眼科研究 2000年第2期第18卷 实验研究

作者：S．A．Yakimenko　R．I．Chalanova　N．F．Leus　S．G．Kolomiychuk

单位：乌克兰费拉托夫眼科研究所，270061

关键词：眼烧伤；早期角膜移植；溶解酶

　　摘要 目的 研究角膜碱性烧伤后，早期用蛋白溶解酶清除坏死组织，然后即行板层角膜移植，动态观察其疗效。 方法 实验兔36只，用10%?NaOH造成兔角膜烧伤模型，早期应用水解蛋白酶冲洗除去表层坏死组织后，即行板层角膜移植。 结果 有70.5%实验兔角膜透明或半透明愈合。 结论 在严重眼烧伤时，早期应用水解蛋白酶创造一个板层角膜移植的良好环境可以获得较好的治疗效果。

　　分类号 R772．2

Urgent keratoplasty in the treatment of severe eye burns

S．A．Yakimenko，R．I．Chalanova，N．F．Leus，S．G．Kolomiychuk

　　（Institute of Eye Diseases and Tissue Therapy by V．P．Filatov，Odessa，270061 Ukraine）

　　Abstract ObjectiveTo examine the efficiency of urgent lamellar keratoplastic surgery with preliminary ferment necrectomy of corneal isolated alkaline burns and its influence on proteolytical indices in serum and camera moisture．MethodsExperiments were conducted on both eyes of rabbits（n＝36）using an alkaline burn model of 10％ NaOH with 10-s exposure time．The doses of proteases（lekozim，alkaline proteases）were established．ResultsThe research showed that with the aid of proteolitical ferments it is possible to remove necrotic corneal layers and prepare the cornea for lamellar keratoplasty．This allows improved wound healing after lamellar keratoplasty in eye burns．More favorable course of eye burn disease reflected positively also on the proteolitical activity（PA） indices of the serum and camera moisture．Urgent keratoplasty with preliminary necrectomy resulted in transparent and half-transparent healing of the transplant in 70.5% of cases．ConclusionThe application of proteolitical ferments in the early terms allows to create better conditions for the lamellar keratoplasty with the severe eye burns．Urgent keratoplasty with preliminary ferment necrectomy appears to be more effective for the treatment of chemical burns of rabbit corneas．

　　Key words eye burn urgent keratoplasty proteolytical ferments

　　INTRODUCTION

　　Clinical displays of eye burn disease are stipulated by those violations which cause damages in biological eye structures．Violations of innervation，blood supply，suppression of all types of metabolism，the phenomena of autosensibilization and autointoxication of the organism with products of tissue necrosis lead to deepening of structural violations，burdening of course of eye burn disease and to severe invalidizing results．

　　Taking all this into consideration N．A．Puchkovskaya and co-authors^［1］suggested during first 24 h after severe eye burn to carry out urgent lamellar keratoplasty with preliminary necrectomy of damaged corneal layers．Authors’ experimental investigations showed that the efficacy of urgent keratoplasty depends on the burn’s severeness．The more severe the burn，the more quickly lamellar keratoplasty should be performed．However，despite positive results of these investigations，the operation of urgent keratoplasty did not find application．The reason of it is the lack of diagnostic methods of severeness and depth of corneal affection．

　　We studied necrolitical properties of a number of proteases on a model of severe alkaline burns to the cornea and ascertained that with the help of ferments，it is possible to achieve full removal of necrotic layers of the cornea and prepare the cornea for keratoplasty．We also ascertained concentrations and exposure time of proteases necessary to achieve removal of changed corneal tissues^［2］．

　　Study of the efficiency of urgent lamellar keratoplasty with preliminary ferment necrectomy on isolated alkaline burns of the cornea and its influence upon indices of proteolytical activity in blood serum and camera moisture in the dynamics of burn disease．

　　MATERIALS AND METHODS

　　Experiments were carried out on both eyes of 36 rabbits．Using a special applicator，an isolated corneal burn with 10％ NaOH was reproduced with exposure time of 10 s（Fig．1）．19 rabbits formed I control group（CG），where the treatment was carried out with thrice-repeated instillations of desinfecting means daily．In the second experimental group（EG），of 17 rabbits in 3 h after burn a ferment processing of cornea was carried out with following urgent lamellar keratoplasty．Applications of 27 units of alkaline protease in 2．0 ml of polyvinyl spirit or lekozym 17．5 Fip in 2．0 ml 3．5％ of urea were carried out with the help of eye-bath-eyelid-dilator for 5 min．In 25～30 min full tearing away of necrotic layers of cornea was seen （Fig．2）．A layer-by-layer transplant 10 mm in diameter was cut out and was fixed with main stitches to the edge of the dislike bed（Fig．3）．After the operation the treatment was carried out the same way as in the control group with thrice-repeated instillations of desinfecting means daily．The observation over animals was carried out for 1．5 months with the help of biomicroscopy and fluorescein sample．At the same time the following symptoms of burn disease were evaluated：the duration of the inflammatory reaction，the terms of the beginning and finishing of the epithelization of the defect of the cornea and the transplant，the development of such complications as ulcerization or fusion of the cornea or the transplant，outcomes of the burn disease according to the intensity of cornea dimness．

　　fig．1 The alkaline model burn of the cornea．The cornea was dimness accordance the “porcelain plate” Fig．2 The cornea after ferments necrectomy．Full tearing away of necrotic layers Fig．3 Lamellar transplant was fixed to the edge of the bed Fig．4 The result of keratoplasty is the half-transparent grafting of the transplant　　In both groups on d 1，3，7，14 and 21，the blood and camera moisture were taken for biochemical analysis．The study of proteolytical activity of these biological liquids were carried out according to methods based on splitting of the substratum bensoyl-arginin-r-nitroanilyn with proteolitical ferments．

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