Hoffmann Stephan, Szentmáry Norá, Seitz Berthold
Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany.
Cornea. 2013 Oct;32(10):1321-5. doi: 10.1097/ICO.0b013e318298de10.
Emergency keratoplasties for inflamed eyes are considered to have a worse prognosis because of immunologic graft rejection. Amniotic membranes have antiinflammatory and antiangiogenic abilities. Therefore, amniotic membrane transplantation (AMT) was performed to stabilize the situation of eyes with severe infectious keratitis before elective penetrating keratoplasty (PK).
Retrospective, nonrandomized observational case series. Seven to 41 days (median, 20 days) after the onset of intensive antiinfectious medication, an AMT (6 multigrafts and 6 sandwich) was performed in 12 patients [8 men and 4 women; age 46-80 years (median, 66 years)] with herpetic (n = 5), bacterial keratitis (n = 3), or combinations (n = 4). Three to 12 months (median, 5 months) after cessation of the inflammatory status of the eye, a central elective PK (diameter, 7-8 mm) became feasible in 10 eyes. Follow-up ranged from 4 to 38 months (median, 20 months) after PK.
The primary success rate of AMT was 11/12 (92%). Five recurrences (41%) were treated successfully 4 times by repeat AMT (sandwich) and 1 time by emergency PK. In 2 of the 12 eyes, an irreversible endothelial immunologic graft reaction appeared 18 and 21 months after PK. One eye suffered from reversible recurrence of herpetic keratitis on the corneal graft. At the end of the follow-up, 10 of 12 grafts (83%) were clear.
A rapid decrease in the inflammatory reaction and a fast reepithelialization because of AMT after intensive antiinfectious medication in case of severe ulcerative keratitis may help to avoid an emergency keratoplasty and improves the prognosis of the elective keratoplasty.
由于免疫性移植排斥反应，炎症性眼病的急诊角膜移植术被认为预后较差。羊膜具有抗炎和抗血管生成能力。因此，在择期穿透性角膜移植术（PK）前，进行羊膜移植（AMT）以稳定重症感染性角膜炎患者的眼部情况。
回顾性、非随机观察病例系列。在强化抗感染药物治疗开始7至41天（中位数为20天）后，对12例患者[8例男性和4例女性；年龄46 - 80岁（中位数为66岁）]进行了AMT（6例多层移植和6例三明治式移植），这些患者患有疱疹性角膜炎（n = 5）、细菌性角膜炎（n = 3）或混合性角膜炎（n = 4）。在眼部炎症状态消退后3至12个月（中位数为5个月），10只眼可行中央择期PK（直径7 - 8 mm）。PK术后随访时间为4至38个月（中位数为20个月）。
AMT的主要成功率为11/12（92%）。5例复发（41%）患者经重复AMT（三明治式移植）成功治疗4次，经急诊PK成功治疗1次。12只眼中有2只在PK术后18个月和21个月出现不可逆的内皮免疫性移植反应。1只眼在角膜移植片上出现疱疹性角膜炎可逆性复发。随访结束时，12只移植眼中有10只（83%）透明。
在重症溃疡性角膜炎患者强化抗感染药物治疗后，AMT可使炎症反应迅速减轻，上皮快速再生，有助于避免急诊角膜移植术，并改善择期角膜移植术的预后。
