新鲜与保存人羊膜移植在眼表重建中的效果比较

Comparison between the effects of ocular surface reconstruction by fresh and preserved amniotic membranes

目的:新鲜羊膜移植已经在严重疾患的眼表重建中取得了良好的效果,但存在手术时间与材料来源是否能吻合的问题,比较新鲜与保存人羊膜移植在眼表重建中的疗效,以期为重建正常眼表结构提供有效措施。方法:选择2004-01/2005-12承德医学院附属医院眼科收治的严重眼表疾病患者36例(43眼),患者均知情同意。将36例患者的43眼按随机数字表法分为两组,即新鲜人羊膜移植组(23眼)和保存人羊膜移植组(20眼)。术后定期随访,第1周每日检查,其后1次/周,直至羊膜存活1个月以上停止随访。每次均在裂隙灯下观察羊膜植片成活情况,观察角膜、结膜上皮化情况,新生血管生长、视力以及并发症等。结果:36例患者43眼全部进入结果分析,无脱落。①36例患者43眼随访2-8个月,其中<2个月8眼,2-5个月20眼,6-8个月15眼。②新鲜人羊膜移植组、保存人羊膜移植组患者术眼视力提高率分别为83%,90%,两组差异无显著性意义(P>0.05)。③新鲜人羊膜移植组、保存人羊膜移植组患者术眼羊膜成活率分别为91%,95%,两组差异无显著性意义(P>0.05)。④新鲜人羊膜移植组23眼中,术后两三拆线后21眼(占91.3%)充血消退,2眼(占8.7%)术后4周充血消退;保存人羊膜移植组20眼中,术后2周拆线后19眼(95%)充血消退,1眼(5%)术后4周充血消退,两组差异无显著性意义(P>0.05)。结论:在眼表修复与重建过程中,羊膜移植能有效改善严重眼表疾病患者眼表基底,重建上皮,其临床疗效与羊膜材料是新鲜或保存人羊膜无直接关系,二者预后基本一致。

AIM： Fresh amniotic membranes （AMs） are effective on the ocular surface reconstruction of patients with serious diseases, but the operation time and material sources are in debate. This paper aims to evaluate the therapeutic effects of fresh and preserved AMs for reforming ocular surface structure. METHODS： A total of 36 patients （43 eyes） who had serious ocular disease were enrolled from the Department of Ophthalmology, Affiliated Hospital of Chengde Medical College from January 2004 to December 2005, and were randomly divided two groups： transplantation of fresh AMs （23 eyes） and transplantation of preserved AMs （20 eyes）. All the subjects were followed up everyday at the first week and then once a week, until the AMs were survival for one month. Then the survival of AMs transplants was observed under slit lamp to investigate the corneal and conjunctival epithelization, neovascular vessel, visual acuity and complications after the operation. RESULTS： All 36 patients of 43 eyes were involved in the result analysis without any drop. （1）All 36 patients of 43 eyes were followed up for 2-8 months, including 8 eyes for less than 2 months, 20 eyes for 2-5 months and 15 eyes for 6- 8 months.（2）In fresh AMs group, operative eyes showed an improvement in visual acuity （83%）. In preserved AMs group, those eyes showed an improvement in visual acuity （90%）. There was no significant difference between the two groups （P〉 0.05）. （4）In fresh group, 21 eyes （91.3%） showed a hyperemia regression 2 or 3 weeks after operation, 2 eyes （8.7%） regressed 4 weeks after operation. In preserved group, 19 eyes （95%） showed a hyperemia regression 2 weeks after operation, 1 eye （5%） regressed 4 weeks after operation. There was no significant difference between two groups （P 〉 0.05）. CONCLUSION： Transplantation of AMs has positive therapeutic effects for improving ocular surface and reforming epithelium in patients with serious ocular diseases. The clinical effects and outcome of treating ocular surface disorder with fresh AMs transplantation is the same as that with preserved AMs transplantation.