羊膜移植重建急性期严重烧伤眼表的临床研究

目的探讨羊膜重建急性烧伤期眼表面的可行性,比较新鲜和保存羊膜的疗效差异,评价手术方法及其疗效.方法全角膜Ⅲ度以上烧伤且全周角膜缘坏死的临床连续病例分别接受羊膜移植(19例20只眼)或全板层角膜移植手术(22例24只眼).19例羊膜移植患者中8例8只眼接受新鲜羊膜移植,11例12只眼接受保存羊膜移植.患者术后随访12～26个月,平均(15±2)个月.结果羊膜移植后眼表迅速稳定.新鲜羊膜移植者眼表面迅即并维持上皮化.保存羊膜移植者第2或3周才完成上皮化,且12只眼中有3只眼不能完全上皮化,最后由于持续性上皮缺损而发生羊膜融解,其后接受了板层角膜移植.眼表上皮化的术眼随着时间的延长新生血管开始沿着羊膜从角膜周边长入,羊膜被逐渐吸收.新生血管多为表浅性.新鲜羊膜多数(7/8)在术后2～8(4.3±0.8)个月、保存羊膜多数(10/12)在术后1～3(2.0±0.3)个月基本被吸收或融解(t=4.22,P<0.01).羊膜移植重建的结膜眼表均获成功,仅1例发生影响眼球运动的中度睑球粘连.板层角膜移植组22例(24只眼)均保全眼球,但在术后大多发生角膜植片上皮反复脱落,最终植片新生血管化,其中4只眼由于角膜植片融解而接受植片更换,7只眼因植片上皮持续性缺损而行睑缘缝合术,5只眼发生轻中度睑球粘连.在无合并青光眼和白内障的患者中,羊膜移植术后的视力基本保留了眼前手动,而板层角膜移植者则多见眼前指数.结论羊膜尤其新鲜羊膜的移植可以减轻角膜急性烧伤期的炎症反应,阻止眼表的进行性溃烂和融解,加速眼表的稳定;同时减少角膜新生血管的形成,并在相当长的时间内将其局限在角膜周边部,从而为后续的角膜复明手术打下良好的基础.     

羊膜遮盖和羊膜移植在急性期眼表烧伤的临床研究

目的：：探讨羊膜遮盖和羊膜移植术在急性期不同程度眼表烧伤中的应用价值和疗效。方法：回顾性分析了我院2007-03/2012-03不同程度化学性或热烧伤患者28例28眼,其中13例角膜Ⅱ或Ⅲ度烧伤伴部分角膜缘Ⅳ度烧伤患者行新鲜羊膜遮盖术,15例全角膜Ⅲ度以上烧伤且全周角膜缘坏死不伴有严重眼睑缺损患者行新鲜羊膜移植术,术后随访6~24 mo。术后主要观察视力、羊膜植片情况、角膜恢复情况及术后并发症。结果：术后视力提高者20眼(71%),不变者5眼(18%),降低者3眼(11%)。羊膜移植片情况：28眼患者术后羊膜成活23眼,成活率达82%。角膜恢复情况：28眼中角膜最终恢复透明4眼,角膜云翳8眼,角膜斑翳10眼,角膜白斑4眼,2眼术后角膜表面进行性溶解,行板层角膜移植手术。羊膜脱落后暴露的角膜很快上皮化,但部分患者再次出现上皮缺损,经再次重复手术后稳定。结论：新鲜羊膜遮盖和羊膜移植术是治疗急性期眼表热烧伤的有效方法。     

羊膜移植治疗眼表烧伤的临床应用分析

目的:评价羊膜移植治疗眼表化学烧伤及热烧伤的临床疗效。方法:收集我院眼部化学及热烧伤24例28眼,行新鲜羊膜移植术治疗,随访6～24mo。术后观察视力,羊膜移植片情况,角膜恢复情况及角膜上皮修复时间,并发症。结果:术后视力提高者22眼(79%),不变者6眼(21%),无视力下降者,术前术后视力差别无统计学意义。羊膜移植片情况:28眼中羊膜覆盖成活24眼,成活率达86%。角膜恢复情况:28眼中角膜最终恢复透明8眼,角膜云翳12眼,角膜斑翳5眼,角膜白斑3眼。角膜上皮愈合时间:22眼角膜上皮1～3wk全部愈合。术前4眼睑球粘连患者,睑球粘连情况均得到改善,3眼完全分离。结论:新鲜羊膜移植术是治疗眼表化学及热烧伤的有效方法。     

