羊膜移植在眼表重建术中的应用

A Clinical Study on Amniotic Membrance Transplantation for Treatment of Severe Ocular Surface Injury or Disorders

目的:探讨羊膜移植治疗严重的急性眼表损伤和一些难治性眼表疾病的可行性并对其疗效进行评价。方法:选择本院门诊或住院的急性眼表化学伤、热灼伤共30例(38眼),各种角膜溃疡15例(15眼),翼状胬肉20例(31眼),大泡性角膜病变4例(4眼)。行单纯羊膜移植术54例(67眼),羊膜移植联合板层角膜移植术12例(18眼),羊膜移植联合角膜缘移植术3例(3眼)。术后随访3至40个月,平均18.6个月。结果:38眼化学伤、热灼伤中,24眼角膜恢复透明,10眼残留薄翳,4眼(包括联合板层角膜移植术和联合角膜缘移植术各2眼),因损伤严重,眼表组织大量缺血坏死,虽行联合板层角膜移植及角膜缘移植术,仍未能保留眼球;15眼角膜溃疡中,溃疡全部愈合,残留轻度不等的云翳,无一眼发生角膜穿孔;31眼翼状胬肉中,除1眼在术后半年又复发外(未再次手术),其他均未见复发;大泡性角膜病变4眼中,大泡消失,无疼痛感。结论:羊膜移植可减轻炎性反映,减少新生血管生长,防止纤维瘢痕组织增生,促进局部上皮化,是眼表重建的有效方法。

Objective: To investigate the effect and the safety of amniotic membrance transplantation to reconstruct the ocular surface with severe ocular surface injury or disorders. Method: Amniotic membrance transplantation (54 cases, 67 eyes), or combined with either limbal transplantation (3cases, 3eyes),or lamellar keratoplasty (12cases, 18eyes) was performed on ocular burns (30 cases,38 eyes); corneal ulcers (15case, 15eyes); pterygium (20cases, 31eyes); bullous keratopathy (4cases, 4eyes). All patients were followed up for 3~40 months (mean, 18.6 months). Results: No acute rejection was observed after amniotic membrance transplantation. Ocular surface reconstruction was successful in 34 of 38 eyes with burns injury, 4eyes with corneal perforation. Of 15eyes with corneal ulcer, all eyes recovered successfully with corneal opacity in various degrees. Thirty one eyes with pterygium did not recurred during the follow-ups except one eye. Ocular surface reconstruction was successful also in 4eyes with bullous keratopathy. Conclusion: Amniotic membrance can be used as a graft to reconstruct ocular surface. This operation can effectively reduce neovascularization, fibrosis and inflammation.[