羊膜联合角膜缘干细胞移植治疗眼表疾病的临床效果

Clinical efficacy of amniotic membrane combined with limbal stem cell transplantation for ocular surface diseases

目的分析羊膜联合角膜缘干细胞移植治疗眼表疾病的效果。方法前瞻性随机对照研究。将南阳南石医院于2019年3月至2021年3月眼表疾病82例(82眼)随机分为两组:对照组41例行自体角膜缘干细胞移植,观察组41例在此基础上联合应用羊膜移植。比较两组临床疗效,术前、术后3个月角膜厚度、新生血管面积、泪液分泌试验结果、术后角膜上皮修复用时、视力提升率、术后复发率和手术满意度。结果观察组治疗总有效率(40/41,97.56%)高于对照组(33/41,80.49%)(χ^(2)=4.49,P=0.034);观察组术后患眼新生血管面积(25.17±6.84)mm 2小于对照组(31.25±5.44)mm 2、泪液分泌试验(10.31±1.08)mm长于对照组(8.64±1.33)mm(t=4.46、6.24,均P<0.001);观察组患者角膜上皮修复用时(3.17±0.64)d短于对照组(3.81±0.71)d(t=4.29,P<0.001),观察组视力提升率(41/41,100.00%)高于对照组(35/41,85.37%)(χ^(2)=4.49,P=0.021),两组术后1年复发率比较差异无统计学意义(χ^(2)=1.99,P=0.158);观察组对治疗效果满意程度(39/41,95.12%)显著高于对照组(32/41,78.05%)(χ^(2)=5.15,P=0.023)。结论眼表疾病应用羊膜联合角膜缘干细胞移植效果良好。

Objective To analyze the efficacy of amniotic membrane combined with limbal stem cell transplantation on ocular surface diseases.Methods This was a prospective randomized controlled study.A total of 82 eyes of 82 patients with ocular surface diseases from Mar.2019 to Mar.2021 in Nanyang Nanshi Hospital were divided randomly into two groups:the control group with 41 cases which received limbal stem cell autologous transplantation,and the observation group with 41 cases which was treated with amniotic membrane transplantation.The clinical efficacy,corneal thickness,neovascular area,tear secretion test results,postoperative corneal epithelial repair time,visual improvement rate,postoperative recurrence rate and surgical satisfaction were compared between the two groups before and at 3 months after surgery.Results The total effective rate of the observation group(40/41,97.56%)was higher than the(33/41,80.49%)of the control group(χ^(2)=4.49,P=0.034).The neovascularization area(25.17±6.84)mm 2 in the observation group was smaller than the(31.25±5.44)mm 2 in the control group,and the tear secretion experiment length[(10.31±1.08)mm was longer than the(8.64±1.33)mm in the control group(t=4.46,6.24;all P<0.001);The time of corneal epithelial repair in the observation group was shorter[(3.17±0.64)days]than that in the control group[(3.81±0.71)days](t=4.29,P<0.001),and the visual acuity improvement rate in the observation group(41/41,100.00%)was higher than that in the control group(35/41,85.37%)(χ^(2)=4.49,P=0.021).There was no significant difference in recurrence rate at 1 year after surgery between the two groups(χ^(2)=1.99,P=0.158).The satisfaction rate of the observation group(39/41,95.12%)was significantly higher than that of the control group(32/41,78.05%)(χ^(2)=5.15,P=0.023).Conclusion The application of amniotic membrane combined with limbal stem cell transplantation for ocular surface diseases is feasible,which can reduce the area of neovascularization in cornea and conjunctiva,promote corneal repair,improve visual acuity and improve patients’satisfaction in treatment.