羊膜手术治疗急性期眼表疾病的临床疗效

目的探讨羊膜手术治疗急性期眼表疾病的手术方式和临床疗效。方法对51例(60只眼)保守治疗无效的急性期眼表疾病患眼分别行单纯羊膜移植术(32只眼)、羊膜移植联合羊膜遮盖术(24只眼)和(或)羊膜填充术(4只眼)治疗。术后观察不同方式羊膜手术同原眼病的预后、植片转归、角膜上皮的愈合、新生血管和假性胬肉的侵入、睑球黏连等情况的关系。随访期为4~12个月,平均9.4个月。结果在39只急性角膜溃疡的患眼中,有30只眼给予1次手术治愈、有6只眼给予第2次羊膜手术后治愈、有3只眼(2只为真菌性角膜溃疡,1只为棘阿米巴角膜溃疡)在羊膜手术失败后给予深板层角膜移植手术治愈。在12只化学性烧伤的患眼中,所有患眼术后均未见角膜进行性融解或穿孔,随访期内角膜表面逐渐血管化,未见睑球黏连永久性形成。在蚕蚀性角膜溃疡的6只患眼中,5只眼给予单次羊膜手术于随访期内未见复发,1只眼最终复发以板层角膜移植治愈。结论在保守治疗无效的前提下,针对不同的眼表疾病应给予不同方式的羊膜手术治疗。

Curative effect of amniotic membrane surgery on treatment of severe ocular surface diseases at acute inflammatory stage

Objective To evaluate the surgical techniques and clinical effects of using amniotic membrane surgery for the treatment of severe ocular surface diseases at acute inflammatory stage.Methods The amniotic membrane graft(32 eyes),patching(24 eyes) or filling(4 eyes) techniques were applied to 51 cases(60 eyes) suffered from severe drug-resistant acute ocular surface diseases.The three techniques were applied alone or in a combined style.Slit-lamp microscope was used to examine the correlation between different techniques and the diseases' prognosis,amniotic membrane changing,corneal reepithelization,neovascularization and symblepharon formation.The follow up periods were 4~12 months.Results Thirty eyes after one time surgery,6 eyes after two times surgery were cured in 39 acute corneal ulceration cases.The failed 3 eyes were cured finally by the deep lamellar keratoplasty.No cornea progressing melting,perforation,persistent epithelium defect or long lasting symblepharon formed in all the 12 eyes suffered from severe acute chemical burns.Five out of six Mooren's ulcer eyes did not show recurrence during the follow up period.Conclusion Different techniques of amniotic membrane surgery should be selected for different kinds of acute ocular surface diseases when the conservative therapy failed.