Amniotic membrane transplantation for reconstruction after excision of large ocular surface neoplasias

AIM: To evaluate the clinical outcome of patients in whom ocular surface reconstruction was performed using amniotic membrane transplantation (AMT) after the excision of large (>20 mm square) ocular surface neoplasias (OSN). METHODS: A non-comparative interventional case series. In 16 eyes of 16 patients, excision of large OSN including conjunctival intraepithelial neoplasia (CIN), primary acquired melanosis, and malignant melanoma was followed by adjunctive cryotherapy and suturing of a single layer of amniotic membrane (AM) with the basement membrane side facing up to the healthy bordering tissue. Epithelial healing, complications, and tumour recurrences were analysed. RESULTS: During a mean follow up of 23.7 (SD 11, range 11-43) months, ocular surface healing was rapid and complete in all cases. One complication of pyogenic granuloma was noted. Tumour recurrence occurred in one out of 10 CIN cases (10%), no recurrences were observed in the patients with melanotic lesions. CONCLUSIONS: AMT in lieu of conjunctival or mucosal autograft is an effective substrate for reconstructing the ocular surface following excision of large OSN. AMT is effective in managing large OSN by avoiding the complications that may be associated with conventional removal, specifically in cases where the limbal architecture is destroyed by surgical resection or adjuvant therapies.     

春季角结膜炎巨大乳头手术治疗的临床分析

目的探讨上睑乳头切除、冷冻联合羊膜移植治疗有巨大乳头的春季角结膜炎的临床效果。方法对8例（16只眼）以上睑结膜巨大乳头为特征的药物治疗无效的春季角结膜炎患者,采用上睑结膜巨大乳头切除,-70℃二氧化碳冷冻上睑结膜表面,并移植单层羊膜于上睑表面的方法予以治疗。术后随访3～22个月,观察患者症状、体征的改变及并发症等情况。结果术后1周内,盾性角膜溃疡、角膜上皮点片状着色全部愈合,且在随访期间未复发。14只眼治愈,眼刺激症状手术后1个月基本消失,巨大乳头无复发、未出现睑内翻、倒睫等并发症,但上睑结膜血管纹理欠清,有少许瘢痕。2只眼巨大乳头复发,但范围较术前缩小,眼刺激症状也较术前减轻;其中1只眼经药物治疗后好转;另1只眼再次手术,用5-氟尿嘧啶棉片浸润上睑后行羊膜移植,术后随访9个月未复发。结论切除加冷冻联合羊膜移植可能是治疗难治的有巨大乳头的春季角结膜炎的安全有效的方法,但是应严格选择手术适应证。     

Role of amniotic membrane transplantation for conjunctival reconstruction in ocular-cicatricial pemphigoid

PURPOSE: To evaluate the role and the effectiveness over time of amniotic membrane transplantation (AMT) as a first-step procedure to treat conjunctival reconstruction in late-stage ocular-cicatricial pemphigoid (OCP). DESIGN: Prospective interventional noncomparative case series. PARTICIPANTS: Nine eyes (9 patients) with advanced OCP. METHODS: Preoperatively, the ocular surface conditions were evaluated by immunohistochemistry of conjunctival biopsy and impression cytology specimens. The amniotic membrane was obtained during cesarean section from women who were 39 weeks pregnant and seronegative for human immunodeficiency virus, hepatitis B and C, and syphilis; it was processed, histologically tested, and stored at -80 degrees C. After scar tissue was removed, the preserved amniotic membrane was placed over the cornea, the bulbar, and tarsal conjunctiva, and was secured with 8-0 Vicryl sutures to the conjunctival edges and the deep fornices with double-armed 6-0 silk sutures. In 2 cases a double layer of amniotic membrane was transplanted. All patients received immunosuppressive systemic therapy and preservative-free tear substitutes and steroids topically for at least 6 months. During follow-up (average, 48 weeks; range, 28-96 weeks), a new standardized method was used to evaluate the fornix depth, and impression cytology testing was performed and conjunctival inflammation recorded and used as parameters for monitoring disease activity. MAIN OUTCOME MEASURES: Symblepharon, increased inferior fornix depth, presence of conjunctival goblet cells, and the degree of conjunctival inflammation. RESULTS: The conjunctival surface was free from symblepharon in all subjects for the first 16 weeks. At the week 28 examination, a small area of symblepharon was present in four eyes (44.4%). The depth of the fornix was significantly (P < 0.0001, analysis of variance) improved at weeks 4, 16, and 28. The normal conjunctival epithelium with goblet cells was restored in 6 of 9 eyes (66.7%) at the week 4 examination and in 4 eyes (44.4%) at the week 28 examination. Conjunctival inflammation was clinically but not statistically reduced. The visual acuity improved in 5 subjects. CONCLUSIONS: AMT can be a first-step procedure for ocular surface reconstruction in OCP, but its effectiveness deteriorates slightly over time.     

