封闭结膜和Tenon囊间隙联合羊膜移植及纤维蛋白胶治疗睑球粘连的疗效观察

目的　研究封闭结膜和Tenon囊间隙技术联合羊膜移植及纤维蛋白胶治疗睑球粘连的临床疗效。方法　对31例（34眼）睑球粘连患者进行睑球粘连松解并切除异常纤维血管组织后，采用连续缝线封闭结膜和Tenon囊间隙技术联合羊膜移植进行治疗，术中辅以纤维蛋白胶固定羊膜。对结膜不足的重度睑球粘连病例使用自体唇黏膜移植封闭间隙。观察眼表重建效果、眼表炎症、眼球活动度、视力、移植材料情况及并发症等。结果　术后12个月34眼中完全成功25眼、部分成功6眼、失败3眼。术后疗效和术前睑球粘连的长度、宽度以及炎症活动度均有相关性（均为P＜0.05）。术后眼球活动度及炎症活动度得到显著改善（P＜0.05），6眼视力提高。结论　封闭结膜和Tenon囊间隙联合羊膜移植及纤维蛋白胶治疗睑球粘连疗效显著，其中使用连续缝线封闭结膜和Tenon囊技术是手术治疗睑球粘连的一个重要步骤。     

新鲜羊膜移植治疗重症睑球粘连

目的探讨新鲜羊膜移植治疗重症睑球粘连的方法,评价其疗效。方法对19例21眼不同病因的重症睑球粘连患者行睑球粘连分离、新鲜羊膜移植手术并进行随访观察。结果经平均6月随访观察,所有病例结膜上皮化效果满意,16眼睑球粘连手术后完全治愈,5眼明显改善,无手术并发症,睑球粘连未见复发。结论新鲜羊膜移植治疗重症睑球粘连安全、有效。     

羊膜移植治疗严重眼烧伤后的睑球粘连

目的:探讨羊膜移植在治疗严重眼烧伤后的睑球粘连眼表成型中的方法及效果。方法:化学烧伤或热烧伤后结膜囊狭窄、睑球粘连、结角膜假性胬肉等引起眼表变形、泪液动力学改变、眼球运动障碍等患者应用羊膜移植行结膜囊重建及眼表成型。结果:患者23例随访4～27mo,2例结角膜假性胬肉再次复发,但结膜囊缩短好转;4例轻度、2例中度结膜囊缩短;其余患者均能较好的重建眼表。结论:羊膜移植治疗严重眼烧伤后的睑球粘连眼表成型的效果良好。     

化学及热烧伤后睑球粘连的手术治疗

目的评价眼化学及热烧伤所致睑球粘连，行睑球粘连分离后单纯羊膜移植术及羊膜移植同时联合板层角膜移植手术的疗效。方法44例(44眼)化学及热烧伤后睑球粘连行睑球粘连分离，对18眼结膜缺损处行单纯羊膜移植术；对26眼睑球粘连牵涉角膜或角膜有大量新生血管者，行羊膜移植联合板层角膜移植术，其中12眼联合新鲜大板层角膜移植术，14眼联合干燥保存供体板层角膜移植术。结果44眼术后睑球粘连治愈16眼(36．4％)，好转20眼(45．5％)，无效8眼(18．1％)。结论对于化学及热烧伤后睑球粘连，单纯羊膜移植术或羊膜移植联合板层角膜移植术，可有效地缓解睑球粘连或部分达到治愈。     

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）     

人羊膜移植治疗翼状胬肉等眼表疾病的临床观察

目的：观察用人羊膜移植术治疗翼新诗胬肉、角膜热灼伤、化学伤、睑球粘连等眼表疾病的临床疗效。方法：用人羊膜移植术治疗翼状胬肉46例65只眼，其中复发性胬肉16只眼，假性翼状胬肉1只眼，角膜热灼伤、化学伤3例4只眼，睑球粘连2例2只眼，手术均在显微镜下完成。结果：随访3-11个月，羊膜移植手术均一次成功，无免疫排斥反应。翼状胬肉组，角膜透明，无新生血管，巩膜面结膜覆盖良好，充血消失；2只眼复发，复发率为3.1％，成功率96.9％。3例（4只眼）角膜热灼伤、化学伤者，术后均未见继续溶解、穿孔。睑球粘连者，结膜囊形成，睑球粘连者，结膜囊形成，睑球粘连松解，眼球活动基本正常。结论：人羊膜移植是治疗翼状胬肉等眼表疾病较有效方法，它可抑制结膜下及角膜纤维化，促进结膜、角膜的上皮化。     

