新鲜人羊膜移植在重建眼表结构中的临床应用

A clinical study on transplantation of fresh human amniotic membrane for ocular surface reconstruction.

目的 评价新鲜羊膜移植手术在眼表结构重建中的临床效果。方法 对76例不同眼表疾病采用新鲜人羊膜移植手术以重建眼表结构,其中2例眼球碱烧伤角膜缘干细胞严重缺乏角膜溃疡,8例为大泡性角膜炎,4例为真菌性角膜炎,1例严重睑球粘连,61例翼状胬肉(4例为复发性)。结果 术后均未见新鲜羊膜植片急性排斥反应。碱烧伤的2眼,无角结膜进行性溶解和穿孔,无新生血管或假性胬肉侵入角膜表面。大泡性角膜炎,症状均消失;真菌性角膜炎,溃疡全部痊愈。61例翼状胬肉4例复发。结论 新鲜羊膜移植重建角结膜表面,减轻了炎症反应,减少新生血管的生成,抑制纤维组织增生。充分清除眼表的病变组织和羊膜移植片的缝合固定,对羊膜移植重建眼表结构,恢复功能极其重要。

Objective To evaluate the clinical efficacy of fresh human amniot-ic membrane transplantation for ocular surface reconstruction. Methods 76 patients(76 eyes) with various ocular surface diseases were treated for ocular surface reconstruction with transplantation of fresh human amniotic membrane. 2 patient with severe alkali chemical burn combined with corneal ulcer and deficiency of limbal stem cell,8 patients with bullous keratitis, 4 patients with corneal ulcer, 1 eye with severe symblepharon, 61 patients with pteygia (4 patients of them was recurrent). Results No acute rejection was observed after fresh amniotic membrane transplantation. No progressive melt and perforation were seen in two eyes, neovas-cularization, pseudopterygium and iris atrophy were not forund during the follow - up, visual acuity was improved in various degrees. 8 patients with bullous keratitis were successful, corneal ulcer was successful in 4 cases (4 eyes). Ocular surface reconstruction was successful in the eyes with severe symblepharon. Pterygium was successful in 57 of 61 cases. Conclusion Fresh amniotic membrane can be used as a graft to reconstruct ocular surface. Such transplantation can effectively reduce neovasculariza-tiori,fibrosis and inflammation. Our data indicated that complete removal of pathological tissues and perfect fixation of amniotic membrane graft are crucial steps in the reconstruction of ocular surface.