羊膜移植重建眼表的临床观察

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

目的 :评价羊膜移植重建眼表的临床疗效。方法 :对角膜溃疡等角结膜疾病 19眼施行羊膜移植术并随访 5～ 18月。其中角膜溃疡 8眼 ,睑球粘连 2眼 ,复发性蚕蚀性角膜溃疡 1眼 ,眼化学伤 2眼 ,复发性翼状胬肉 6眼。术中根据病情清除病变组织 ,行单层或双层羊膜移植或角膜板层移植联合羊膜移植或羊膜移植联合眼睑再造术。结果 :19眼中 18眼获得稳定眼表面 ,1～ 3周角膜上皮愈合 ,炎症得到控制 ,睑球粘连解除。术后 15眼视力有不同程度的提高。其中提高 3行以上 9眼 ,视力不变 4眼。 5眼术后 9～ 13d羊膜变薄 ,数天后羊膜大部溶解 ,2眼植片溶解后角膜上皮逐渐愈合 ,术后 2 1d荧光素染色转阴 ;1眼为复发性翼状胬肉术后羊膜植片下积液致使植片溶解脱落 ,术后 4个月新生血管长至角膜缘内 2mm ;1例角膜瘘患者术后瘘孔愈合 ,眼压升至正常 ,前房形成 ,视力从光感提高至指数 ,3月后行穿透性角膜移植手术成功。结论 :羊膜移植可有效的重建角结膜表面 ,减轻炎性反应 ,减少新生血管的生成 ,抑制纤维组织增生 。

Objective:To investigate the method and the efficacy of human amniotic membrane transplantation (AMT) in the reconstruction of ocular surface with severe inflammation ,scarring and other disorders. Methods:19 eyes including corneal ulceration 8 eyes, symblepharon 2 eyes, recurrent Mooren's ulcer 1 eye, chemical burn of corneal 2 eyes, recurrent pterygium 6 eyes, were treated with AMT, or combined with lamellar keratoplasty and followed up for 5～18 months.Results:In 19 eyes, 18 eyes were reconstructed the ocular surface,the cornea epithelium was recovered ,the ocular inflammation was controlled, and the symblepharon improved. Healing of the corneal ulcer was obtained at 1～3 weeks after surgery. No acute rejection was observed after amniotic membrane transplantation. Visual acuity was improved in various degrees in 14 eyes.Conclusion:The transplantation of amniotic membrane have shown to be effective in enhancing healing of the corneal defects, in prevention of symblepharon formation and recurrent pterygium ingrowth.Such AMT can effectively reduce neovascularization, fibrosis and inflammation. In case of impending perforation, AMT alone is not a method of treatment but is useful as a first step procedure in prepairing the eye for the corneal transplantation.