbic acid in collagen metabolism. Ann NY Acad Sci 1975;258:264-277
Wagoner MD,Kenyon KR:Chemical injuries of the eye, in Albert DM, Jakobice FA (eds): Principles and practice of ophthalmology: clinical practice. Philadephia, WB Saunders 1994;Vol 1:234-245
陈良君,于晓莉。.碱性眼化学灼伤并发症及其处理。眼外伤职业眼病杂志2000,22:221～222
赵敏,陈家祺等.。鼠角膜碱烧伤的免疫学研究.。中华眼科杂志,2000, 36:40～42
马伯俐,王莹、王敬钦等。职业中毒病例研究。化工工业出版社,4
赵敏。眼球热烧伤。中国实用眼科杂志,1997,15:194～197
Buck RC. Cell migration in repair of mouse corneal epithelium. Invest Ophthalmol Vis Sci 1979;18:767-784
Buck RC. Measurement of centripetal migration of normal corneal epithelium cells in the mouse. Invest Ophthalmol Vis Sci 1985;26:1296-1299
Thoft RA, Friend J. The X,Y,Z hypothesis of corneal epithelial maintenance. Invest Ophthalmol Vis Sci 1983;24:1442-1443
Friedenwald JS.Growth pressure and metaplasia of conjunctival and corneal epithelium.Doc Ophthalmol 1951;5-6:184-192
Friedenwald JS, Buschke W. Some factors concerned in the mitotic and wound-healing activities of the corneal epithelium.Trans Am Ophthalmol Soc 1944;42:371-383
Kaye DB.Epithelial response in penetrating keratoplasty. Am J Ophthalmol 1980;89: 381-387
Kinoshita S, Friend J, Thoft RA. Sex chromatin of donor corneal epithelium in rabbits. Inv Ophthalmol Vis Sci 1981;21:434-441
Hanna C, Bicknell DS, O Brien JE. Cell turnover in the adult human eye.Arch Ophthalmol 1961:65:695-698
Bron AJ.Vortex patterns of the corneal epithelium. Trans Am Ophthalmol Soc UK 1973;93:455-472
Spigelman AW, Vernot AJ, Deutsch TA, et al. Fibronectin in alkali burns of the rabbit cornea.Cornea 1985:4:169-173
Sharma A, Coles WH. Kinetics of corneal epithelial maintenance and graft loss. Invest Ophthalmol Vis Sci 1989;30:1962-1971
Zieske JD, Bukusoglu G, Yankauckas MA.Characterization of a potential marker of corneal epithelial stem cells. Invest Ophthalmol Vis Sci 1992;33:143-152
Zieske JD, Bukusoglu G, Yankauckas MA, Wasson ME, Keutmann HT.Alpha-enolase is restricted to basal cells of stratified squamous epithelium. Dev Biol 1992;151:18-26
Friedenwald JS. Hughes WF, Hermann H. Acid burns of the eye.Arch Ophthalmol 1946;35:98-108
Huang AJW, Tseng SCG. Corneal epithelium healing in the absence of limbal epithelium. Invest Ophthalmol Vis Sci 1991;32:96-105
Shapiro MS, Friend J, Thoft RA. Corneal re-epithelialization from the conjunctiva. Invest Ophthalmol Vis Sci 1981;21:135-142
Gartaganis SP, Margaritis LH, Koliopoulous JX. The corneal epithelium basement membrane complexes after alkali burns: an ultrastructuralstudy. Ann Ophthalmol 1987;19:263-268
Hirst LW, Fogle JA, Kenyon KR, Stark WJ.Corneal epithelial regeneration and adhesion following acid burns in the rhesus monkey. Invest Ophthalmol Vis Sci 1982;23:764-773
Friend J, Thoft RA. Functional competence of regenerating ocular surface epithelium. Invest Ophthalmol Vis Sci 1978;17:134-139
HarrisTM, Berry ER, Pakurar AS, Sheppard LB.Biochemical transformation of bulbar conjunctiva into corneal epithelium:an electrophoretic analysis. Exp Eye Res 1985;11: 597-606
Huang AJW, Tseng SCG,et al. Modulation of paracellular permeability during corneal epithelial wound healing. Invest Ophthalmol Vis Sci 1986;27(Suppl):51
Kinoshita S, Friend J. et al. Keratin-like proteins in corneal and conjunctival epithelium are different. Invest Ophthalmol Vis Sci 1983;24:577-581
Saika S, Kobata S, Hashizume N, et al. Epithelial basement membrane in alkali-burned corneas in rats. Immunohistochemical study. Cornea 1993;12:383-390
