羊膜移植治疗睑球黏连的临床观察（英文）

Role of amniotic membrane transplantation in symblepharon

目的:评估羊膜移植(AMT)在治疗睑球黏连中的应用效果。方法:这项无对照干预性病例研究于2013/01~2015/12,包括连续就诊的12名患者共14眼。患者均接受永久性羊膜移植,以治疗睑球黏连,使用冷冻保存或冷冻干燥的羊膜(AM)。这12例(14眼)患者,年龄在26~62岁,平均43.38±11.25岁,其中8例(4名男性,4名女性)10眼为翼状胬肉切除术后继发,4例患者(1名男性,3名女性)斜视手术后继发。所有患者距上次手术至少6mo。术后以恢复深度稳定的穹窿为手术成功,无瘢痕或炎症发生,6mo的随访期间无眼球运动的限制。结果:随访期平均为7±4.2mo(6-9mo)。在所有14只眼中,手术后3wk均观察到AM完全上皮化,手术部位无炎症表现。总共14眼中有8眼(成功率57%)显示穹窿重建成功,穹窿深,无复发。有4眼(29%)表现出部分成功,中度深度的穹窿和中度瘢痕。有2眼(14%)显示重建失败,穹窿完全闭合。有7眼手术后视力改善,7眼视力保持稳定。AMT术后并发症少,14眼中1眼(7%)发生严重的结膜反应和眼球运动受限。而在术后前3mo中,14眼中有2眼发生化脓性肉芽肿(14%),予以手术切除,局部糖皮质激素注射。结论:单用AMT是一种治疗睑球黏连安全有效的方法。考虑到与角膜缘切除有关的潜在不良反应,AMT也是一种有效的重建穹窿以修复各种眼表疾病所致睑球黏连的方法。

AIM： To evaluate the use of amniotic membrane transplantation（AMT）in symblepharon. METHODS： This non-comparative interventional case study was conducted from January 2013 to December 2015 and included a consecutive series of 14 eyes of 12 patients. Patients were selected for permanent AMT. The amniotic patches were grafted for the treatment of symblepharon. Cryo-preserved or freeze-dried amniotic membrane（AM）was used. Regarded to the 14 eyes（12 patients）, their age was ranged from 26-62y, with the mean age of 43.38±11.25, 10 eyes of 8 patients（4 males/4 females）were presented with symblepharon secondary to previous pterygium surgery, and 4 eyes of 4 patients（1 male/3 females）were presented with symblepharon secondary to previous strabismus surgery, at least 6mo after the last surgery. The outcome of success was defined as restoration of a stable-depth fornix and being free of scar or inflammation, and no motility restriction during the follow up of 6mo. RESULTS： The mean follow-up period was 7±4.2mo（range 6-9mo）. In all 14 eyes, complete epithelialization of AM was observed 3wk after surgery, resulting in a non-inflamed appearance of the surgical site. Eight eyes out of total 14 eyes showed successful fornix reconstruction with success rate（57%）, the fornix was deep, and no recurrence was observed. Four eyes（29%）showed partial success with moderate depth of the fornix and moderate scar. Two eyes（14%）showed failure of reconstruction of the fornix with complete fornix obliteration. The visual acuity improved after surgery in 7 eyes while remained stable in 7 eyes. Post-operative complications from the AMT was very limited as severe conjunctival reaction and motility restriction was occurred only in one eye out of 14 eyes（7%）and pyogenic granuloma occurred in 2 eyes out of 14 eyes（14%）in the first 3mo after surgery and was managed with surgical excision, with local corticosteroid injection. CONCLUSION： AMT alone is a safe and effective method for symblepharon. Considering the potential adverse effects associated with limbal excision, also, AMT is an effective method of fornix reconstruction for the repair of symblepharon in a variety of ocular surface disorders.