新鲜羊膜移植重建急性烧伤眼表的临床研究

Clinic study of fresh amniotic membrane transplantation for ocular surface reconstruction

目的:探讨新鲜羊膜移植重建急性眼表烧伤眼表的可行性,并评价其疗效。方法:近2年我院就诊的急性眼表烧伤病例(20例24只眼),施行新鲜羊膜移植手术治疗。患者术后随访12～26个月,平均(15±2)月。观察视力、角膜上皮愈合、角膜透明度、角膜新生血管和羊膜的转归。结果:羊膜移植后眼表迅速稳定,眼表面迅即并维持上皮化,无排斥,继发感染。20例中19例23眼在治疗后14～28d,羊膜基本溶解或吸收,角膜上皮完全愈合,1例1眼手术后12d发生角膜自融性基质溃疡,再次用药物治疗效果不佳,立行板层角膜移植术。新鲜羊膜移植术后的视力基本保留了眼前指数。结论:新鲜羊膜的移植可以减轻角膜急性烧伤期的炎症反应,阻止眼表的进行性溃烂和融解,加速眼表的稳定;同时减少角膜新生血管的形成,并在相当长的时间内将其局限在角膜周边部,从而为后续的角膜复明手术打下良好的基础。但对于严重化学烧伤患者,羊膜移植术的疗效是有限的。

Objective：To explore the possibility of fresh amniotic membrane transplantation for reconstruction of ocular surface with acute burn and evaluate the effect. Method：20 cases（24 eyes）due to acute burn of ocular surface were performed fresh amniotic membrane transplantation. All patients were followed up for 12 months to 26 months, the mean follow-up was （15 ± 2）months. Visual acuity,epithelial healing, corneal transparency,corneal neovascularization and transplanted amniotic membrane were observed. Results：After fresh amniotic membrane transplantation, ocular surface was soon stable,immune rejection and secondary infection didn＇t occur. In 19 of 20 cases（23 eyes） the amniotic membrane autolyzed or disappeared with epithelized corneal surface at 14 to 28 days after operation. In one case（one eye） autolyzed corneal ulcer occurred at 12 days after operation. After another medication treatment was invalid, lamellar keratoplasty was performed. In other cases with AMT visual acuity keeps CF/5cm. Conclusion：Fresh amniotic memhrane transplantation can lighten corneal inflammation in acute course of burn, can prevent ocular surface from ulcer and deliquescion,can fasten the stabilization and reduce corneal neovascularization, which provide a good basis for the following keratoplasty. With regard to severe eye burn,the effect of AMT is limited.