新鲜羊膜移植治疗急性眼表烧伤25眼

Fresh amniotic membrane transplantation for burns at the acute stage in 25 eyes

目的：眼表烧伤致盲率高，羊膜移植因其独特的治疗效果成为近年来的研究热点。观察新鲜羊膜移植治疗急性眼表化学性烧伤、热烧伤的疗效。方法：①对象：选择2002—01／2007—06延安大学附属医院收治的酸烧伤8例8眼，碱烧伤10例10眼，热烧伤6例7眼，男23例，女1例，年龄16～50岁。术前视力〈0．05者18眼，0．06～0．1者6眼，0．25者1眼。②羊膜移植：羊膜取自剖宫产的新鲜胎盘，经产妇知情同意。通过羊膜与绒毛膜剩余部分两层之间的潜在腔隙进行钝性分离获得透明羊膜，处理后，置于4℃冰箱内24h应用。采用单层或多层新鲜羊膜移植联合常规药物治疗急性眼表烧伤患者24例25眼。③评估：术后观察羊膜黏附，角膜透明度，上皮修复及纤维增殖情况，随访3-6个月，平均4．5个月。结果：24眼术后无排斥反应，上皮修复，眼表迅速稳定，角膜不同程度恢复透明，24眼视力不同程度提高，术前后对比差异具有显著性（P〈0．01）。一眼因角膜缘〉3／4缺血未能恢复眼表上皮，二次行带角膜缘干细胞移植术上皮恢复。结论：新鲜羊膜能有效阻止炎症和角膜融解的发展，加快眼表的重建，减少新生血管的形成，减轻瘢痕，且来源广泛，成本低廉，新鲜羊膜移植是治疗急性眼表烧伤的有效方法。

AIM： Eye surface bum is easy to cause blindness. Amniotic membrane transplantation has become a hot spot of research for its special effects in recent years. This study observed the therapeutic outcome of fresh amniotic membrane transplantation for acute chemical or thermal bums at eye surface. METHODS： ①Eight eyes with acid bum in eight cases, ten eyes with alkali bum in ten cases, and seven eyes with thermal bum in six cases were selected from Yan＇an University Affiliated Hospital between January 2002 and June 2007 including 23 males and 1 female aged 16-50 years. There were 18 eyes with preoperative vision 〈 0.05, 6 eyes with 0.06-0.1, and 1 eye with 0.25. ②Amniotic membrane from the caesarean delivered fresh placenta （informed consent from the parturient） was separated by blunt dissection from the hidden lacune between amniotic membrane and chorionic vesicle, stored at 4 ℃ for 24 hours. All 25 eyes with acute eye surface bums of 24 cases were treated by monolayer or multilayer fresh amniotic membrane transplantation in combination with regular medicine treatment. ③Amniotic membrane adherence, corneal transparency, epithelium recovery and fiber proliferation were observed after surgery. All the patients were followed up for 3-6 months with an average of 4.5 months. RESULTS： In 24 eyes, epithelium was recovered and ocular surface stabilized rapidly with no rejection; cornea regained transparent to certain extent. The vision of 24 eyes was significantly improved compared with preoperative one （P 〈 0.01）. Epithelium of 1 eye failed to recover because of the necrosis of 3/4 corneal limbus, and treated by second limbal stem cell transplantation. CONCLUSION： Fresh amniotic membrane can effectively reduce inflammation, block corneal melting, accelerate ocular surface reconstruction, reduce the growth of blood vessel, and relieve cicatricle. Moreover, the amniotic membrane resource is sufficient, and the cost is low. Fresh amniotic membrane transplantation is an effective way to treat eye bums at acute stage.