羊膜移植在眼表疾病的临床应用

目的 探讨和评估新鲜羊膜移植治疗眼表疾病的疗效.方法 对结膜肿物,睑球粘连,碱烧伤,酸烧伤,热灼伤共24例(28眼)施行新鲜羊膜移植术,术后观察眼表重建情况,羊膜植片情况,术后视力情况,随访4-18个月.结果 24例(28眼)均未发生新鲜羊膜植片的排斥反应.2 5眼一次羊膜移植术后结膜、角膜上皮化痊愈,眼表重建成功.睑球粘连的患者第三眼位复视消失.1眼发生睑球粘连,2眼角膜部分上皮缺损,再次行羊膜覆盖术,术后随访完成上皮化,术后视力不同程度提高.结论 新鲜羊膜移植能有效的促进上皮细胞的分化移行、抑制局部的炎症反应、阻止新生血管和瘢痕的形成、阻止烧伤的病理发展,是治疗眼表疾病的一种积极有效的治疗方法.     

新鲜羊膜移植治疗严重的急性炎症期及瘢痕期眼表疾病的临床研究

目的　探讨新鲜羊膜移植治疗严重的急性炎症期和瘢痕期眼表疾病的可行性并对其疗效进行评价。方法　选择本院急性化学伤、热烧伤共 5例 (6只眼 ) ,复发性蚕蚀性角膜溃疡 8例 (8只眼 ) ,各种原因导致的大面积睑球粘连 42例 (49只眼 ) ,共计 5 5例 (6 3只眼 )临床连续住院患者 ,分别行单纯新鲜羊膜移植术 38例 (46只眼 ) ,羊膜移植联合板层角膜移植术 8例 (8只眼 ) ,羊膜移植联合角膜缘移植术 9例 (9只眼 )。术后均经印迹细胞学追踪观察移植后羊膜上皮细胞存活的时间。术后随访观察 6～ 18个月 ,平均 11个月。结果　 5 5例术后临床上均未见新鲜羊膜植片急性排斥反应。严重急性眼烧伤的 6只眼中 ,术后 5只眼无角结膜进行性溶解和穿孔 ,无新生血管和假性胬肉侵入角膜表面 ,虹膜亦未见萎缩 ,视力有不同程度的提高。复发性蚕蚀性角膜溃疡 8只眼术后未见复发。严重睑球粘连 49只眼中 ,46只眼恢复了眼球的运动功能 ,3只眼术后 3个月再次发生睑球粘连。泪液分泌功能基本正常者羊膜上皮细胞移植后可存活约 3个月。结论　新鲜羊膜移植可有效地用于重建角结膜表面 ,减轻炎性反应 ,减少新生血管的生成 ,抑制纤维组织增生 ,同时可用于防止蚕蚀性角膜溃疡的复发。充分清除眼表的病变组织和羊膜移植片的缝合固定 ,对羊膜     

生物羊膜联合带自体角膜缘干细胞的结膜瓣移植治疗伴睑球粘连的复发性翼状胬肉

目的:观察生物羊膜联合带自体角膜缘干细胞的结膜瓣移植治疗伴睑球粘连的复发性翼状胬肉的临床效果。方法:将68例76眼伴睑球粘连的复发性翼状胬肉患者按年龄、性别、翼状胬肉大小、睑球粘连程度分为A,B两组,A组30例34眼为翼状胬肉切除加生物羊膜移植组,B组38例42眼为翼状胬肉切除加生物羊膜联合带自体角膜缘干细胞的结膜瓣移植组。术后随访6～24mo。观察角膜透明程度,新生血管的有无,胬肉复发及睑球粘连复发情况。结果:A组有不同程度角膜云翳21眼(62%),其中9眼(26%)伴新生血管,4眼(12%)胬肉复发,1例睑球粘连复发。B组有不同程度角膜云翳9眼(21%),其中3眼(7%)伴新生血管,2眼(5%)胬肉复发,无睑球粘连复发患者。两组比较有角膜云翳及新生血管的发生率有显著性差异,复发率无显著性差异。结论:生物羊膜联合带自体角膜缘干细胞的结膜瓣移植治疗伴睑球粘连的复发性翼状胬肉是一种较理想的治疗方法。     

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 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.     

