兔眼碱烧伤行羊膜移植术后转归的实验研究

An experimental study on postoperative transformation of amniotic membrane transplantation in ocular alkali burns of rabbits

目的探讨兔眼碱烧伤行羊膜移植术后在眼表大体结构、病理组织学和超微结构三个方面的转归状况。设计随机对照实验性研究。研究对象60只新西兰白兔(120眼),按照伤后不同时间手术随机分为5组,包括保存羊膜移植组(A1组、A2组)、新鲜羊膜移植组(B1组、B2组)和对照组。每组12只兔(24眼)。方法分别应用保存羊膜和新鲜羊膜,在兔眼碱烧伤后第1天和第15天行羊膜移植术,裂隙灯检查术后第1、3、7、10、15、30天时羊膜在位情况,术后第3、7、15、30天作病理学和透射电子显微镜检查。主要指标裂隙灯显微镜观察角膜透明度、新生血管及球结膜充血情况;病理学检查和透射电子显微镜观察羊膜移植术后羊膜的动态变化。结果羊膜移植术后第30天,羊膜移植组兔眼的新生血管程度减轻,角膜透明度有不同程度的恢复,与对照组差异有显著统计学意义(P<0.001),早期羊膜移植组(A2组、B2组)的疗效明显优于晚期移植组(A1组、B1组)(P<0.001)。新鲜羊膜移植组(B2组)疗效优于保存羊膜移植组(A2组)(P<0.05)。病理学结果:术后第30天,角膜各层结构恢复完整,可见少量嗜酸性粒细胞和少量残存的新生血管。透射电镜检查:新鲜羊膜组术后第15天,羊膜上皮完整,基底层变薄,羊膜和角膜组织间形成连接,羊膜基底层面与角膜表面融合。30天后,角膜表面可见一层羊膜上皮细胞,羊膜基底层消失。结论碱烧伤早期羊膜移植对抑制角膜新生血管形成、减轻炎症和恢复角膜透明度有较好的治疗效果,新鲜羊膜优于保存羊膜。

Objective To explore the characteristics of anatomy,pathology and ultrastructure of amniotic memberane transplantation on ocular alkali burns rabbits.Design Randomized,comparative experimental study.Participants The experimental animals of New Zealand 60 rabbits(120 eyes)were randomly divided into five groups,the preserved amnion(group A1 and A2)and fresh amnion(group B1 and B2)were transplanted during the early stage(group A2 and B2)and the later stage(group A1 and B1).The control group of ocular alkali burns rabbits had not been treated.There were 12 rabbits(24 eyes)in every group.Methods Changes of ocular surface at the postoperative day 1,3,7,10,15 and 30 were examined with slit lamp,transformation of amnion,cornea and conjunctiva were observed.The pathological and ultrastructure examination were done at the postoperative day 3,7,15 and 30.Main Outcome Measures The dynamic changes of corneal clarity,neovascularization,conjunctival hyperemia,pathological and ultrastructure changes after amniotic membrane transplantation.Results At the day 30 after surgery,keratoconjunctival neovascularization were less and the clarity of cornea were better in experimental groups(group A1,A2,B1 and B2)than that in the control group(P<0.001).Therapy effects in early experimental groups(group A2,B2)were better than that in later groups(A1,B1)(P<0.001).Therapy effects in the fresh amnion group(group B2)were better than that in the preserved amnion(group A2)(P<0.05).At the day 30 after surgery,pathological examination showed that corneal tissue was restored completely,a few acidophil soakage and less residual new vessel were seen.Ultrastructure examination showed that at the 15 day,epithelia of amniotic membrane were integrated and stroma became thinner in group B,conjunction between amniotic membrane and cornea was established,amniotic membrane syncretized with cornea.A layer of amniotic epithelium could be detected on corneal surface,but amniotic stroma was disappeared.Conclusions At the early stage of ocular alkali burns,amniotic membrane transplantation plays important role in suppressing neovascularizition,alleviated inflammation and recovering corneal clarity.Therapy effect of fresh amniotic membrane is better than that of preserved one.