Hughes technique, amniotic membrane allograft, and topical chemotherapy in conjunctival melanoma with eyelid involvement

A 59-year-old woman presented with a pigmented mass in the inferior tarsal conjunctiva of the left eye with an associated diffuse, multifocal pigmentation involving largely the inferior half of the bulbar conjunctiva, fornix, and eyelid skin. Histopathologic examination of map biopsies disclosed conjunctival melanoma from primary acquired melanosis. Surgical excision of the inferior bulbar conjunctiva, fornix, and lower eyelid with histopathologic free margins was performed. Adjuvant cryotherapy was applied. The bulbar conjunctiva and lower fornix were reconstructed with an amniotic membrane allograft. Lower eyelid reconstruction was accomplished by use of the Hughes technique. Topical mitomycin C (0.04%) was applied after surgery. After 2 years of follow-up, no tumor recurrence has been detected and the eyelid and conjunctival defect have been satisfactorily corrected. This combined surgical procedure using amniotic membrane allograft and a composite tarsoconjunctival flap is shown to be useful in the treatment of an advanced conjunctival neoplasia with extensive eyelid involvement.     

Amniotic membrane transplantation with conjunctival autograft for recurrent pterygium

OBJECTIVE: To study the effect of amniotic membrane transplantation (AMT) combined with either limbal autograft transplantation (LAT) or conjunctival autograft transplantation (CAT) in recurrent pterygium. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Twenty-seven eyes of 27 patients with recurrent pterygium. The mean number of prior surgeries was 3.1 (range, 1-10). Fifteen eyes each had restriction of ocular movement and symblepharon before surgery. INTERVENTION: Patients were treated by AMT with either LAT (n = 15) or CAT (n = 12). MAIN OUTCOME MEASURES: Recurrence of pterygium, improvement in ocular movement, and symblepharon formation. RESULTS: Twenty-three (85.2%) of 27 eyes showed no recurrence with a mean observation period of 67.0 weeks. Fourteen eyes (93.3%) each showed improvement in ocular movement restriction and symblepharon after AMT. In four eyes that developed recurrence, three had LAT and one had CAT combined with AMT, suggesting that there was no difference in surgical outcome between LAT and CAT. CONCLUSIONS: AMT with CAT is a safe and effective method for recurrent pterygium, especially that associated with ocular movement restriction and symblepharon. Considering the potential adverse effects associated with limbal excision, AMT plus CAT may be preferred over AMT plus LAT.     

Amniotic membrane transplantation for reconstruction of the conjunctival fornices

