Division of Ophthalmic Plastic and Reconstructive Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts 02114, USA.
Ophthalmic Plast Reconstr Surg. 2009 Sep-Oct;25(5):371-5. doi: 10.1097/IOP.0b013e3181b2f796.
Vascular malformations of the conjunctiva are symptomatically distressing and surgically challenging. Because their expansive nature necessitates broad conjunctival sacrifice in some cases, epithelial reconstitution may be the best way to avoid symblepharon formation. Amniotic membrane grafts have been useful for conjunctival reconstruction after excision of squamous cell carcinoma and melanoma but have not been used after excision of extensive conjunctival vascular malformations. The authors report the use of amniotic membrane grafts in the management of large conjunctival vascular malformations.
The authors reviewed the clinical records and photographs of 4 patients with combined orbital and conjunctival vascular malformations. The operative details including amniotic membrane grafting and postoperative results were included. The average follow-up period was 9 months.
Four patients underwent a total of 6 resections; 2 patients required reoperation. Three of these lesions were lymphatic and 1 was venous. Dehydrated amniotic membrane was initially used in 2 patients who were subsequently grafted with cryopreserved amniotic membrane. Postoperative trauma in 1 case and staged surgery in the other necessitated these second surgeries. Cryopreserved amniotic grafting was successful in all 4 patients with no signs of graft dislocation, rejection, or tumor overgrowth after an average postoperative period of 9 months.
Large conjunctival vascular malformations, when extensively resected, leave large, denuded epibulbar and palpebral surfaces that would likely produce severe symblepharon. Conversely, incomplete resection can lead to early recurrent growth. Commercially available amniotic membrane grafts now provide a method for reconstructing these defects, allowing more extensive resection of the tumor.
结膜血管畸形会引起症状性不适，并给手术带来挑战。由于其扩张性，在某些情况下需要广泛牺牲结膜，因此上皮重建可能是避免形成睑球粘连的最佳方法。羊膜移植已被用于鳞状细胞癌和黑色素瘤切除后的结膜重建，但尚未用于广泛结膜血管畸形切除后。作者报告了使用羊膜移植治疗大的结膜血管畸形。
作者回顾了 4 例眼眶和结膜血管畸形患者的临床记录和照片。包括羊膜移植和术后结果的手术细节。平均随访时间为 9 个月。
4 例患者共进行了 6 次切除；2 例需要再次手术。其中 3 例为淋巴管畸形，1 例为静脉畸形。2 例患者最初使用脱水羊膜，随后移植冷冻羊膜。1 例术后创伤和另 1 例分期手术需要进行这两次手术。冷冻羊膜移植在 4 例患者中均成功，术后平均 9 个月无移植物脱位、排斥或肿瘤过度生长的迹象。
广泛切除大的结膜血管畸形后，会留下大面积裸露的球结膜和睑结膜表面，很可能导致严重的睑球粘连。相反，不完全切除可能导致早期复发生长。市售的羊膜移植片现在提供了一种重建这些缺陷的方法，允许更广泛地切除肿瘤。
