角膜结膜化学伤及热灼伤中羊膜移植术的应用

Amniotic membrane transplantation in chemical and thermal burns of cornea and conjunctiva.

目的 探讨羊膜移植术治疗严重的眼部化学伤及热灼伤等的疗效。方法 18例 ( 18眼 )连续病人 ,因化学伤及热灼伤后 ,角结膜组织坏死、融解并形成睑球粘连。羊膜材料来源 :无传染性疾病的健康剖腹产羊膜 ,10例为新鲜羊膜材料 ,8例为保存材料。结果 18例患者术后羊膜组织全部成活 ,防止了角膜鳞状化生。随访 1～ 8月 ,平均 5月。视力 :由 0 4提高到 1 0的 1例 ,12例视力不同程度的改善 ,视力无明显改善的 6例 ,但角膜缘新生血管得以抑制 ,为今后行角膜移植奠定了基础。术后 3月 ,角膜新生血管生长 6例 ,比术前明显减少 ,且只限于周边区 ,未达中央部。炎症反应得以及时控制 ,未见睑球粘连。均无排斥反应。结论 羊膜移植治疗严重化学伤及热灼伤等眼表疾患 ,效果满意。可以抑制角膜新生血管 ,防止睑球粘连及上皮角化 ,避免干眼症。减少瘢痕形成 ,保持一定视力。

Objective To examine the clinical effects of preserved human amniotic membrane transplantation(AMT) in patients with severe chemical and thermal burns of ocular surface.Methods 18 eyes of 18 patients with chemical and thermal burns were studied.We found all patients with necrosis and melting in cornea and conjunctiva.We treated them with amniotic membrane trasplantation which was taken from the health donors with Caesarean birth,10 of them are fresh the other 8 cases are not.Results With the observation period from 1 to 8 months,average five month,the amniotic membrane tissue survived in all the 18 eyes and no squamous epithelial metaplasia in cornea occured.We found the visual acuity of one case improved from 0.4 to 1.0,and twelve cases have improved their visions in some degrees.The other six have no improvement,but the limbal neovascularizations are suppressed so that they can be treated with keratoplasty later.Three months after operation,corneal neovascularization occured in three eye,much less than those before operation.The corneal neovascularization only occured at peripheral areas but not reached the central part of the cornea.The inflammation was controlled and no blepharosynechia occured.No rejective reaction happened.Conclusion AMT can be used to treat the chemical and thermal burns of the ocular surfaces through suppressing corneal neovascularization.It will promote success of keratoplasty.It can prevent the blepharosynechia and squamous epithelial metaplasia of cornea and conjunctiva,and less scar formation.The vision acuity can be partially recovered.The meterial is easy to be obtained,and obtains satisfactory clinical effects.