新鲜羊膜移植治疗难治性眼表疾病的临床观察

目的探讨新鲜羊膜移植治疗难治性眼表疾病的疗效。方法选择本院酸碱热烧伤5例、角膜溃疡10例、角膜上皮完全剥脱1例、大面积睑球粘连5例、结膜延迟愈合1例患者,共计22例(22只眼);采用单层或多层羊膜移植,术后随访观察6-12个月,平均9个月。结果 22例术后临床上均未见新鲜羊膜植片急性排斥反应;同时眼表迅速稳定。严重酸碱热烧伤的5例无角结膜进行性溶解和穿孔,甚至1例铁水烫伤伴角膜穿孔患者术后保全眼球;10例角膜溃疡患者,9例溃病愈合,视力不同程度提高,1例溃病复发(糖尿病患者),放弃再移植;5 例睑球粘连患者眼球运动功能恢复。结论新鲜羊膜移植是重建眼表的有效方法,它可以减轻角膜的炎症反应, 阻止眼表进行性溶解,加速眼表的稳定,同时减少角膜新生血管的形成。

A clinical study on fresh amniotic membrane transplantation for reconstruct of severe ocular surface diseases

Objective To investigate the feasibility and the effect of fresh amniotic membrane transplantation in treatment of the severe ocular surface diseases. Method 22 patients of severe ocular surface diseases including 5 patients whose cornea had been burned, 10 patients who had corneal ulcer, 5 patients who had extensive symblepharon, 1 patient whose ocular epithelial cell had peeled off completely and 1 patient whose conjunctiva healed lately. All patients were operated by single-layer or multi-layers with fresh amniotic membrane and followed for 6 - 12months. Results 22case did not occur acute exclusive reaction , and stable ocular surface were maintained fast. 5 eyes which had been severe burned by acid and alkali were not dissolved and perforated. 1 case eyeball of burned by iron water with perforation was rescued. The visual acuities were improved to various degrees in 9 cases of corneal ulcer. 1 patient who had recurred give up to re-transplant. Ocular movements were recovered in 5 cases of symblepharon. Conclusion Fresh amniotic membrane transplantation is effective method for the severe ocular surface diseases, and can reduce the inflammation of the cornea, and prevent ocular surface from ulcer perforation and can make the stabilization fast. It can also decrease corneal neovascularization as well as establish better conditions.