羊膜移植治疗难治性眼表疾病的临床效果

Clinical study of amniotic membrane transplantation for refractory ocular surface disorder.

目的评价羊膜移植治疗难治性眼表疾病的临床效果。方法采用羊膜移植治疗46例（48眼）难治性眼表疾病，其中角膜溃疡24例（24眼），急性碱烧伤5例（5眼），睑球粘连4例（4眼），复发性翼状胬肉13例（15眼）。结果除1例（1眼）角膜溃疡需行结膜瓣遮盖外，23例（23眼）角膜溃疡于羊膜移植术后10天内角膜炎症控制，角膜溃疡于术后2周内愈合，9眼角膜透明，14眼溃疡区瘢痕愈合，成功地重建眼表。术后裸眼视力0．2—0．6者15眼，手动-0．1者8眼。碱烧伤、睑球粘连、翼状胬肉病例术后无一眼发生感染，羊膜植片于术后2周后融解，随访6—15月，除2例（2眼）翼状胬肉复发外，其余病例成功重建眼表，视力有不同程度改善。结论羊膜移植能有效地治疗部分难治性眼表疾病，重建眼表，但对严重的角膜溃疡和翼状胬肉疗效不甚理想。

Objective To evaluate the clinical efficacy of amniotic membrane transplantation （AMT） for treating refractory ocular surface disorder. Methods Performing AMT on 46 patients （48 eyes） with refractory ocular surface disorder, including corneal ulcer（24 patients,24 eyes）, acute alkali burns （5 patients, 5 eyes）, blepharia （4 patients,4 eyes）, recurring pterygium （ 13 patients, 15 eyes）. Results （1） After AMT,in 23 patients （23 eyes） with corneal ulcer,the infection and inflammation was controlled within 10 days and they were cured in 2 weeks but 1 patient needed conjunctival transplantation. There were corneal transparency in 9 eyes, corneal macula in 14 eyes and reconstructed ocular surface successfully. The uncorrected visual acuity was from 0.2 to 0.6 in 15 eyes and hand moving to 0.1 in 8 eyes. （2） After surgery,no eyes developing infection in cases with alkali bums, blepharia, and pterygium, the amniotic membrane dissolved after 2 weeks. After 6 to 15 month of follow-up, 1 patients（2 eyes） with pterygium recurred, other cases were reconstructed ocular surface successfully and the visual acuity impoved to various extent. Conclusions AMT can effectively reconstructed ocular surface in some patients with refractory ocular surface disorder, but the efficacy is not ideal in serious corneal ulcer and pterygium eyes.