PURPOSE: To describe the clinical outcome of amniotic membrane transplantation (AMT) for fornix reconstruction in a variety of ocular surface disorders. DESIGN: Noncomparative interventional case series. PARTICIPANTS: Seventeen eyes in 15 patients with symblepharon. Four eyes had ocular-cicatricial pemphigoid, two eyes had symblepharon after pterygium excision, four eyes had chemical or mechanical trauma, two eyes had strabismus surgery, two eyes (one patient) had Stevens-Johnson syndrome, one eye had toxic epidermal necrolysis, and two eyes (one patient) had chronic allergic conjunctivitis. INTERVENTION: The subconjunctival scar tissue was dissected from the episclera, and the freed conjunctival flap was recessed to the fornix. A layer of amniotic membrane (AM) was applied to cover the exposed episclera. The fornical edge of the membrane was anchored with sutures passing through the full thickness of the lid. MAIN OUTCOME MEASURES: A deep conjunctival fornix, lack of motility restriction. RESULTS: The mean follow-up period was 37 +/- 24 months (range, 9-84 months). Complete fornix reconstruction was demonstrated in 12 of 17 eyes (70.6%), whereas 2 eyes had a partial success, and 3 eyes (3 patients) had recurrence of symblepharon with restricted motility. In eyes that demonstrated partial success or failure, the underlying etiology was either an autoimmune disorder or a recurrent pterygium. The most successful outcome was observed in eyes with symblepharon associated with trauma. CONCLUSIONS: AMT is an effective method of fornix reconstruction for the repair of symblepharon in a variety of ocular surface disorders. Future modifications, including an epithelial cellular component on the AM (conjunctival autograft or ex vivo expanded epithelial stem cells) may improve the outcome of this surgical procedure.     

Amniotic membrane transplantation in the management of conjunctival malignant melanoma and primary acquired melanosis with atypia

AIM: To evaluate the efficacy of amniotic membrane transplantation (AMT) for the management of conjunctival malignant melanoma and primary acquired melanosis (PAM) with atypia. METHODS: Four consecutive patients with histologically proved invasive, primary conjunctival malignant melanoma were treated with wide surgical excision and AMT. Amniotic membrane grafts were harvested and processed under sterile conditions according to a standard protocol. The grafts were sutured to the margins of the surface defect. In one case, AMT was combined with a corneoscleral graft. RESULTS: A satisfactory result and rapid postoperative recovery with few, transient side effects was noted in three patients with limbal/epibulbar melanomas. In another patient with an extensive lesion, involving the epibulbar, forniceal, and palpebral conjunctiva, AMT following wide excision was complicated by symblepharon formation and restricted ocular motility. Monitoring of local recurrence was facilitated by the transparency of the thin graft in all cases. The postoperative follow up time varied between several months and 3 years. In one case, local recurrence of PAM was observed and treated using topical mitomycin. CONCLUSIONS: AMT is a useful technique for the reconstruction of both small and large surface defects that result from the surgical excision of conjunctival malignant melanoma and PAM. This method facilitates wide conjunctivectomy, although its role in repairing larger defects involving the fornix or palpebral conjunctiva still needs to be established. The transparency of amniotic membrane allows for monitoring of tumour recurrence, which is-together with superior cosmesis-an advantage over thicker (for example, buccal) mucous membrane grafts.     

Amniotic membrane transplantation for ocular surface reconstruction in Stevens-Johnson syndrome

PURPOSE: To evaluate amniotic membrane transplantation (AMT) for ocular surface reconstruction in Stevens-Johnson syndrome (SJS). DESIGN: Prospective interventional case series. PARTICIPANTS: Ten consecutive patients (10 eyes) with SJS that underwent AMT as the first step in staged ocular surface reconstruction were included. METHODS: Amniotic membrane was processed under sterile conditions from a fresh placenta obtained from cesarean section in a seronegative pregnant woman and stored at -700 degrees C. Symblepharon release, excision of epibulbar fibrous tissue, and clearing of the fibrovascular membrane over the cornea was performed in all cases. Amniotic membrane covered the entire bulbar surface up to the fornices in five eyes; cornea and the perilimbal area in two eyes; cornea, the inferior bulbar surface, and the lower fornix in two eyes; and cornea and the superior bulbar surface in one eye. Obliterated fornices were deepened by use of fornix-formation sutures in all eyes. Symblepharon ring was placed postoperatively for 3 weeks to 2 months. Mean postoperative follow-up was 13.5 months (SD, +3.8 months; range, 9-30 months). MAIN OUTCOME MEASURES: Restoration of adequate bulbar surface free of symblepharon and good fornix depth were the main outcome measures. RESULTS: Complete corneal reepithelization occurred in all eyes between 1 and 6 weeks. Adequate bulbar surface and fornix depth were achieved in nine eyes, all of which were free of symblepharon at the final follow-up visit. Cicatricial entropion resolved in four of five lower eyelids and one of two upper eyelids after AMT. One patient had a central corneal melt that required or necessitated a penetrating keratoplasty. CONCLUSIONS: AMT restores adequate bulbar surface and fornix depth and prevents recurrence of symblepharon in severe cases of SJS.     