First experience with amniotic membrane transplantation

BACKGROUND: The purpose of this retrospective study was to analyze the outcome of amniotic membrane transplantation (AMT) performed at the University Eye Clinic Bern during the last 12 months. PATIENTS AND METHODS: Nine men (62.4 +/- 16.7 yrs.) and four women (78.3 +/- 22.3 yrs.) were treated with an AMT and grouped according to the ophthalmologic diagnosis: Group A, chronic corneal surface defect without limbal stem cell deficiency (n = 8); Group B, conjunctival fornix reconstruction (n = 7); Group C, filtering bleb defect (n = 2). RESULTS: 11/17 (65 %) AMT's performed in 14 eyes of 13 patients showed a favorable postoperative result after a mean follow-up time of 8.7 (+/- 2.9) months. In Group A (chronic corneal surface defect) 4/8, in Group B (conjunctival fornix defect) 7/7 and in Group C (filtering bleb defect) 0/2 showed an improvement of the basic ocular problem. 4/8 patients from Group A and 7/7 patients of Group B showed postoperatively a strong reduction of the ocular inflammation. CONCLUSIONS: In the present small study, favorable results were achieved in patients with chronic corneal surface defects without limbal stem cell deficiency and conjunctival fornix defects following AMT. In patients with fornix defects, the AMT seemed to be a valuable alternative to the more complicated transplantation of mouth- or nose mucous membrane. The two eyes with filtering defects failed.     

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.     

Fresh Ammiotic Membrane Transplantation for Conjunctival Surface Reconstruction

Purpose: To determine whether fresh human amniotic membrane can be used to reconstruct the conjunctival defect created during symblepharon lysis. Methods: Forty-two eyes of 39 consecutive patients with eye burns and Stevens -Johnson syndrome were randomized to accept fresh or preserved human amniotic membrane transplantation (AMT) during the period of severe scarring. Impression cytology was performed in 12 eyes with normal tear secretion which received fresh AMT. Results: During a mean follow-up of 11 months (range, 6 to 18 months), thirty-five patients (37 eyes) showed successful ocular surface reconstruction and resolution of motility restriction while four patients (2 eyes with fresh AMT, 3 eye with preserved AMT) with minimal recurrence of symblepharon. There was no significant difference statistically between two groups (Chi-square test). Amniotic epithelial cells can survive about three months after being transplanted onto ocular surfaces with normal tear secretion.Conclusion: Both fresh and pres     

保存人羊膜联合自体角膜缘移植治疗陈旧性眼部烧伤

观察羊膜移植在重建眼表面,治疗陈旧性眼部烧伤中的应用价值。方法采用保存入羊膜联合自体角膜缘移植治疗１５例。结果１５只眼中,１２只眼眼表面重建成功,１０只眼角膜透明或半透明,８只眼脱盲。     

新鲜和保存羊膜移植重建结膜眼表的临床对比研究

目的：比较新鲜羊膜和保存羊膜治疗睑球粘连的疗效差异，分析影响疗效的因素。方法：共51例55只眼因陈旧性化学伤、热烧伤或Stevens—Johnson综合征而发生睑球粘连的临床连续病例接受睑球粘连分离联合新鲜羊膜移植（22只眼）或保存羊膜移植（33只眼）。其中男30例32只眼．女21例23只眼。年龄4～51岁．平均（34．2±4.3）岁。其中11只眼在烧伤后5～11个月，平均（7．4±1．6）个月时接受手术，40只眼在烧伤后1～8年，平均（2．0±0．7）年进行手术。结果：术后随访12-32个月，平均（19．3±4．1）个月。所有移植存结膜眼表面的羊膜（包括新鲜羊膜）植片在术后早期均未见溃烂和溶解，周边对合良好。31／55（56．4％）只眼形成了足够深的穹窿部且恢复了眼球运动功能。9／55（16．4％）只眼发生部分睑球粘连，眼球运动轻度受限，但其面积远较术前为小。15／55（27.3％）眼术后发生中度以上的睑球粘连。新鲜羊膜和保存羊膜重建眼结膜表面的效果相似（X2=0．466，P=0．797）；不同程度睑球粘连的患者其羊膜移植术后的效果不同（新鲜羊膜．X2=27．995，P=0．000；保存羊膜，X2=33．610，P=0．000）；在眼表烧伤后1年内手术比1年以上进行羊膜移植的效果也不同（X2=4、243，P=0．039）。结论：新鲜羊膜和保存羊膜一样可以有效地用于重建睑球粘连解除后的结膜眼表。患眼术前睑球粘连程度以及烧伤后其眼表炎症是否处于安静状态等因素都会直接影响羊膜移植重建眼结膜表面的远期疗效。     

