Amniotic membrane transplantation with fibrin glue as treatment of refractory conjunctivochalasis

CASE REPORT: A 63-year-old man with bilateral conjunctivochalasis presented with tearing, irritation, foreign body sensation and a delayed fluorescein clearance test. After no symptomatic improvement with topical treatment, surgery was carried out, with amniotic membrane transplantation and fibrin sealant. DISCUSSION: Conjunctivochalasis is a frequent disorder that shares symptoms with dry eye syndrome. When there is no response to topical treatment, surgical treatment is needed. The surgical technique described by Tseng, and based on amniotic membrane transplantation without suture, resulted in a very useful response, due to less inflammation and a rapid resolution and improvement of symptoms.     

Amniotic membrane transplantation for symptomatic conjunctivochalasis refractory to medical treatments

PURPOSE. To determine whether preserved human amniotic membrane can restore the large conjunctival defect created during surgical removal of conjunctivochalasis. METHODS: Amniotic membrane transplantation was performed at two facilities in 40 consecutive patients (47 eyes) with symptomatic conjunctivochalasis refractory to conventional treatments. RESULTS: The majority of patients were elderly (73.1 +/- 9.7 years) and women (75%). Over a follow-up period of 6.9 +/- 4.3 months, 46 (97.8%) eyes recovered smooth, quiet, and stable conjunctival surfaces. Epithelial defects healed in 16.5 +/- 7.3 days. Episodic epiphora was resolved in 24 of 30 (83.3%) eyes and improved in five other eyes. Notable relief was also noted for such symptoms as fullness or heaviness (19/19, 100%), sharp pain (6/6, 100%), redness (14/17, 88.2%), tiredness (17/20, 80.9%), itching (11/13, 78.6%), blurry or decreased vision (6/8, 75%), burning (8/13, 61.5%), foreign body sensation (8/13, 61.5%), and crust formation (1/2, 50%). Complications included focal inflammation of the host conjunctiva adjacent to the graft (six eyes), scar formation (five eyes), and suture-induced granuloma (one eye). CONCLUSION: Amniotic membrane transplantation can be considered as an effective means for conjunctival surface reconstruction during removal of conjunctivochalasis.     

胶联羊膜移植治疗兔角膜深层损伤的研究

Objective To treat deep layer corneal damage using fibrin glue and amniotic memrbane transplant. Methods Forty-five rabbits were given deep lamellar keratectomies to cause deep layer corneal damage in their right eyes and were then randomly divided into 3 groups. The first group was given doublelayer amniotic membrane transplants where fibrin glue was used to connect the two layers of amniotic membrane. The second group was given double-layer amniotic membrane transplants where no fibrin glue was used. The third group was given no treatment. Clinical outcome was graded by corneal integrity, opacity and neovascularization, and detachment of amniotic membrane was recorded. The expression of apoptosis was monitored to assess the changes of morphology and histology on the 7th, 14th and 28th days after surgery.Results While the double-layer amniotic membrane without fibrin glue covered the cornea for (13. 15 ±2. 68 ) d, the double-layer amniotic membrane using fibrin glue covered the surface of the cornea for (20. 00 ± 2. 43 ) d ( t = 8. 470, P = 0. 000 ). The corneas in the first group recovered smoothly and transparently, maintained normal thickness and less neovascularization, whereas the corneas in the other two groups recovered irregularly, lost their transparency, became turbid and showed higher levels of neovascularization. There were statistically significant differences between the first and third groups for corneal opacity and neovasculariazation, where the 14th day after surgery, the first group scored 2. 62 and the third group scored 5. 19 (t =3. 986, P =0. 004), and the 28th day after surgery, the first group scored 2. 87 and the third group scored 4. 78 (t =3. 608, P=0. 007). Perforation did not appear in the first group,but the second group had 3 cases and the third group had 2 cases, all due to infection. The changes of morphology and histology showed that the damaged corneas were contained normal epithelial cells and regularly arranged fibrous cells on the 28th day after surgery. The apoptosis in corneas of the first group was less than that of the third group at all observed points (7th day: t =8. 153, P =0.000; 14th day: t =9. 693, P =0. 000; 28th day: t = 14. 050, P =0. 000), however, apoptosis in corneas in the second group was only different from that in the third group on the 7th day after surgery while other observed points showed no difference (7th day: t =5.474, P=0. 000). Conclusion Using bio-engineered fibrin glue in amniotic membrane transplants can repair deep layer corneal damage, reduce neovascularization, scarring and corneal apoptosis.     