血管膜切除联合羊膜移植治疗复发性免疫性角结膜炎

目的报告局部血管膜切除联合羊膜移植治疗复发性免疫性角结膜炎的初步临床结果。设计回顾性病例系列。研究对象病变反复发作并开始累及角膜、药物控制欠佳的泡性角膜炎患者2例、结节状巩膜炎累及角膜1例、角膜基质炎2例。方法切除局部角巩膜缘部结膜及巩膜表面变性组织,并移植相应大小的羊膜组织。术后局部免疫抑制剂治疗2￣3周,随访6￣12个月。主要指标并发症与复发情况。结果4例患者在停药4￣10个月后无复发,角膜浸润逐渐减轻,血管萎缩。1例结节状巩膜炎患者在术后12个月时病变复发,但仅局限于球结膜部位,角膜病变无复发。结论对于反复发作、病变累及角膜的免疫性角结膜炎,局部球结膜切除联合羊膜移植可以阻止角膜病变的进展。(眼科,2006,15:177-179)     

Surgical Excision, Cryotherapy, Autolimbal Transplantation and Mitomycin-C in Treatment of Conjunctival–corneal Intraepithelial Neoplasia

Purpose To report surgical excision, cryotherapy, autologous conjunctival–limbal transplantation and topical mitomycin C (MMC) in the patient with extensive conjunctival–corneal intraepithelial neoplasia. Methods Case report and literature review. Results A 75-year-old woman was referred to our department with the diagnosis of conjunctival–corneal neoplasia. Slit-lamp microscopic examination revealed an extensive papilliform tumoral mass invading the limbus at 360-degrees, and bulbar conjunctiva and cornea. Visual acuity was finger counting from 2 m in the right eye and 20/20 in the left eye. We performed total surgical excision, cryotherapy and autologous conjunctival–limbal transplantation in the right eye. Mitomycin-C 0.02% eye drops four times a day were prescribed for 4 weeks after the surgery. After the treatment, the visual acuity increased to 0.7 in the right eye. Corneal epithelium completely healed within 1 week after the surgery. No corneal epithelium-related problem or neoplasia recurrence were noted during the 2-year follow-up period. Conclusions This technique may be useful in reconstruction of eyes with extensive neoplastic involvement of the conjunctiva, limbus, and cornea. In addition, mitomycin C drops may be useful in preventing postoperative recurrence of conjunctival–corneal intraepithelial neoplasia.     

Surgical management of ocular surface squamous neoplasms: the experience from a cornea center

PURPOSE: To report the surgical outcomes of treatment for ocular surface squamous neoplasms. METHODS: Retrospective review of squamous neoplasms of the ocular surface managed at a cornea center over a 15-year period. Surgical treatment was divided into two methods. The procedure was identical within each group. One group of patients was treated with simple excision of the lesion. The second group of patients was treated with excision followed by focal cryotherapy to the involved limbus and/or conjunctival margin. Follow-up is reported. RESULTS: A total of 28 lesions were reviewed. Included were 20 primary tumors and 8 recurrent tumors referred following initial treatment at other centers. Histopathologic diagnoses included 1 actinic keratosis, 7 dysplasias, 18 carcinomas in situ, and 2 invasive squamous cell carcinomas. The rate of recurrence for primary tumors was 28.5% with simple excision and 7.7% for excision combined with cryotherapy (p = 0.27). The rate of recurrence for recurrent tumors was higher: 16.6% for tumors treated with excision and cryotherapy and 50% (one in two) for lesions treated with simple excision (p = 0.46). CONCLUSION: Simple excision of ocular surface squamous neoplasms appears to result in a higher recurrence rate when compared to excision with adjunctive cryotherapy. Judicious cryotherapy to the involved limbus and conjunctival margins results in recurrence rates comparable with other, more extensive cryotherapy procedures. This technique of cryotherapy has very few adverse effects on the eye.     