Thoft RA, Friend J. Biochemical transformation of regenerating ocular surface epithelium. Invest Ophthalmol Vis Sci 1977;16:14-20
Tseng SCG.Concepts and application of limbal stem cells. Eye 1989;3:141-157
Tseng SCG, Hirst LW, Farazdaghi M, Green WR. Goblet cell density and vascularization during conjunctival transdifferentiation. Invest Ophthalmol Vis Sci 1984;25:1168-1176
Zhu G, Ishizaki M, Heseba T, et al. Expression of K12 keratin in alkali-burned rabbit corneas. Curr Eye Res 1992;11:875-887
Chen JJ, Tseng SCG, Corneal epithelial wound healing in partial limbal deficiency. Invest Ophthalmol Vis Sci 1990;31:1301-1314
Kinoshita S, Kiorpes TC, Friend J, Thoft RA, Limbal epithelium in ocular surface wound healing. Invest Ophthalmol Vis Sci 1982;23:73-80
Maumenee AE, Repair in cornea. Adv Biol Skin. 1964;5:208-215
Srinivasan BD, Worgul BV, Iwamoto T, Eakins KE, The re-epithelialization of rabbit cornea following partial and complete epithelial denudation. Exp Eye Res.1977; 25:343-351
Tseng SCG, Farazdaghi M. Reversal of conjunctival trans-differentiation by topical tretinoin. Cornea 1988;7:273-279
Tseng SCG, Farazdaghi M, Rider AA. Conjunctival trans-differentiation induced by systemic Vitamin A deficiency in vascularized rabbit corneas. Invest Ophthalmol Vis Sci 1987;28:1497-1504
Tseng SCG, Hatchell D, Tierney N, et al. Expression of specific keratin markers by rabbit corneal, conjunctival ,and esophageal epithelium during Vitamin A deficiency. J Cell Biol 1984;99:2279-2286
Tseng SCG, Hirst LW, Farazdaghi M., Green WR. Inhibition of conjunctival trans -differentiation by topical retinoids. Invest Ophthalmol Vis Sci 1987;28:538-542
Tseng SCG, Maumenee AE, Stark WF. et al. Topical retinoid therapy for various eye disorders. Ophthalmology 1985;92:717-727
Geggel HS, Thoft RA, Friend J, Histology of human conjunctival transplantation.. Cornea 1984;3:11-15
Gross J. An essay on biological degradation of collagen, in Hay ED(ed): Cell biology of the extracellular matrix. New York, Plenum 1982;pp217-258
Foster CS, Zelt R, Kenyon KR, et al. Ascorbate therapy for experimental chemical burns. Invest Ophthalmol Vis Sci 1980;19(suppl):227
Levinson RA, Paterson CA, Pfister RR. Ascorbic acid prevents corneal ulcerationation and perforation follwing experimental alkali burns. Invest Ophthalmol Vis Sci 1976;15:986-993
Pfister RR, Haddox JL, Lank KM. Citrate or ascorbatecitrate treatment of established corneal ulcerations in the alkali injuried rabbit eye. Invest Ophthalmol Vis Sci 1988; 29:1110-1115
Pfister RR, Haddox JL,Yuille-Barr D. The combined effect of citrate/ascorbate treantment in alkali-injuried rabbit eyes. Cornea 1991;10:100-101
Pfister RR, Nicolearo ML, Pterson CA. Sodium citrate reduces the incidenceof corneal ulcerationation and perforation in extreme alkali-burned eyes-acetylcysteine and ascorbate have no favorable effect. Invest Ophthalmol Vis Sci 1989;21:186-190
Pfister RR, Pterson CA. Ascorbic acid in the treatment of alkali burns of the eye.Ophthalmology 1980;87:1050-1057
Pfister RR, Pterson CA. Additional clinical and morphological observation on the favorable effect of ascorbate in experimental ocular alkali burns. Invest Ophthalmol Vis Sci 1977;16:478-487
Pfister RR, Pterson CA, Spiers JW, et al. The efficacy of ascorbate treatment after severe experimental alkali burns depends upon the route of administration. Invest Ophthalmol
Vis Sci 1980;19:1526-1529
Phan TM, Zelt RP, Kenyon KR,et al. Ascorbic acid therapy in a thermal burn model of corneal ulcerationation in rabbit. Am J Ophthalmol 1985;99:74-82
