Chandra Abhishek, Maurya O P S, Reddy Bhaskar, Kumar Gaurav, Pandey Kshama, Bhaduri Gautam
Department of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi.
J Indian Med Assoc. 2005 Jul;103(7):364-6, 368.
In this prospective study, 81 eyes of 70 patients diagnosed with various ocular surface disorders were enrolled to document the use of amniotic membrane transplantation in various ocular surface disorders. Detailed history and ocular examination was done. Ocular photographs and consent from all patients were taken. Fluorescein staining and impression cytology was done preoperatively and postoperatively in selected cases. Amniotic membrane was prepared from the placenta of a donor (consent taken and negative for infectious disorders), after separating amnion from chorion. It was washed with antibiotic solutions, transferred over nitrocellulose paper and stored in Dulbecco's modified Eagle's minimum essential medium at -80 degrees C. Recipient bed was prepared by removing the fibrovascular pannus and necrosed conjunctiva. Amniotic membrane was transplanted with the epithelial side up and sutured. Sixty-four eyes had good result by clinical evaluation or impression cytology findings, 5 eyes later required limbal stem cell culture and transplantation. All the 3 eyes had failure of the fornix reconstruction and 5 eyes had recurrence of the pterygium. Amniotic membrane provides lower recurrence rate in cases of recurrent pterygium. Alkali injuries are more dangerous but showed good response to amniotic membrane transplantation combined with limbal autografting or ex-vivo expansion and later transfer. Initial proper assessment of limbal involvement, conjunctival necrosis and corneal involvement is the key to the management of acute cases. Contracted sockets showed no improvement. Shield ulcers and persistent epithelial defect and ocular surface defects secondary to tumour excision showed excellent results.
在这项前瞻性研究中，纳入了70例诊断为各种眼表疾病的患者的81只眼，以记录羊膜移植在各种眼表疾病中的应用情况。进行了详细的病史询问和眼部检查。拍摄了所有患者的眼部照片并获得了同意书。在选定的病例中，术前和术后进行了荧光素染色和印迹细胞学检查。羊膜取自供体胎盘（已获得同意且无感染性疾病），将羊膜与绒毛膜分离后，用抗生素溶液冲洗，转移到硝酸纤维素纸上，保存在-80℃的杜尔贝科改良伊格尔最低必需培养基中。通过切除纤维血管性血管翳和坏死的结膜来制备受体床。将羊膜上皮面朝上移植并缝合。通过临床评估或印迹细胞学检查结果，64只眼效果良好，5只眼后来需要进行角膜缘干细胞培养和移植。所有3只眼的穹窿重建失败，5只眼翼状胬肉复发。在复发性翼状胬肉病例中，羊膜移植的复发率较低。碱烧伤更危险，但对羊膜移植联合自体角膜缘移植或体外扩增并随后转移显示出良好的反应。对角膜缘受累、结膜坏死和角膜受累进行初步的正确评估是急性病例处理的关键。睑裂狭小综合征患者的眼窝没有改善。盾形溃疡、持续性上皮缺损以及肿瘤切除术后继发的眼表缺损效果极佳。