Use of nonpreserved human amniotic membrane for the reconstruction of the ocular surface

PURPOSE: To describe the use of nonpreserved human amniotic membrane (NP-AMT) as an alternative to preserved human amniotic membrane (AMT) for the reconstruction of the ocular surface in several diseases. METHODS: NP-AMT was used in the treatment of five patients with the following diseases: noninvasive conjunctival squamous cell carcinoma, corneal persistent epithelial defect, severe alkali burn, near total limbal deficiency secondary to multiple surgeries, and ocular cicatricial pemphigoid. In some cases, a limbal autograft or allograft was employed simultaneously, sutured on top of the NP-AMT. All sutures were made with 10-0 Nylon and were removed at two weeks. RESULTS: Ocular surface was satisfactorily reconstructed, eyes were quiet, and patients were comfortable despite prolonged deepithelialization in some cases. There was a case of a limbal autograft ischemia--in the burned patient--that caused partial corneal conjunctivalization. Initially, the NP-AMT looks thickened but thins around the fifth day and looks similar to AMT. CONCLUSION: Results using NP-AMT are similar to those of AMT. It is a good alternative and it is easily obtained in places were AMT is not available or is too expensive to procure.     

Management of conjunctival and corneal melanoma with surgical excision, amniotic membrane allograft, and topical chemotherapy

PURPOSE: To illustrate a novel method of management for extensive conjunctival and corneal melanoma. METHODS: Interventional case report. A 40-year-old Caucasian woman presented with a large, diffuse conjunctival melanoma involving 6 clock hours of the limbus. The remaining bulbar conjunctiva and the entire corneal epithelium were affected by diffuse, flat melanosis. RESULTS: The conjunctival melanoma was completely resected microsurgically in one piece without disrupting the tumor. The conjunctival melanosis was treated with double freeze-thaw cryotherapy. The extensive conjunctival defect, involving one-half of the bulbar conjunctiva, was reconstructed with an amniotic membrane allograft. The corneal melanosis was subsequently treated with topical mitomycin C eyedrops. At 8 months follow-up, the conjunctiva and the cornea were completely healed with resolution of all pigment and 20/20 visual acuity. CONCLUSION: Preliminary evidence suggests that combined therapeutic approaches, consisting of extensive tumor removal, cryotherapy, amniotic membrane allograft, and topical mitomyin C, can be effective in the management of diffuse conjunctival and corneal melanoma arising from primary acquired melanosis.     

羊膜移植治疗春季角结膜炎的角膜缘病变

目的:评估角膜缘病变区球结膜环形切除联合羊膜移植治疗角膜缘病变为主的春季角结膜炎的临床效果。方法:对 10 例(20 眼)以角膜缘病变为特征的春季角结膜炎患者,采用角膜缘病变区球结膜环形切除联合羊膜移植的方法予以治疗。术后随访 5～21mo,观察其症状、体征的改变及复发情况。结果:手术后,患者症状明显改善:痒感、分泌物多、异物感等症状基本消失;手术后 1wk 内,畏光、流泪明显,后逐渐减轻,手术 1mo 后基本消失。角膜缘黄褐色或污红色胶样结节手术清除后在随访期间未复发;角膜上皮点状着色(11 眼),角膜溃疡(3 眼)于手术后 1wk 内愈合染色转阴且在随访期间未复发;术后球结膜充血逐渐减轻,19 眼手术1mo 后充血基本消失,且角膜缘羊膜移植区的球结膜较正常偏白,但有 1 眼术后球结膜充血间断反复约 5mo 并伴有轻度痒感,药物可减轻该眼的痒和充血,但多次出现反复。所有病例随访期间未发现严重的并发症。结论:角膜缘病变区球结膜切除联合羊膜移植治疗角膜缘病变为主的春季角结膜炎是有效安全的,但应严格选择手术对象。     

Nonpreserved human amniotic membrane transplantation in acute and chronic chemical eye injuries

