Fresh Amniotic Membrane Transplantation Combined Lamellar Keratoplasty for Patients with Recurrent Mooren＇s Ulcer

Purpose: To investigate the possibility of amniotic membrane as an immunological insulating band to reduce the recurrent frequency of Mooren's ulcer.Methods: Twelve cases(12 eyes) with recurrent Mooren's Ulcer were observed. Among them, 4 cases(4 eyes)were male and 8 cases(8 eyes)female, ranging in age between 26 and 51 years [mean (41 ±3) years]. Three eyes recurred once, 5 eyes twice, and 4 eyes three before. Eleven of 12 cases (11/12 eyes) with frequently recurrent Mooren's ulcer underwent lamellar keratoplasty combined amniotic membrane transplantation (AMT) . One patient who had entire corneal ulceration accepted AMT alone. Results: Follow-up time is 12 to 29 months, [mean (23 ±6)months]. Before AMT, the recurrent frequency of Mooren's Ulcer of all cases after corneal surgery was 1-7 months [ mean (3 ± 2) months ]. Nine of 12 eyes with lamellar keratoplasty combined AMT did not recur within the observation period; 2 eyes recurred 11 months after the surgery. Three months postoperatively, neovasc     

Excision with Corneoscleral Lamellar Keratoplasty and Amniotic Membrane Transplantation of a Corneal Displaced Recurrent Conjunctival Melanoma

An 81-year-old woman with a raised pigmented nodule over her left cornea for 7 months duration was examined. Dark conjunctival pigmentation was observed in the upper bulbar fornix conjunctiva. She had previously undergone primary surgical excision of a malignant conjunctival melanoma four years earlier. The tumor separated easily from the corneal surface, but remained slightly attached to the corneoscleral surface. A corneoscleral lamellar dissection of 3 mm in width and 2 mm in depth as well as a corneoscleral lamellar keratoplasty for the reconstruction of the corneoscleral defect were performed. The wide upper bulbar and fornix conjunctiva were excised, and an amniotic membrane transplantation was performed. Biopsy revealed an invasive melanoma with a depth of 1 mm. Left, right, and inferior tumor margins of the corneoscleral lesion and the pigmentary lesion in the conjunctiva were free of the tumor. After surgery, 0.04% mitomycin was administered topically 4 times daily for 4 weeks. There was no recurrence 2 years after surgery, and systemic evaluation revealed no metastasis.     

大气泡技术联合湿剥法深板层角膜移植术

目的：介绍大气泡技术联合湿剥法深板层角膜移植术。方法：选择2016 年1 月至2017 年6 月期间在温州医科大学附属眼视光医院因单纯疱疹病毒性角膜炎（HSK）拟行大气泡技术联合湿剥法深板层角膜移植术患者59例（59眼）。术中行大气泡技术联合深板层角膜移植时,如遇2型大气泡或小气泡,改湿剥法完成手术。结果：59 眼均成功行深板层角膜移植术,无一例出现术中微穿孔,术中2 型大气泡占71%。结论：HSK患者术中可出现高比例2 型大气泡,出现2 型大气泡或小气泡改湿剥法钝性 分离,保留后弹力层前膜,手术安全。     

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。     

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     

Effect of Age and Early Intervention with a Systemic Steroid,Intravenous Immunoglobulin or Amniotic Membrane Transplantation on the Ocular Outcomes of Patients with Stevens-Johnson Syndrome

Purpose

This retrospective observational case series of fifty-one consecutive patients referred to the eye clinic with acute-stage Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) from 1995 to 2011 examines the effect of early treatment with a systemic corticosteroid or intravenous immunoglobulin (IVIG) on the ocular outcomes in patients with SJS or TEN.

Methods

All patients were classified by age (≤18 years vs. >18 years) and analyzed by treatment modality and early intervention with systemic corticosteroids (≤5 days), IVIG (≤6 days), or amniotic membrane graft transplantation (AMT) (≤15 days). The main outcomes were best-corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (logMAR) and ocular involvement scores (OIS, 0-12), which were calculated based on the presence of superficial punctate keratitis, epithelial defect, conjunctivalization, neovascularization, corneal opacity, keratinization, hyperemia, symblepharon, trichiasis, mucocutaneous junction involvement, meibomian gland involvement, and punctal damage.

Results

The mean logMAR and OIS scores at the initial visit were not significantly different in the pediatric group (logMAR = 0.44, OIS = 2.76, n = 17) or the adult group (logMAR = 0.60, OIS = 2.21, n = 34). At the final follow-up, the logMAR and OIS had improved significantly in the adult group (p = 0.0002, p = 0.023, respectively), but not in the pediatric group. Early intervention with IVIG or corticosteroids significantly improved the mean BCVA and OIS in the adult group (p = 0.043 and p = 0.024, respectively for IVIG; p = 0.002 and p = 0.034, respectively for corticosteroid). AMT was found to be associated with a significantly improved BCVA or OIS in the late treatment group or the group with a better initial OIS (p = 0.043 and p = 0.043, respectively for BCVA; p = 0.042 and p = 0.041, respectively for OIS).

Conclusions

Our findings suggest that patients with SJS or TEN who are aged 18 years or less have poorer ocular outcomes than older patients and that early treatment with steroid or immunoglobulin therapy improves ocular outcomes.