胶联羊膜移植治疗兔角膜深层损伤的研究

Objective To treat deep layer corneal damage using fibrin glue and amniotic memrbane transplant. Methods Forty-five rabbits were given deep lamellar keratectomies to cause deep layer corneal damage in their right eyes and were then randomly divided into 3 groups. The first group was given doublelayer amniotic membrane transplants where fibrin glue was used to connect the two layers of amniotic membrane. The second group was given double-layer amniotic membrane transplants where no fibrin glue was used. The third group was given no treatment. Clinical outcome was graded by corneal integrity, opacity and neovascularization, and detachment of amniotic membrane was recorded. The expression of apoptosis was monitored to assess the changes of morphology and histology on the 7th, 14th and 28th days after surgery.Results While the double-layer amniotic membrane without fibrin glue covered the cornea for (13. 15 ±2. 68 ) d, the double-layer amniotic membrane using fibrin glue covered the surface of the cornea for (20. 00 ± 2. 43 ) d ( t = 8. 470, P = 0. 000 ). The corneas in the first group recovered smoothly and transparently, maintained normal thickness and less neovascularization, whereas the corneas in the other two groups recovered irregularly, lost their transparency, became turbid and showed higher levels of neovascularization. There were statistically significant differences between the first and third groups for corneal opacity and neovasculariazation, where the 14th day after surgery, the first group scored 2. 62 and the third group scored 5. 19 (t =3. 986, P =0. 004), and the 28th day after surgery, the first group scored 2. 87 and the third group scored 4. 78 (t =3. 608, P=0. 007). Perforation did not appear in the first group,but the second group had 3 cases and the third group had 2 cases, all due to infection. The changes of morphology and histology showed that the damaged corneas were contained normal epithelial cells and regularly arranged fibrous cells on the 28th day after surgery. The apoptosis in corneas of the first group was less than that of the third group at all observed points (7th day: t =8. 153, P =0.000; 14th day: t =9. 693, P =0. 000; 28th day: t = 14. 050, P =0. 000), however, apoptosis in corneas in the second group was only different from that in the third group on the 7th day after surgery while other observed points showed no difference (7th day: t =5.474, P=0. 000). Conclusion Using bio-engineered fibrin glue in amniotic membrane transplants can repair deep layer corneal damage, reduce neovascularization, scarring and corneal apoptosis.     

胶联羊膜移植治疗兔角膜深层损伤的研究

目的 探讨胶联羊膜治疗兔角膜深层损伤的效果,分析其促进角膜损伤愈合的机制.方法 新西兰大白兔45只,均以右眼作为实验眼,实验前采用裂隙灯显微镜检查排除角膜疾病,建立兔角膜深层损伤模型.采用单纯随机抽样法,将兔分为胶联羊膜组、普通双层羊膜组及损伤对照组,每组15只.前两组行嵌合式羊膜移植.术后观察记录羊膜溶解脱落时间,角膜荧光素染色,角膜混浊及新生血管等情况,并进行临床疗效评定.术后第7、14、28天,行苏木素-伊红染色组织病理学检查;原位末端标记法检测角膜基质凋亡细胞.两个实验组和对照组各时间点参数评分以及末端脱氧核苷酸转移酶介导的脱脲苷三磷酸缺口末端标记法(TUNEL)阳性细胞表达值分别进行正态性检验,方差齐性检验,采取的统计方法为两独立样本t检验.结果 胶联羊膜覆盖于角膜创面的时间(20.00±2.43)d,明显长于普通双层羊膜(13.15±2.68)d(t=8.470,P=0.000).术后第28天,胶联羊膜组角膜创面全部恢复正常厚度,角膜上皮荧光素染色均为阴性,角膜透明度高,新生血管较少.而普通双层羊膜和对照组尚有部分动物角膜荧光素小片浅层着色,角膜混浊明显,瘢痕致密,粗大新生血管长入角膜中央.胶联羊膜组和对照组术后第14、28天,角膜混浊和新生血管总评分比较,差异有统计学意义(术后第14天:胶联羊膜组2.62,对照组5.19,t=3.986,P=0.004;术后第28天:胶联羊膜组2.87,对照组4.78,t=3.608,P=0.007).整个观测期,胶联羊膜组损伤角膜无感染穿孔;而普通双层羊膜组和对照组分别有3例和2例,因角膜上皮迁延愈合导致感染穿孔.组织病理检查显示胶联羊膜组损伤角膜全部正常上皮化,基质胶原纤维排列整齐.在各观察时间点上,胶联羊膜组角膜基质凋亡细胞均明显少于对照组(术后第7天:t=8.153,P=0.000;术后第14天:t=9.693,P=0.000;术后第28天:t=14.050,P=0.000).而普通双层羊膜组与对照组比较,仅在术后第7天,差异有统计学意义(术后第7天:t=5.474,P=0.000).结论 胶联羊膜对兔角膜深层损伤具有良好的治疗效果,可显著促进角膜损伤愈合,抑制新生血管和瘢痕形成,抑制角膜基质细胞凋亡.