羊膜移植治疗早期眼表化学烧伤的临床探讨

目的探讨羊膜移植治疗早期眼表化学烧伤的临床效果。方法18例（24只眼）早期眼表化学烧伤,采用羊膜移植治疗,术后随访3—12个月。观察视力、羊膜植片情况、角膜恢复情况及并发症。结果术后矫正视力≤0．04者1只眼,0．05～0．1者2只眼,0．12—0．25者5只眼,≥0．3者16只眼,脱盲率95．8％（23／24）,脱残率66．7％（16／24）。24只眼中羊膜移植成活22只眼,成活率91．7％。24只眼中角膜最终恢复透明8只眼,角膜遗留薄翳者13只眼,角膜斑翳者2只眼,角膜白斑者1只眼。6只眼角膜新生血管长人。18只眼眼表情况稳定。并发症：4只眼发生假性胬肉,2只眼睑球粘连。结论羊膜移植可有效地用于早期化学烧伤的眼表重建,减轻炎性反应,减少新生血管的生成,抑制纤维组织增生,有较好的疗效。     

羊膜保存方法及眼表重建临床观察

近年,羊膜移植联合角膜缘干细胞移植治疗眼表疾病在临床上得到广泛应用,并收到了满意的效果。以往的羊膜多采用低温干燥保存方法,这带来了两个问题,一是可能引起羊膜活性成分的效价降低,二是在有些基层医院因条件限制难以开展。针对这两个问题,我们进行了羊膜保存方法的研究及临床应用观察,现将结果报告如下。     

羊膜移植治疗眼表疾病临床观察

目的　探讨羊膜移植治疗眼表疾病的临床效果。方法　采用新鲜羊膜移植治疗几种眼表疾病 2 5例 (2 7眼 ) ,术后随访观察 3月～ 1年。结果　复发性翼状胬肉 2眼 3月后复发 ;1眼 3 60°蚕蚀性角膜溃疡伴穿孔 ,行多层羊膜移植 ,1月后 ,部分羊膜脱落 ,再次给予羊膜加巩膜、结膜覆盖后治愈。结论　羊膜移植重建眼表是目前较理想的治疗手段。     

羊膜移植联合角膜缘干细胞移植在严重眼表烧伤中的应用

目的 观察羊膜移植联合角膜缘干细胞移植在严重眼表烧伤中的疗效。方法 16例严重眼表烧伤病例采用羊膜移植联合角膜缘干细胞移植进行治疗。结果 所有患者均保存了眼球，无明显睑球粘连，未发生急性排异反应，视力有不同程度的提高。结论 羊膜移植联合角膜缘干细胞移植是治疗严重眼表烧伤一种较为理想的方法。     

羊膜移植在急性重症眼表烧伤中的应用

目的对羊膜移植治疗急性重症眼表烧伤的疗效进行评价。方法20例（28眼）Ⅲ～Ⅳ度急性眼表酸、碱及热烧伤施行了新鲜或冷冻保存羊膜移植，观察眼表重新上皮化进程、视力恢复情况和术后并发症，随访3～12月。结果28眼均在术后3周内眼表重新上皮化；术后矫正视力〈0．05者2眼，0．05～0．1者3眼，0．12～0．25者3眼，≥0．3者20眼，脱盲率92．00％（23／25），脱残率71．43％（20／28）：角膜恢复透明者15眼，遗留薄翳10眼，角膜斑翳2眼，角膜白斑1眼；角膜血管新生6眼，其中4眼仅限角膜周边部，2眼进入角膜瞳孔区；轻度睑球粘连2眼。结论羊膜移植能使急性重症眼表烧伤眼表早日上皮化，可以阻止和减轻角膜浑浊、溃疡穿孔、角膜新生血管化、假性胬肉长入及睑球粘连等并发症，至少可以获得一个稳定的眼表，为日后行光学性角膜移植创造了条件。     

羊膜移植眼表重建术的临床观察

目的评价保存羊膜移植重建眼表治疗眼表疾患的疗效。方法2001年7月~2004年7月我院住院的眼表疾病16例(16眼)(化学烧伤引起的睑球粘连、瘢痕性结膜囊狭窄8例,顽固性角膜上皮缺损3例,复发性翼状胬肉切除后大面积结膜缺损5例)进行单层保存羊膜移植重建眼表,术后随访6~12月,行视力及裂隙灯显微镜等眼科常规检查,观察羊膜植片及角结膜上皮愈合情况。结果所有术眼均未见羊膜植片溃烂或溶解。术后早期(1周内)羊膜植片有轻度水肿,后逐渐透明。所有术眼眼表得以重建,随访期间未见复发。结论羊膜作为一个含基膜和基质成分的胶原支架,可以使受体的结膜或角膜上皮细胞扩展及移行于其上,达到真正的结膜及角膜眼表的重建,是眼表重建术的一大进展。     