PURPOSE: To evaluate the safety and efficacy of nonpreserved amniotic membrane transplantation (AMT) with or without limbal autograft transplantation (LAT) in management of acute and chronic chemical eye injuries. METHODS: Amniotic membrane transplantation or AMT + LAT was performed on nine eyes of seven consecutive patients, five eyes with acute chemical burn and four eyes with limbal stem cell deficiency secondary to previous chemical burn. Nonpreserved amniotic membrane was used in all procedures. RESULTS: Five patients (71.5%) were men and two (28.5%) were women. The average age at the time of surgery was 32.7 +/- 10.9 years (range, 20-45). Mean follow-up after last surgery was 8.9 +/- 3.2 months (range, 6-14). The average epithelial healing time was 24.6 +/- 17.3 days (range, 3-45). At the end of the follow-up period, visual acuity improved in all eyes, inflammation subsided, and the subjective complaints decreased remarkably. CONCLUSION: AMT with nonpreserved amniotic membrane promoted epithelial healing, reduced surface inflammation, increased patient comfort, and decreased the extent and severity of vascularization when used in patients with acute chemical burns. When used in limbal stem cell deficiency owing to past chemical burns, AMT alone or in combination with LAT aided in ocular surface reconstruction. Infectious, inflammatory, or toxic/allergic reactions were not encountered in any patient owing to the use of nonpreserved amniotic membrane. Further studies are required to establish the safety and efficacy of preserved and nonpreserved AMT in ocular surface reconstruction.     

Amniotic membrane as an adjunct to donor sclera in the repair of exposed glaucoma drainage devices

PURPOSE: To describe a novel method of repairing exposed glaucoma drainage devices (GDD) using amniotic membrane transplantation (AMT) in place of conjunctiva to cover donor sclera when conjunctival closure is hampered by adjacent scarring. DESIGN: Retrospective noncomparative interventional case series. METHODS: Consecutive case series of nine GDD erosions over 5 years repaired by a double-layer technique of scleral allograft plus AMT. RESULTS: Successful repair was achieved in seven cases. One GDD plate re-eroded after pars plana vitrectomy; a second leaked from the tube entry site. CONCLUSIONS: AMT is a safe and useful conjunctival substitute to cover donor sclera in situations where conjunctival scarring might otherwise preclude successful repair.     

Amniotic membrane transplantation with conjunctival limbal autograft for total limbal stem cell deficiency

PURPOSE: To evaluate the outcomes of corneal surface reconstruction with conjunctival limbal autograft when combined with amniotic membrane transplantation on both the donor and recipient eyes. DESIGN: Retrospective, noncomparative, interventional small case series. PARTICIPANTS: Five eyes of five patients with total limbal stem cell deficiency (LSCD) resulting from pseudopemphigoid (n = 1), chemical burns (n = 3), and extensive removal of conjunctival intraepithelial neoplasia (n = 1) were operated on by one surgeon (SCGT). INTERVENTION: After the removal of fibrovascular pannus from the corneal surface, two conjunctival limbal free grafts were harvested from the fellow eyes in all five patients with unilateral LSCD. Amniotic membrane, with the basement membrane side up, was grafted onto the defect created at the donor site and onto the recipient corneal and limbal sclera before placement of conjunctival limbal grafts. MAIN OUTCOME MEASURES: Symptomatic relief, improvement in visual acuity, fornix deepening, and rapid healing and restoration of normal cornea and limbus in the recipient and donor eyes were assessed. RESULTS: During the mean follow-up of 22 months (range, 11-48 months), all eyes experienced symptomatic relief. All recipient eyes had a mean improvement in visual acuity of nine lines (range, 7-12). The three eyes with stromal vascularization showed regression, and all recipient eyes had marked improvement in corneal clarity. Three eyes receiving simultaneous symblepharon lysis and fornix reconstruction successfully regained deep, stable fornices. The donor eyes showed rapid healing and restoration of the normal limbal landmark, even in one eye where nearly the entire limbus was removed. CONCLUSIONS: Limbal conjunctival transplantation is an effective procedure for restoring the corneal surface integrity in eyes with total LSCD. The additional use of amniotic membrane may contribute to a higher rate of success in the recipient eye and a lower rate of complications in the donor eye, as well as allow the simultaneous correction of concomitant cicatricial abnormalities.     

