Amniotic membrane transplantation in entropion surgery.

PURPOSE: To evaluate the role of amniotic membrane transplantation in the management of cicatricial eyelid entropion. DESIGN: Prospective, noncomparative interventional case series. PARTICIPANTS: Eighteen consecutive patients with cicatricial entropion. METHODS: A gray line lid split procedure with vertical anterior lamella repositioning was performed on 25 eyelids (upper or lower) of 18 patients with moderate to severe cicatricial entropion. Preserved human amniotic membrane (AM) was used to cover the bare tarsus up to the lid margin and secured with running 7-0 Vicryl. Impression cytology of the AM was performed at various stages postoperatively to study the epithelialization process. MAIN OUTCOME MEASURES: (1) Reepithelialization of bare tarsus, (2) extent of tarsal shrinkage, (3) recurrence of entropion. RESULTS: All the AM grafts took well. The most common complication was hemorrhage below the graft, which occurred in six cases. Complete success with no lashes touching the globe was achieved in 22 of 25 (88%) lids after a minimum follow-up of 12.0 months. The mean follow-up was 17.8 months. Two cases (qualified success) had recurrent trichiasis treated successfully with electrolysis. One case with severe trachomatous upper lid entropion recurred 14 months after surgery. The AM accelerated the epithelialization of bare tarsus; this was demonstrated by lack of fluorescein staining and reversion to skin color within 2 to 3 weeks. However, AM could not prevent tarsal shrinkage. Impression cytology demonstrated that features of conjunctival epithelium were present for the first postoperative month, but this was gradually replaced by squamous metaplasia, with keratinization appearing as early as 3 weeks postoperatively. CONCLUSIONS: The use of AM in a lid split procedure for correction of cicatricial entropion helps the bare tarsus epithelialize rapidly and improves the initial cosmetic result of surgery.     

Amniotic membrane use in ophthalmology

PURPOSE OF REVIEW: The purpose of this review is to describe the most recent and relevant clinical and experimental data about the use of amniotic membrane in ophthalmology. RECENT FINDINGS: The amniotic membrane is a biologic tissue that has been used as a graft for corneal and conjunctival reconstruction in a variety of ocular surface diseases. It is avascular and possesses anti-angiogenetic, anti-scarring and antiinflammatory properties. It is not a substitute but rather a substrate upon which cells can migrate and regenerate, forming new and healthy tissue. The amniotic membrane can also be used as a biologic patch, as a bandage, to treat acute inflammatory disorders. With the development of cell therapy, amniotic membrane can be also used as a carrier of limbal stem cells or their progeny, cultivated in vitro. SUMMARY: Amniotic membrane use in ophthalmic surgery has been shown to provide an alternative for corneal and conjunctival reconstruction in many clinically challenging situations; however, there is still a lack of scientific evidence based on randomized comparative studies to prove that its use is better than other alternative therapies for ocular surface reconstruction.     

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。     

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。     

眼外伤睑球粘连的羊膜移植治疗

目的 评价羊膜移植治疗眼化学伤及热烧伤所致睑球粘连的效果。方法 我院眼部化学伤及热烧伤后睑球粘连病例34例（36眼）行睑球粘连分离联合保存人羊膜移植术。结果 术后随访半年以上，睑球粘连被彻底分开，眼球恢复自由活动者28例（30眼）占83．3％；6例（6眼）术后复发，占16．6％。结论 保存人羊膜移植治疗眼部化学伤及热烧伤后睑球粘连取材方便，效果显著。     

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。     

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。     

Amniotic membrane corrects surgically induced astigmatism

Human amniotic membrane (AM) has been widely used for the reconstruction of ocular surface. We conducted this study to investigate whether AM shows efficacy in maintaining the correction of astigmatism or not. We performed photoastigmatic refractive keratectomy (PARK) on rabbits and grafted AM on the cornea. The effect of AM on the degree of astigmatism was evaluated by topography and cycloplegic refraction. As will be shown, AM did not show any efficacy in maintaining the correction of astigmatism. On the contrary, AM not only eliminated PARK-induced astigmatism but prevented surgically induced astigmatism. We suggest that AM could be a useful tool for controlling the astigmatism induced by laser refractive surgery. Further clinical study is still left to be elucidated.