Abstract：

Objective To treat deep layer corneal damage using fibrin glue and amniotic memrbane transplant. Methods Forty-five rabbits were given deep lamellar keratectomies to cause deep layer corneal damage in their right eyes and were then randomly divided into 3 groups. The first group was given doublelayer amniotic membrane transplants where fibrin glue was used to connect the two layers of amniotic membrane. The second group was given double-layer amniotic membrane transplants where no fibrin glue was used. The third group was given no treatment. Clinical outcome was graded by corneal integrity, opacity and neovascularization, and detachment of amniotic membrane was recorded. The expression of apoptosis was monitored to assess the changes of morphology and histology on the 7th, 14th and 28th days after surgery.Results While the double-layer amniotic membrane without fibrin glue covered the cornea for (13. 15 ±2. 68 ) d, the double-layer amniotic membrane using fibrin glue covered the surface of the cornea for (20. 00 ± 2. 43 ) d ( t = 8. 470, P = 0. 000 ). The corneas in the first group recovered smoothly and transparently, maintained normal thickness and less neovascularization, whereas the corneas in the other two groups recovered irregularly, lost their transparency, became turbid and showed higher levels of neovascularization. There were statistically significant differences between the first and third groups for corneal opacity and neovasculariazation, where the 14th day after surgery, the first group scored 2. 62 and the third group scored 5. 19 (t =3. 986, P =0. 004), and the 28th day after surgery, the first group scored 2. 87 and the third group scored 4. 78 (t =3. 608, P=0. 007). Perforation did not appear in the first group,but the second group had 3 cases and the third group had 2 cases, all due to infection. The changes of morphology and histology showed that the damaged corneas were contained normal epithelial cells and regularly arranged fibrous cells on the 28th day after surgery. The apoptosis in corneas of the first group was less than that of the third group at all observed points (7th day: t =8. 153, P =0.000; 14th day: t =9. 693, P =0. 000; 28th day: t = 14. 050, P =0. 000), however, apoptosis in corneas in the second group was only different from that in the third group on the 7th day after surgery while other observed points showed no difference (7th day: t =5.474, P=0. 000). Conclusion Using bio-engineered fibrin glue in amniotic membrane transplants can repair deep layer corneal damage, reduce neovascularization, scarring and corneal apoptosis.     

Amniotic membrane transplantation and fibrin glue in the management of corneal ulcers and perforations: a review of 33 cases

PURPOSE: To evaluate the efficacy of amniotic membrane in corneal ulcers refractive to conventional treatment and amniotic membrane with fibrin glue in corneal perforations. METHODS: Amniotic membrane transplantation (AMT) was performed in 33 eyes from 32 patients for corneal ulcers refractive to conventional treatment. Fourteen ulcers were perforated and received fibrin glue and amniotic membrane. Ulcers were divided into 3 groups: neurotrophic or exposure, autoimmune, and other etiology. RESULTS: Overall success was observed in 80% (27/33 eyes) of the cases, with success rates of 87.5% (14/16 eyes), 70% (7/10 eyes), 85.7% (6/7 eyes) in groups 1, 2, and 3, respectively. The ulcers healed in a mean time of 3.6 +/- 1.6 weeks and the follow-up was 14.8 +/- 9.9 months. Failure was noted in 6 eyes with severe neurotrophic keratitis, Stevens-Johnson syndrome, ocular cicatricial pemphigoid, and Acanthamoeba keratitis. Grafts with fibrin sealant showed a success rate of 92.9 % (13/14 eyes) compared to 73.7% (14/19 eyes) for amniotic grafts alone. In patients with severe limbal damage, a success rate of only 20% (1/5) was observed. CONCLUSIONS: AMT is a viable option in the treatment of nonhealing corneal ulcers of various depth and etiologies. Perforations up to 3 mm can be safely managed by fibrin glue and AMT. These techniques lead to rapid reconstruction of the corneal surface and can give a good final functional result or allow keratoplasty to be done in more favorable conditions.     

羊膜移植治疗翼状胬肉及复发原因分析

目的探讨羊膜移植术治疗翼状胬肉的临床效果。方法采用羊膜移植术治疗原发性及复发性翼状胬肉71例78眼，术后随访12～28个月。结果74眼（94．87％）治愈，4眼（5．13％）翼状胬肉复发，复发的原因可能是胬肉组织残留及止血不彻底。结论羊膜移植治疗翼状胬肉安全有效，彻底止血、清除胬肉组织是关键。     

Limbal allograft transplantation using fibrin glue

Limbal transplantation is now widely accepted as the treatment of advanced limbal stem cell deficiency. Herein, we describe a technique for harvesting thin limbal grafts from cadaveric corneoscleral rims and a sutureless method to secure the grafts to the recipient eye using fibrin glue. We report the results of fibrin glue-assisted keratolimbal allograft in 19 eyes of 16 patients, with the outcome measures being ocular surface stability, visual acuity, and postoperative complications. The results indicate that limbal allograft transplantation can be performed safely and successfully using only fibrin glue to secure the grafts. This can potentially improve surgical efficiency and patient comfort postoperatively.     

