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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。
Objective: To evaluate the effect of amniotic membrane transplantation (AMT) in the treatment of symblepharon. METHODS: This uncontrolled, interventional case study was conducted in 13 eyes from 12 months to 2015/12, including 12 consecutive patients. Patients underwent permanent amniotic transplantation to treat symblepharon, using cryo-preserved or freeze-dried amniotic membrane (AM). The 12 patients (14 eyes), aged 26 to 62 years (mean 43.38 ± 11.25 years), of whom 8 (4 males and 4 females) were secondary to pterygium excision and 4 were ( 1 males, 3 females) secondary to strabismus surgery. All patients from the last surgery at least 6mo. After surgery to restore the depth of the dome for the successful surgery, no scars or inflammation occurred during the 6mo follow-up period without eye movement restrictions. Results: The average follow-up period was 7 ± 4.2 months (6-9 months). In all 14 eyes, AM was completely epithelized at 3 weeks after surgery, and there was no inflammation at the surgical site. Eight of 14 eyes (success rate 57%) showed successful cul-de-sac reconstruction, deep domes, and no recurrence. Four eyes (29%) showed partially successful, moderately deep fornix and moderate scarring. Two eyes (14%) showed failure to reconstruct, and the dome was completely closed. Visual acuity improved in 7 eyes and remained stable in 7 eyes. There were fewer complications after AMT, with severe conjunctival reactions and limited eye movement in one of 14 eyes (7%). In 3 months before surgery, 2 of 14 eyes developed pyogenic granulomas (14%), underwent surgical resection and local glucocorticoid injection. Conclusions: AMT alone is a safe and effective method for the treatment of symblepharon. Given the potential adverse effects associated with limbal resection, AMT is also an effective method of reconstructing vaults to repair symblepharon caused by various ocular surface diseases.