Rehany U, Lahav M, Shoshan S. Collagenolytic activity in keratoconus.Ann Ophthalmol 1982;14:751-753
Grant WM. Toxicology of the eye.Drugs ,chemicals, plants, venoms. Springfield,Charles C, Thomaas 1974; ed 2:pp5-22
Kao WWY, Ebert J, Kao CWC, et al. Development of monoclonal antibodies recongnizing collagenase from rabbit PMN:the presenceof the enzyme in ulcerationating corneas.Curr Eye Res 1986;5:801-805
Lazarus GS, Brown RS, Daniel JR, et al. Human granulocyte collagenase. Science 1968;159;1483-1485
Lazarus GS, Daniel JR, Brown RS, et al. Degradation of collagen by a human granulocyte collagenolytic system. J Clin Invest 1968;47:2622-2629
Macartney A,Tschesche H. latent and active human polymorphonuclear leukocyte collagenase. J Biochem 1983;130:71-78
Ogloblina OG, Platonova LV, Paskhina TS, et al. On the identity of the kininogenase and plasminogen activators of human granulocytes. Biokhimiia 1984;49:302-309
Pfister RR. Chemical injuries of the eye. Ophthalmology 1983;90:619-633
Paterson CA, Williams RN. Sodium citrate inhibits PMN accumulation in aqueous humor and iris-ciliary body following endotoxin-induced inflammation. Invest Ophthalmol Vis Sci 1983;24(suppl):199
Paterson CA, Williams RN, Parker AW. Characteristics of polymorphonuclear leukocyte infiltration into alkali burned eyeand influence of sodium citrate. Exp Eye Res 1984; 39:701-708
Reim M,.The results of ischaemia in chemical injuries. Eye 1992;6:376-380
Reim M, A new treatment concept in severe caustic injuries and thermal burns of the eye. Fortschr Ophthalmol 1989;86:722-726
Reim M, Teping C. Surgical procedures in the treatment of most severe eye burns. Revival of the artificial epithelium. Acta Ophthalmol 1989;192(suppl):47-54
Wagoner MD, Kenyon KR, Gipson IK, et al. Polymorphonuclear neutrophils delay corneal epithelial wound healing in vitro. Invest Ophthalmol Vis Sci 1984;25:1217-1220
Berman MB, Barber JG, Talamo RC, Langley CE. Corneal ulcerationation and the serum antiproteases.I. alpha-1-antitrypsin. Invest Ophthalmol Vis Sci 1973;12:759-770
Cooper TW, Eisen AZ, Stricklin GP, Welgus HG. Platelet derived collagenase inhibitor: characterization and subcellular localization.Proc Natl Acad Sci USA 1985;82:2779-2783
Gunderson T. Conjunctival flaps in the treatment of corneal disease with reference to a new technique of application. Arch Ophthalmol 1958;60:880-888
Teping C, Reim M,.Tenoplasty as a new surgical principle in the early treatment of the mose severe chemical eye burns. Klin Monatsbl Augenheilkd 1989;194:1-5
Kuckelkorn R, Wenzel M, Lamprecht J, et al.Autologous transplantation of nasal mucosa after severe chemical and thermal eye burn. Klin Monatsbl Augenheilkd 1994;204: 155-161
Naumann GOH, Lang GK,Rummelt V, Wigand ME.Autologous nasal mucosa transplantation in severe bilateral conjunctival mucus deficiency syndrome. Ophthalmology 1990;97:1011-1017
Shore JW, Foster JS, Westfall CT, Rubin PAD.Results of buccal mucosal grafting for patients with medically controlled ocular cicatrical pemphigoid. Ophthalmology 1990;99:383-395
Kuckelkorn R,Kottek A, Reim M. Intraocular complications after severe chemical burns-incidence and surgical treatment. Klin Monatsbl Augenheilkd 1994;205:86-92
Pfister RR,Friend J, Dohlman CH. The anterior segments of rabbits after alkali burns. Arch Ophthalmol 1971;86:189-193
Pfister RR, Paterson CA, Hayes SA. Topical ascorbate descreases the incidence of corneal ulcerationation after experimental alkali burns. Invest Ophthalmol Vis Sci 1978;17:1019-1024