Szurman Peter, Warga Max, Grisanti Salvatore, Roters Sigrid, Rohrbach Jens M, Aisenbrey Sabine, Kaczmarek Radoslaw T, Bartz-Schmidt Karl U
Department of Ophthalmology I, University of Tubingen, Tubingen, Germany.
Cornea. 2006 May;25(4):460-6. doi: 10.1097/01.ico.0000183493.00884.8f.
Amniotic membrane transplantation has become an important treatment option for corneal surface reconstruction. However, suture fixation of the transplant has various disadvantages like corneal irritation, scarring, graft loss due to membrane shrinkage, and the need for subsequent suture removal. Replacement of sutures by bioadhesives might be an advantageous alternative. This controlled study was designed to evaluate a new sutureless technique for amniotic membrane fixation onto the corneal surface by using fibrin glue.
Standardized disks of cryopreserved amniotic membranes were transplanted onto the deepithelialized cornea of 12 rabbits using either conventional suture fixation or a new fibrin glue technique. The rabbits were followed-up with slit-lamp examination and fluorescein staining until epithelialization was completed. Consecutively, the rabbits were killed and the eyes processed for histology and immunohistochemistry for cytokeratin-3.
All membranes of both groups stayed in place throughout the follow-up time and showed a progressive graft epithelialization that was completed after 12 days. Whereas suture-fixated membranes showed progressive tissue shrinkage, fibrin-glued sheets remained unaltered. In the bioadhesive group, histology revealed a smooth fibrin layer in the graft-host interface and a continuous, stratified layer of cytokeratin-3 expressing corneal epithelial cells on the membrane surface. In contrast, suture-fixated membranes showed contracted and prominent membrane edges with epithelial ingrowth into the submembrane interface.
Our results demonstrate the general feasibility of reproducible and reliable sutureless amniotic membrane fixation onto the corneal surface in rabbits. Stable adherence is maintained until epithelialization is completed. The sutureless technique gives sufficient manipulation time for the sheet before the final cross-linking process is completed. Furthermore, several advantageous characteristics could be demonstrated as increased biocompatibility, better epithelialization pattern and the lack of membrane shrinkage.
羊膜移植已成为角膜表面重建的重要治疗选择。然而，移植片的缝线固定存在各种缺点，如角膜刺激、瘢痕形成、因膜收缩导致移植片丢失以及后续需要拆线。用生物黏合剂替代缝线可能是一种有利的选择。本对照研究旨在评估一种使用纤维蛋白胶将羊膜固定于角膜表面的新型无缝线技术。
将标准大小的冷冻保存羊膜盘分别采用传统缝线固定或新型纤维蛋白胶技术移植到12只兔的去上皮角膜上。用裂隙灯检查和荧光素染色对兔进行随访，直至上皮化完成。随后，处死兔并对眼睛进行组织学和细胞角蛋白-3免疫组织化学处理。
两组的所有膜在整个随访期间均保持在位，并显示出渐进性的移植片上皮化，在12天后完成。而缝线固定的膜显示出渐进性的组织收缩，纤维蛋白胶粘贴的片材则保持不变。在生物黏合剂组，组织学显示移植片-宿主界面有一层光滑的纤维蛋白层，且在膜表面有一层连续的、表达细胞角蛋白-3的分层角膜上皮细胞。相比之下，缝线固定的膜显示膜边缘收缩且突出，上皮向内生长至膜下界面。
我们的结果证明了在兔角膜表面可重复且可靠地进行无缝线羊膜固定的总体可行性。在完成上皮化之前，能保持稳定的附着。无缝线技术在最终交联过程完成前为片材提供了足够的操作时间。此外，还可证明该技术具有一些有利特性，如生物相容性增加、上皮化模式更好以及膜无收缩。
