无缝合冷冻保存羊膜移植与准分子激光原位角膜磨镶术后的伤口愈合
Sutureless cryopreserved amniotic membrane graft and wound healing after photorefractive keratectomy.
作者信息
Vlasov Anton, Sia Rose K, Ryan Denise S, Mines Michael J, Stutzman Richard D, Rivers Bruce A, Tseng Scheffer C G, Bower Kraig S
机构信息
From the Ophthalmology Service (Vlasov, Stutzman), Walter Reed National Military Medical Center, Bethesda, Maryland, the Warfighter Refractive Eye Surgery Program and Research Center (Sia, Ryan, Rivers), Fort Belvoir, Virginia, the Ophthalmology Service (Mines), Madigan Army Medical Center, Tacoma, Washington, the Ocular Surface Center and Ocular Surface Research & Education Foundation (Tseng), Miami, Florida, and the Wilmer Eye Institute (Bower), Johns Hopkins University, Baltimore, Maryland, USA.
From the Ophthalmology Service (Vlasov, Stutzman), Walter Reed National Military Medical Center, Bethesda, Maryland, the Warfighter Refractive Eye Surgery Program and Research Center (Sia, Ryan, Rivers), Fort Belvoir, Virginia, the Ophthalmology Service (Mines), Madigan Army Medical Center, Tacoma, Washington, the Ocular Surface Center and Ocular Surface Research & Education Foundation (Tseng), Miami, Florida, and the Wilmer Eye Institute (Bower), Johns Hopkins University, Baltimore, Maryland, USA.
出版信息
J Cataract Refract Surg. 2016 Mar;42(3):435-43. doi: 10.1016/j.jcrs.2015.11.045.
PURPOSE
To evaluate the effect of sutureless cryopreserved amniotic membrane (Prokera) on corneal wound healing after photorefractive keratectomy (PRK).
SETTING
Center for Refractive Surgery, Walter Reed Army Medical Center, Washington, DC, USA.
DESIGN
Prospective nonrandomized control trial.
METHODS
Patients had PRK for myopia with or without astigmatism. A 20% ethanol solution was used to create a standard 9.0 mm epithelial defect followed by photoablation with the Allegretto Wave Eye-Q 400 Hz laser. After surgery, a high-oxygen-transmissible bandage contact lens (Acuvue Oasys) was applied on the dominant eye and cryopreserved amniotic membrane on the nondominant eye. The postoperative regimen was otherwise identical for both eyes. Postoperatively, patients were evaluated daily until complete corneal reepithelialization occurred in both eyes and then at 2 weeks and 1, 3, 6, and 12 months. Reepithelialization was assessed daily with slitlamp examination, fluorescein staining, and photography. Secondary outcome measures included adverse effects, ocular comfort, visual outcomes, and corneal haze.
RESULTS
Forty patients were enrolled. The amniotic membrane graft sped corneal reepithelialization 1 day after PRK but was not better than the bandage contact lens in hastening complete reepithelialization of the cornea. Visual outcomes, corneal clarity, and optical quality of the cornea were comparable between the amniotic membrane graft eyes and bandage contact lens eyes.
CONCLUSION
Although the amniotic membrane graft was reasonably well tolerated with few significant adverse effects, the role of amniotic membrane in modulating wound healing after PRK remains speculative.
目的
评估无缝合冷冻保存羊膜（Prokera）对准分子激光原位角膜磨镶术（PRK）后角膜伤口愈合的影响。
设置
美国华盛顿特区沃尔特·里德陆军医疗中心屈光手术中心。
设计
前瞻性非随机对照试验。
方法
患者因近视伴或不伴散光接受PRK。使用20%乙醇溶液制造标准的9.0毫米上皮缺损，然后用Allegretto Wave Eye-Q 400 Hz激光进行光消融。术后，在优势眼上应用高透氧绷带式隐形眼镜（Acuvue Oasys），在非优势眼上应用冷冻保存羊膜。两只眼睛的术后治疗方案在其他方面相同。术后，每天对患者进行评估，直至双眼角膜完全重新上皮化，然后在2周以及1、3、6和12个月时进行评估。每天通过裂隙灯检查、荧光素染色和摄影评估重新上皮化情况。次要观察指标包括不良反应、眼部舒适度、视力结果和角膜 haze。
结果
纳入40例患者。羊膜移植在PRK后1天加速了角膜重新上皮化，但在加速角膜完全重新上皮化方面并不优于绷带式隐形眼镜。羊膜移植眼和绷带式隐形眼镜眼之间的视力结果、角膜清晰度和角膜光学质量相当。
结论
尽管羊膜移植耐受性良好，几乎没有明显不良反应，但羊膜在调节PRK后伤口愈合中的作用仍存在推测性。
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