新鲜羊膜移植治疗重症角膜溃疡

Fresh amniotic membrane transplantation for the treatment of severe keratic ulcer

背景:羊膜具有抗原性低、促进眼表上皮化修复、减轻炎性反应、抑制纤维组织增生和新生血管形成等作用。在修复角膜缺损区的创面,可提供一个理想的基底膜,使其迅速上皮化和创口愈合。目的:新鲜羊膜移植治疗重症角膜溃疡的安全性及其临床疗效。方法:纳入非感染性继发角膜溃疡6例(6只眼)和感染性原发角膜溃疡8例(8只眼),共14例临床连续住院患者。非感染性角膜溃疡行单纯新鲜羊膜移植(6只眼),感染性角膜溃疡羊膜移植联合碘酊烧灼(8只眼)。移植后裂隙灯显微镜下观察角膜溃疡的愈合过程,角膜透明性的变化,移植羊膜存活的时间。结果与结论:新鲜羊膜植片未发生排斥反应。14例重症角膜溃疡移植治疗后病情缓解,未发生角巩膜穿孔、坏死等严重并发症。其中非感染性角膜溃疡组1只眼溃疡未愈合。角结膜未发生进行性溶解、穿孔,视力无提高。随访期间溃疡未出现复发及严重的并发症。提示,新鲜羊膜移植治疗重症角膜溃疡是一种有效、安全的方法。

BACKGROUND： Amnion has many beneficent effects, including low antigen expression, promoting superficial epithelium restoration, relieving inflammation reaction, prohibiting fibrous tissue proliferation and neovascular formation. On corneal defects, amnion can provide an ideal basal membrane to quickly heal the wounds by epithelization. OBJECTIVE： To investigate the safety of fresh amniotic membrane transplantation for severe keratic ulcer, and evaluate its clinical efficacy. METHODS： A total of 14 cases of clinical inpatients continuously on treatment were selected, including 6 cases （6 eyes） of secondary non-infective corneal ulcer and 8 cases （8 eyes） of primary infective corneal ulcer. The 6 eyes had been treated with fresh amniotic membrane transplantation, and 8 eyes with amnion transplantation combined with iodine tincture cauterization. The healing process of corneal ulcer, corneal transparency alterations and amniotic existing time were examined under slit-lamp microscope. RESULTS AND CONCLUSION： No rejection reaction occurred in fresh amniotic implants. A total of 14 cases of severe corneal ulcer convalesced post-operatively and ulceration was restored. None of kerato-conjuntival epithelium progressively metted or perforated, with no improvement in visual acuity in all cases. During the follow up no ulcer relapsed or severe complications were found. Fresh amniotic membrane transplantation can effectively and securely treat severe keratic ulcer.