羊膜移植治疗早期严重角结膜烧伤疗效观察

目的 观察羊膜移植治疗早期严重角结膜烧伤的效果。方法 采用西安市眼库提供的新鲜人羊膜材料，对43例(58只眼)严重的角结膜烧伤患者在伤后7天内行羊膜移植。结果 58只眼中41只眼无睑球粘连，占70％，17只眼留有部分轻度粘连。9只眼角膜旁中央留有薄翳，49只眼角膜不规则混浊，瘢痕愈合，眼表稳定。结论 羊膜具有抗蛋白酶的活性，消除炎症细胞的入侵和炎性介质的释放，且羊膜具有抗粘连的能力，烧伤早期行羊膜移植可明显减少睑球粘连并达到早期眼表稳定。     

Amniotic membrane transplantation for ocular surface reconstruction

The amniotic membrane, composed of 3 layers, the epithelium, basement membrane, and the stroma, was first used along with the chorion as a biologic membrane to promote healing of skin burns in 1910. In ophthalmology, it was used in 1940 in the management of conjunctival defects. Its revival in the 1990s was due to its ability to reduce ocular surface inflammation and scarring, promote rapid epithelialization due to the presence of growth factors, and antimicrobial properties. This has resulted in its application in several ocular disorders. A review of the literature shows that amniotic membrane is definitely beneficial in some but not all pathology. The future of amniotic membrane transplantation is very exciting, especially in the field of limbal stem cell research. However, further work is needed to elucidate whether it functions merely as a biologic contact lens or whether it has additional benefits.     

Amniotic membrane transplantation for ocular surface reconstruction

AIMS: To evaluate the efficacy of amniotic membrane transplantation (AMT) for ocular surface reconstruction. METHODS: 10 consecutive patients who underwent AMT were included. The indications were: group A, cases with persistent epithelial defect after corneal abscess (n = 1), radiation (n = 1), or chemical burn (n = 3); group B, cases with epithelial defect and severe stromal thinning and impending or recent perforation, due to chemical burn (two patients, three eyes) or corneal abscess (n = 2); group C, to promote corneal epithelium healing and prevent scarring after symblepharon surgery with extensive corneo-conjunctival adhesion (n = 1). Under sterile conditions amniotic membrane was prepared from a fresh placenta of a seronegative pregnant woman and stored at -70 degrees C. This technique involved the use of amniotic membrane to cover the entire cornea and perilimbal area in groups A and B, and the epithelial defect only in group C. RESULTS: The cornea healed satisfactorily in four of five patients in group A, but the epithelial defect recurred in one of these patients. After AMT three patients underwent limbal transplantation and one penetrating keratoplasty and cataract extraction. In group B amniotic membrane transplantation was not helpful, and all cases underwent an urgent tectonic corneal graft. Surgery successfully released the symblepharon, promoted epithelialisation and prevented adhesions in the case of group C. CONCLUSION: AMT was effective to promote corneal healing in patients with persistent epithelial defect, and appeared to be helpful after surgery to release corneo-conjunctival adhesion. Most cases required further surgery for visual and ocular surface rehabilitation. Amniotic membrane used as a patch was not effective to prevent tectonic corneal graft in cases with severe stromal thinning and impending or recent perforation.     

羊膜移植联合自体角膜缘移植术治疗陈旧性眼表烧伤

目的 :探讨羊膜移植术联合自体角膜缘移植术对眼表烧伤的治疗效果。方法 :对 11例 11只眼陈旧性眼表烧伤 ,先将增生的薄层纤维血管组织清除干净 ;暴露出透明的角膜及光滑的巩膜面。用保存羊膜 ,及从健眼取得的自体角膜缘进行联合移植。结果 :平均随访 9 0± 2 2个月。术后角膜表面重度血管化的患眼数所占的比率 ( 3 / 11)明显小于术前 ( 9/ 11) (P <0 0 5 )。 3例( 3只眼 )手术失败 ,角膜表面重新血管化。广泛睑球粘连的 2例术后随访期 ,眼球运动障碍解除 ,形成较深的下穹隆部 ,未见重新睑球粘连。术后 0 -Ⅰ级角膜透明度的患眼数所占的比率 ( 7/ 11)明显大于术前 ( 1/ 11) (P <0 0 5 )。手术前 ( 9/ 11)、及手术后单眼盲目率 ( 4 / 11)相比较有显著性差异 (P <0 0 5 )。结论 :①单眼陈旧性眼表烧伤累及角膜厚度小于全厚 1/ 3、全角膜表面被纤维血管组织覆盖 ,或有广泛睑球粘连时 ,用羊膜移植联合自体角膜缘移植术治疗可受到促进角膜表面上皮愈合、抑制纤维血管化、改善角膜透明度、增进视力的较好效果。②眼表烧伤后角膜表层溃疡 ,应用羊膜移植术联合自体角膜缘移植术治疗效果较好。     