羊膜移植术在碱烧伤急性期重建结膜表面的实验研究

目的:(1)研究羊膜移植在治疗兔眼大面积结膜碱烧伤,重建健康结膜表面中的作用.(2)探讨碱烧伤急性期施行羊膜移植术的可行性.方法:选用30只家兔,制作角膜缘上方球结膜至穹隆部的碱烧伤的动物模型.实验组于碱烧伤后1wk时(急性期)行保存的人羊膜移植术及穹隆成形术.术后1,2,3,4,8,12wk时做光镜观察移植部位的结膜上皮生长情况,并于术后1,4,8wk时取移植区结膜做电镜观察其超微结构,同时与碱烧伤后行结膜下注射维生素C及应用抗生素眼药水点眼治疗的对照组结膜作对照观察.并在上述相应时期摄眼外观像、做上角膜缘至上方穹隆部宽度的测量.结果:(1)羊膜移植术后1wk时,光镜、电镜可见羊膜上有结膜上皮细胞长入,4wk时,含有杯状细胞的结膜上皮完全覆盖羊膜,接近于正常的结膜组织,12wk时,羊膜上结膜上皮细胞排列整齐,穹隆部结膜上皮下纤维结缔组织较为疏松,无增生.而对照组1wk时见结膜上皮细胞坏死脱落,未见有含杯状细胞的结膜上皮长入,4～8 wk时所见为大量纤维结缔组织增生,伴炎性细胞浸润.12wk时,穹隆部纤维结缔组织增生明显,未见有正常结膜上皮覆盖.(2)外观眼表可见,12wk时实验组移植区结膜光滑无瘢痕,上穹隆形成良好,穹隆深达7.6～8.2 mm,接近正常穹隆深度8.0～8.5 mm.而对照组结膜表面不光滑,有结膜肉芽肿形成,瘢痕增生明显,上方穹隆明显变浅,穹隆深度为1.0～4.5 mm.结论:以甘油保存的羊膜可作为一种底物载体,提供健康的基底膜,有利于周围正常结膜上皮的粘附、移行和分化,进而重建正常结膜表面.结膜碱烧伤后早期行羊膜移植可重建正常结膜表面,有效地防止睑球粘连的发生.     

Role of amniotic membrane transplantation in symblepharon

目的:评估羊膜移植(AMT)在治疗睑球黏连中的应用效果.方法:这项无对照干预性病例研究于2013/01~2015/12,包括连续就诊的12名患者共14眼.患者均接受永久性羊膜移植,以治疗睑球黏连,使用冷冻保存或冷冻干燥的羊膜(AM).这12例(14眼)患者,年龄在26~62岁,平均43.38±11.25岁,其中8例(4名男性,4名女性)10眼为翼状胬肉切除术后继发,4例患者(1名男性,3名女性)斜视手术后继发.所有患者距上次手术至少6mo.术后以恢复深度稳定的穹窿为手术成功,无瘢痕或炎症发生,6mo的随访期间无眼球运动的限制.结果:随访期平均为7±4.2mo(6-9mo).在所有14只眼中,手术后3wk均观察到AM完全上皮化,手术部位无炎症表现.总共14眼中有8眼(成功率57%)显示穹窿重建成功,穹窿深,无复发.有4眼(29%)表现出部分成功,中度深度的穹窿和中度瘢痕.有2眼(14%)显示重建失败,穹窿完全闭合.有7眼手术后视力改善,7眼视力保持稳定.AMT术后并发症少,14眼中1眼(7%)发生严重的结膜反应和眼球运动受限.而在术后前3mo中,14眼中有2眼发生化脓性肉芽肿(14%),予以手术切除,局部糖皮质激素注射.结论:单用AMT是一种治疗睑球黏连安全有效的方法.考虑到与角膜缘切除有关的潜在不良反应,AMT也是一种有效的重建穹窿以修复各种眼表疾病所致睑球黏连的方法.     

深低温保存羊膜治疗严重睑球粘连的临床观察

目的:探讨深低温保存羊膜移植治疗严重睑球粘连的临床价值。方法:对43例46眼有严重睑球粘连及假性胬肉的患者,进行睑球粘连松解后,应用羊膜移植重建球结膜和角膜表面,观察其临床效果。结果:在随访期内(平均13±3.5mo),24例患者疗效为优,眼睑球粘连均得到明显改善,眼表基本恢复正常;15例疗效为良,睑球粘连部分复发,但较术前有所改善;7例因上下睑球全粘连、结膜囊闭锁愈后效果较差。结论:对于严重的睑球粘连,深低温保存羊膜移植重建眼表是较理想的治疗方法。