Fuchsluger Thomas, Tuerkeli Emre, Westekemper Henrike, Esser Joachim, Steuhl Klaus-Peter, Meller Daniel
Department of Ophthalmology, University of Duisburg-Essen, 45122 Essen, Germany.
Graefes Arch Clin Exp Ophthalmol. 2007 Jul;245(7):955-64. doi: 10.1007/s00417-006-0493-1. Epub 2007 Jan 12.
To examine the efficacy of amniotic membrane transplantation (AMT) and/or botulinum toxin type A-induced ptosis (Dysport) in the treatment of corneal ulcerations of different entities.
Retrospective evaluation of 137 cases of corneal ulcers which have been treated with AMT, botulinum toxin type A and perforating keratoplasty (pKP). Regarding corneal ulcerations the patients were divided into three groups: group A, patients initially having received an AMT (92 eyes eventually followed by AMT or pKP as a second intervention); group B, patients initially having received an AMT (32 eyes followed by botulinum toxin type A injection in the upper lid as a second intervention); group C, patients initially treated only by botulinum toxin type A injection (13 eyes followed occasionally by AMT or pKP or additional botulinum toxin type A injection). Additionally, we analysed the complete epithelialisation rate of the ocular surface in respect to different ocular and systemic diseases and compared the frequency of re-operations in each group.
The overall follow-up was 14.2 (+/-14.7 months; range from 1 to 60 months). The total frequency of re-operations was 45.3% (overall time until complete epithelialisation 12.7 (+/-6.1) days). If the patient was initially treated with an AMT (group A), the re-operation rate was 44.6%. Treating affected eyes in this group with a subsequent amniotic membrane resulted in a reduction of re-operation rate to 30.4%. In cases with induced ptosis by injecting botulinum toxin type A in the M. levator palpebrae (group B), the re-operation frequency could be reduced to 34.4% with similar times of epithelialisation [group A: 12.0 (+/-6.5) days and group B: 11.7 (+/-5.5) days]. In group C, with botulinum toxin type A alone initially, the re-operation rate of 69.2% was the highest one compared with groups A and B; this rate could be drastically reduced by a following AMT to 23.1%. Surprisingly, in the few successful cases with botulinum toxin type A alone a quite low epithelialisation time of 6.5 (+/-1.3) days was achieved, but turned out to be similar after additional interventions if compared with the other groups (botulinum toxin type A + AMT: 15.7 (+/-4.9) day).
AMT alone and combined with botulinum toxin type A-induced ptosis is an effective surgical approach for managing severe corneal ulcerations by promoting wound healing and stabilizing ocular surface homeostasis.
探讨羊膜移植（AMT）和/或A型肉毒杆菌毒素致上睑下垂（Dysport）治疗不同类型角膜溃疡的疗效。
回顾性评估137例接受AMT、A型肉毒杆菌毒素和穿透性角膜移植术（pKP）治疗的角膜溃疡患者。根据角膜溃疡情况，将患者分为三组：A组，最初接受AMT治疗的患者（92只眼，最终接受AMT或pKP作为二次干预）；B组，最初接受AMT治疗的患者（32只眼，随后在上睑注射A型肉毒杆菌毒素作为二次干预）；C组，最初仅接受A型肉毒杆菌毒素注射治疗的患者（13只眼，偶尔接受AMT或pKP或额外的A型肉毒杆菌毒素注射）。此外，我们分析了不同眼部和全身疾病患者眼表完全上皮化率，并比较了每组再次手术的频率。
总体随访时间为14.2（±14.7个月；范围1至60个月）。再次手术的总频率为45.3%（直至完全上皮化的总时间为12.7（±6.1）天）。如果患者最初接受AMT治疗（A组），再次手术率为44.6%。该组患眼随后接受羊膜治疗，再次手术率降至30.4%。在提上睑肌注射A型肉毒杆菌毒素致上睑下垂的病例中（B组），上皮化时间相似（A组：12.0（±6.5）天，B组：11.7（±5.5）天），再次手术频率可降至34.4%。在C组中，最初仅使用A型肉毒杆菌毒素，与A组和B组相比，再次手术率最高，为69.2%；随后进行AMT可将该率大幅降至23.1%。令人惊讶的是，在少数仅使用A型肉毒杆菌毒素成功治疗的病例中，上皮化时间相当短，为6.5（±1.3）天，但与其他组（A型肉毒杆菌毒素+AMT：15.7（±4.9）天）相比，再次干预后的上皮化时间相似。
单独使用AMT以及联合A型肉毒杆菌毒素致上睑下垂是通过促进伤口愈合和稳定眼表稳态来治疗严重角膜溃疡的有效手术方法。