Amniotic Membrane Transplantation for Conjunctival Tumor

Purpose:To evaluate the possibility of amniotic membrane transplantation (AMT) for the treatment of conjunctival tumor.Methods:Preserved AMT was performed in 26 patients (26 eyes) with conjunctival tumor, including 9 eyes (34.62％) with malignant tumor (conjunctival malignant melanoma, corneal and conjunctival squamous cell carcinoma, conjunctival lymphoma), 17 eyes (65.38％) with benign tumor(conjunctival papilloma, conjunctival dermoid tumor, conjunctival nevus, hemangioma etc.).Result:All the patients are followed up for 1～53 months. No acute rejection was observed after preserved AMT. Ideal healing was found in conjunctiva wound.Conclusion:Preserved AMT is a very effective method to repair wound after giant conjunctival tumor operation. Complete removal of tumor and perfect fixation are the key of ocular surface reconstruction. Eye Science 2003;19:165-167.     

眼烧伤后重度睑球粘连眼表重建的临床研究

目的探讨新鲜供体带角膜缘板层角膜移植（LKP）联合带角膜缘干细胞自体球结膜移植和羊膜移植治疗眼烧伤后重度睑球粘连的眼表重建效果。方法选择1998年2月至2003年2月我院收治的眼烧伤后重度睑球粘连患者26例（26只眼）。根据视功能受损程度将睑球粘连分为4度．其中Ⅲ度19只眼、Ⅳ度7只眼。手术方法：（1）分离睑球粘连,保留假性胬肉;（2）利用新鲜供体行带角巩膜缘的部分LKP（19只眼）或全LKP（7只眼）;（3）取带角膜缘组织自体球结膜瓣移植于粘连最重的创面;（4）假性胬肉后徙,部分替代球结膜,联合羊膜移植重建结膜囊。术后随访8～36个月,观察结膜囊情况、眼球活动、角膜植片免疫排斥反应情况以及羊膜和假性胬肉的转归。结果除1只眼因睑裂闭合不全行永久性睑裂缝合术外,其余25只眼的眼表情况均得到不同程度改善。（1）睑球粘连：17只眼（65％）第一次手术后粘连完全分离,复视消失;8只眼（31％）在单纯羊膜覆盖的创面区复发条带状睑球粘连,其中5只眼经再次手术粘连完全解除,3只眼残余Ⅰ度粘连。（2）羊膜在术后1周开始自溶,3个月时完全消失;保留的假性胬肉术后1～3个月充血消退,逐渐变薄,相应区域无睑球粘连复发。（3）角膜情况：6只眼角膜植片发生免疫排斥反应,其中3只眼治疗后植片恢复透明,2只眼因植片混浊行二次LKP。结论新鲜供体带角膜缘LKP联合带角膜缘干细胞自体球结膜移植和羊膜移植是治疗眼烧伤后重度睑球粘连的有效方法,假性胬肉可部分替代球结膜重建结膜囊,羊膜移植在重度睑球粘连的治疗中仅发挥暂时支持创面促进眼表恢复的作用。（中华眼科杂志,2005,41：791-795）     

羊膜移植术治疗早期中度眼化学伤的效果观察

目的探讨羊膜移植治疗早期眼化学伤临床疗效。方法采用甘油保存的羊膜,治疗眼早期中度化学伤31例(32眼),其中酸烧伤10例(10眼)。碱烧伤21例(22眼)。手术时尽量去除眼表面的坏死组织,使植床保持健康。结果术后随访平均18月,所有化学伤患者结膜、角膜均良好愈合,新生血管明显减少。视力超过0.6者8眼。睑球粘连发生1例,有2例前后做了3次羊膜移植,才使角、结膜基本愈合,视力提高到0.2。结论羊膜移植治疗早期中度眼化学伤,疗效良好,且为以后的角膜移植手术打下良好基础。