Amniotic membrane transplantation for Mooren's ulcer

Background: To describe the outcome of surgery using amniotic membrane transplantation for Mooren's ulcer. Design: A prospective interventional case series from the Vietnam National Institute of Ophthalmology. Participants: Eighteen eyes of 14 patients with Mooren's ulcer. Seven eyes had recurrent episodes of ulceration, and 11 were not responsive to medical therapy or conjunctival resection. Methods: All eyes were treated with amniotic membrane grafts for Mooren's ulcer (10 eyes with multilayer grafts; 8 with a single layer graft). Five eyes with a 360° peripheral ulcer were treated with an overlay amniotic membrane graft, and 13 eyes were treated with a freehand graft tailored to fit the localized defect. Main Outcome Measures: Time to epithelial healing. Visual acuity outcome. Result: Sixteen of 18 eyes were treated by a single surgery with amniotic membrane with rapid healing of the epithelial defect (mean time to complete epithelialization 12.4 days). Two eyes required a second amniotic membrane graft: one eye required regrafting following a subgraft haemorrhage and another eye required regrafting for a persistent epithelial defect. Vision was stabilized in all eyes with 10 of 18 eyes obtaining vision of 6/12 or better. Conclusion: Amniotic membrane transplantation may be a useful treatment for selected patients with Mooren's ulcer especially where systemic immunosuppressive drugs are unavailable.     

羊膜移植术治疗真菌性角膜溃疡的疗效观察

目的:观察羊膜移植治疗真菌性角膜溃疡的治疗效果。方法:对26例26眼药物治疗效果较差的真菌性角膜溃疡患者在彻底清除角膜病灶后联合羊膜移植术。结果:随访3～36mo,术后21眼角膜溃疡愈合,其中7眼角膜恢复透明,14眼角膜形成局限性斑翳或白斑。26眼中21眼(81%)的视力有不同程度提高。结论:羊膜移植术是治疗真菌性角膜溃疡一种较好的方法。     

羊膜移植治疗角膜深层溃疡

目的探讨羊膜移植治疗深层角膜溃疡的可行性。方法采用新鲜多层羊膜移植治疗深层角膜溃疡22例（22眼）。其中细菌性角膜溃疡14眼（角膜穿孔3眼）,病毒性角膜溃疡8眼,术后随访6～19个月。结果22眼中20眼治愈,2眼复发。术后均未见新鲜羊膜移植片急性排斥反应,术后3～15d,炎症控制,疼痛消失,4～5周角膜上皮愈合,溃疡灶留下不同程度的瘢痕。角膜基质厚度正常,18眼视力不同程度提高。结论羊膜移植是治疗深层角膜溃疡的有效方法。     

羊膜移植治疗真菌性角膜溃疡

目的 观察羊膜移植治疗具菌性角膜溃疡的效果。方法 治疗15眼进行眼床观察,随访1－7月。结果 15眼的视力有不同程度提高,达到0.04-0.8。结论 羊膜移植法治疗真菌性角膜溃疡效果较好。     

羊膜移植治疗翼状胬肉

目的 现察羊膜移植治疗翼状胬肉的疗效，探讨羊膜移植是否可替代结膜移植治疗翼状胬肉。方法 对44例44眼翼状胬肉行胬肉切除，26眼行羊膜移植，18眼行结膜移植。术后定期随访，现察疗效和眼表情况。结果 羊膜移植组平均随访28月，手术成功率84．6％6；结膜移植组平均随访15．8月，手术成功率83．3％．结论 羊膜移植可替代结膜移植治疗翼状胬肉。     

羊膜移植治疗大泡性角膜病变

目的：研究羊膜移植治疗大泡性角膜病变的疗效。方法：对15例（15只眼）大泡性角膜病变患者采用羊膜移植治疗。其中无晶状体眼5例,人工晶状体眼5例,有晶状体眼者3例,角膜移植片失败者2例,结果：随访期3－12个月,治疗后1－3天内症状解除者13例（86．67％）,症状减轻者2例,氖患者角膜上皮缺损在3－4周内愈合。结论：羊膜移植能有效地控制大泡性角膜病变的症状,促进上皮愈合,且安全、简便,易行,具有很大的发展前途。