角膜缘上皮联合羊膜移植治疗眼表疾病的临床研究

Clinical Research of Limbus Epithelial Associated with Amniotic Membrane Transplantation for Treatment of Ocular Surface Diseases

目的：探讨角膜缘上皮联合羊膜移植治疗眼表疾病的临床效果．方法：对本院复发性翼状胬肉６例（６眼），睑球粘连３例（３眼），陈旧性碱烧伤３例（眼），角膜缘外伤２例（２眼），角巩膜大面积皮样囊肿１例（１眼），采用甘油保存的人羊膜联合自体或异体角膜缘移植进行治疗．结果：复发性翼状胬肉６例（６眼），术后随访４月～２年，上皮愈合稳定，角膜光滑透明，无１例复发．视力提高或保持不变．陈旧性碱烧伤３例（４眼），分别随访３、８、１２个月，眼表面保持安静，角膜中央无血管生长，周边部有少许的新生血管；１例手术失败，出现广泛的角膜血管生长，基质溶解．１例角巩膜大面积皮样囊肿，术后角膜半透明，外观正常，视力除１例失败外，视力均有不同程度提高，从术前光感－０．０５提高至０．０２｀０．８不等．结论：保存的人羊膜无抗原性，具有抗炎和抑制新生血管及纤维化、阻止结膜源组织再侵入的作用．用角膜缘上皮联合羊膜移植是一种有效的治疗眼表疾病的手段．

Objective: To investigate the effect of limbus epithelial associated with amniotic membrane transplantation for treatment of ocular surface diseases. Methods: Amniotic membrane preserved by glycerine associated with allograft or autograft limbal transplantation was performed in 6 patients (6 eyes) with recurrent pterygium, 3 patients (4 eyes) with symblepharon, (4 eyes) with alkali burn, 2 patients (2 eyes) with limbal trauma and 1 patient (1 eye) with wide-ranged dermoid in corneoscleral limbus. Results: In 6 patients with recurrent pterygium, follow-up ranging from 4 months to 2 years, the epithelium was stable, the cornea was transparent and glossy, the visual acuity was improved or unchanged and no recurrence was observed. In 3 patients with alkali burn, follow-up for 3 months, 8 months and 12 months respectively, the epithelium was stable, no neovascular was found in central corneal and only a few in periphery; one was failed with wide-ranging corneal neovascularization and stromal dissolved. In one patient with dermoid, the corneal was semitransparent and the appearance was normal. In all patients, the visual acuity was improved varied from light perception-0.05 pre- operation to 0.02-0.8 post-operation except one with the failed operation. Conclusions: Preserved human amniotic membrane has no antigen and can restrain inflammation, neovascularization and fibrosis and prevent invading of conjunctival tissue. Limbus epithelial associated with amniotic membrane transplatation was a available treatment for ocular surface diseases.