改良羊膜移植术治疗难治性角膜上皮疾病的疗效观察

Modified amniotic membrane transplantationin treatment of refractory corneal epithelial diseases

目的比较改良羊膜移植术与传统羊膜移植术对难治性角膜上皮疾病的治疗效果及差异,为临床提供简便的治疗方法。方法选取2009年1月至2010年6月间住院治疗的难治性角膜上皮疾病患者48例。其中大泡性角膜病变患者16例,角膜化学伤或热烫伤患者14例,病毒性角膜炎角膜上皮持久不愈合患者10例,内眼术后角膜上皮长期缺损患者8例。所有患者随机分为两组(传统组与改良组),传统组行传统羊膜移植术,改良组行改良的羊膜移植术。观察术后两组患者的眼表炎性反应,羊膜贴合情况及角膜上皮愈合情况。结果术后两周内两组患者羊膜均贴合紧密,传统组早期球结膜水肿,有2例患者羊膜下少许积血,拆线后2例患者上皮未愈;改良组于术后2～3 d羊膜边缘均出现不同程度卷曲,但缝线以内羊膜仍贴合良好,拆线后1例患者上皮未愈。拆线后两组患者病情均得到改善。结论改良的羊膜移植术与传统羊膜移植术一样能取得良好的治疗效果,但手术方法简便快捷,且不会出现传统手术方法所发生的羊膜下积血等症,手术刺激少,值得临床应用。

To evaluate the therapeutic effect of modified amniotic membrane transplantation for treatment of refractory corneal epithelial diseases. Methods Forty eight patients with corneal epithelial diseases in this hospital during January 2009 to June 2010 were selected for this study. Among them, 16 patients were suffered from bullous keratopathy, 14 from corneal chemical or thermal burn injury, 10 patients from viral keratitis with sustainod non - healing corneal epithelial lesion and 8 patients from intraocular long - term corneal epithelial defects. All patients were divided into two groups, patients in control group were treated with conventional amniotic membrane transplantation and patients in trial group were treated with modified technique for amniotic membrane transplantation. Postoperative inflammation and ocular surface of amniotic membrane were observed in these two groups. Results Two weeks after the operation, amniotic membranes in patients of two groups were closely fit. Bulbar conjunctival edema and blood clots under amniotic membrane were appeared in group of patients with traditional surgical method. Patients in modified technique group suffered from varying degree of curliness at the margin of amniotic membrane, but the suture in amniotic membrane was still closely fit to the comea. The condition of patients in these two groups after removal of suture was improved with varying degree. Conclusion Modified amniotic membrane transplantation can achieve a good therapeutic effect with fewer complications.