Altiparmak Ugur E, Oflu Yusuf, Yildiz Elvin H, Budak Koray, Aslan Bekir Sitki, Nurozler Ayse, Onat Mustafa, Kasim Remzi, Duman Sunay
Department of Ophthalmology Ankara Research and Training Hospital, Ankara, Turkey.
Am J Ophthalmol. 2009 Mar;147(3):442-446.e1. doi: 10.1016/j.ajo.2008.08.036. Epub 2008 Nov 20.
To determine the outcomes of a modified amniotic membrane transplantation (AMT) suturing technique for pain and discomfort relief in patients with symptomatic bullous keratopathy (BK).
Randomized, double-blind controlled clinical trial.
setting: Ankara Research and Training Hospital 1st and 2nd Eye Clinics, Ankara, Turkey. study population: This prospective study included 39 eyes (39 patients) with BK presenting with intractable pain or discomfort and poor visual potential. intervention: Patients were randomly assigned into two groups: in group 1 (21 patients), patients underwent a modified AMT suturing technique; a groove was prepared by vacuum trephine on the recipient cornea and the edges of the punch-shaped amniotic membrane (AM) were sutured to this groove with the basement membrane side up. In group 2 (18 patients), patients underwent the standard AMT suturing to the cornea. main outcome measure: During a mean follow-up of 27.3 +/- 8.5 months (standard deviation) (range, 12 to 36 months), epithelial healing, persistence of AM, pain relief, and visual changes were analyzed and were compared between groups.
The mean age (P = .15), the mean follow-up (P = .73), and the mean preoperative visual acuity (P = .53) were similar in both groups. With the modified suturing technique, the postoperative visual acuity was better (P = .03), epithelialization time was shorter (P < .001), and the AM remained longer (P < .001). Successful epithelialization was achieved in 20 eyes (95.3%) in group 1, and in 16 eyes (88.9%) in group 2 (P = .586). The pain scores of patients in group 1 remained stable (P = .223) over time, however increased from the first week to the third month postoperatively in group 2 (P = .046).
The modified AMT suturing technique has a similar epithelialization rate to standard AMT suturing to cornea. Though technically more demanding, shorter epithelialization time, longer persistence of AM, and stable pain scores in the postoperative period makes this a promising method for the treatment of symptomatic BK.
确定改良羊膜移植（AMT）缝合技术缓解症状性大疱性角膜病变（BK）患者疼痛和不适的效果。
随机、双盲对照临床试验。
地点：土耳其安卡拉安卡拉研究与培训医院第一和第二眼科诊所。研究人群：这项前瞻性研究纳入了39只眼（39例患者），这些患者患有BK，伴有顽固性疼痛或不适且视力潜力较差。干预措施：患者被随机分为两组：第1组（21例患者），患者接受改良AMT缝合技术；用真空环钻在受体角膜上制备一个凹槽，将冲切形状的羊膜（AM）边缘以基底膜面朝上的方式缝合到该凹槽中。第2组（18例患者），患者接受标准AMT角膜缝合术。主要观察指标：在平均随访27.3±8.5个月（标准差）（范围12至36个月）期间，分析上皮愈合、AM的存留情况、疼痛缓解及视力变化，并在两组之间进行比较。
两组的平均年龄（P = 0.15）、平均随访时间（P = 0.73）和术前平均视力（P = 0.53）相似。采用改良缝合技术时，术后视力更好（P = 0.03），上皮化时间更短（P < 0.001），且AM存留时间更长（P < 0.001）。第1组20只眼（95.3%）实现了成功上皮化，第2组16只眼（88.9%）实现了成功上皮化（P = 0.586）。第1组患者的疼痛评分随时间保持稳定（P = 0.223），然而第2组患者的疼痛评分从术后第一周至第三个月有所增加（P = 0.046）。
改良AMT缝合技术与标准AMT角膜缝合术的上皮化率相似。尽管技术要求更高，但上皮化时间更短、AM存留时间更长以及术后疼痛评分稳定，使得该技术成为治疗症状性BK的一种有前景的方法。