Amniotic membrane transplantation in severe ocular surface disorders

PURPOSE: Amniotic membrane transplantation is currently being used as an alternative approach to treat severe corneal surface disorders refractory to medical therapy. The authors report complications of corneal surface disorders after successful amniotic membrane transplantation. METHODS: Case series. RESULTS: Twenty-eight patients with corneal surface disorders due to severe chemical burns, corneal ulceration, or persistent epithelium defects were treated with amniotic membrane transplantation. Four of these patients showed a spontaneous perforation and three patients developed a descemetocele within 6 weeks after the amniotic membrane transplantation. CONCLUSIONS: In this case series, descemetocele and corneal perforation occurred in 25% of the patients after amniotic membrane transplantation. This might be due to the severity of the underlying disease or to the impact of amniotic membrane on corneal fibroblasts and collagenases. The risk of corneal thinning and perforation should be considered in the decision of treatment with amnion and follow-up regimen.     

Amniotic membrane transplantation for reconstruction of the ocular surface

Amniotic membrane transplantation has been recently gained wide-spread attention as a new method for reconstruction of the ocular surface. However long term prognosis of the surgical intervention as well as action mechanism are poorly defined. Therefore, we review the current literature concerning the application of amniotic membrane in ophthalmology and the outcome of the surgery. Amniotic membrane is used as graft or patch to promote epithelial healing of persistent epithelial defects, corneal ulcers and following penetrating keratoplasty. It is also used to seal corneal perforations and to treat bullous keratopathy. Amniotic membrane patches facilitate epithelial healing and reduce the number of complications after chemical burns. For partial limbal deficiency, amniotic membrane alone can be sufficient, while total limbal deficiency requires combination with stem-cell transplantation. Furthermore amniotic membrane grafts restore conjunctival surfaces following removal of lesions such as pterygium, tumor, scar, symblepharon, and conjunctivochalasis. The prognosis of amniotic membrane transplantation depends on the underlying disease and the quality of the ocular surface and is inversely related to the degree of inflammation. Recent investigations of the action mechanisms describe intrinsic antiinflammatory properties of the amniotic membrane.     

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.     

Amniotic membrane transplantation (AMT) for ocular surface reconstruction

The authors present current opinions about the possibility of amniotic membrane transplantation for ocular surface treatment in patients with chemical and thermal burns, Stevens-Johnson syndrome, ocular cicatrical pemphigoid, persistent epithelial defects with ulceration and large conjunctival defects. Amniotic membrane facilitates migration of epithelial cells, promotes their differentiation, prevents epithelial apoptosis, does not provoke neovascularization and a typical host-versus-graft rejection. Amniotic membrane transplantation is an advance in techniques for managing ocular surface reconstruction revolutionizing corneal disease treatment.     

外伤性睑球粘连分离术中羊膜移植的应用

目的 探讨羊膜移植治疗外伤性睑球粘连的临床效果。方法 对15例外伤性睑球粘连患者施行眼表重建羊膜移植手术。结果 15例患者眼表重建、羊膜在眼表重建中有良好作用，术后反应轻，羊膜存活。结论 羊膜移植可用于睑球粘连分离后的眼表重建，具有安全、有效、恢复快和使用方便等优点。     

Amniotic membrane transplantation for ocular surface reconstruction: indications and outcomes

BACKGROUND: The amniotic membrane is a useful tool in the management of several ocular surface diseases. Despite numerous studies, standardization of the use of the membrane and of outcome measures is lacking. Herein, the authors' results of amniotic membrane transplantation (AMT) in ocular surface reconstruction against defined outcome measures are reported. METHODS: A retrospective case study of 74 consecutive procedures (58 patients) performed against predefined outcome measures. The cases were divided into three groups. Group A AMT in the presence of stem cell loss (32 procedures), Group B AMT without stem cell loss (24 procedures) and Group C AMT for conjunctival reconstruction (18 procedures). The outcomes were evaluated against defined criteria based on the purpose (patch or graft) and objective for use of the membrane. Results were analysed by defining the outcomes as success, partial success or failure. RESULTS: Unequivocal success of the procedure was observed in 22% in Group A, 62.5% in Group B and 50% in Group C. AMT was significantly more successful in the presence of functioning stem cells (P = 0.01). In Group A acute and subacute cases (less than 3 months) needed more procedures compared with chronic cases (P = 0.02). In Group C, results were comparatively worse when AMT was used in progressive cicatrizing conditions. CONCLUSION: Use of AMT can be associated with a significant number of failures. It provides a useful alternative for specific indications where its use should be encouraged. It is important to define criteria for success in order to accurately evaluate efficacy.