Krysik Katarzyna, Dobrowolski Dariusz, Wylegala Edward, Lyssek-Boron Anita
Department of Ophthalmology with Pediatric Unit, St Barbara 5th Regional Hospital, Trauma Centre Medykow Square 1, 41200 Sosnowiec, Poland.
Chair and Clinical Department of Ophthalmology, School of Medicine, Dentistry Division in Zabrze, Medical University of Silesia, Panewnicka 65 Str., 40760 Katowice, Poland.
J Ophthalmol. 2020 Feb 14;2020:4238919. doi: 10.1155/2020/4238919. eCollection 2020.
To report on surgical approaches using amniotic membrane applications and patch grafts in corneal melting and perforations. Anatomical and functional results, including advantages and disadvantages of the interventions, will also be explored.
A five-year retrospective analysis of 189 surgical treatments involving corneal melting with perforation was performed. In one evaluated treatment type, a graft of amniotic membrane, often folded one to three times, was sutured with the epithelial side facing the previously mechanically debrided corneal tissue. A larger monolayer amniotic patch was then sutured, with the epithelial side facing the top of the first membrane, to the perilimbal conjunctiva. For corneal patch grafts, the size-fitting technique of graft trephination was applied, and the donor-recipient junctions were sewn with interrupted sutures. All the procedures were evaluated, noting outcomes and complications of surgery, preoperative and postoperative visual acuities, postoperative intraocular pressures, graft rejection, and other late comorbidities and complications.
We performed 119 amniotic membrane applications (63%) and 70 corneal patch grafts (37%). Anatomical reconstruction of the anterior chamber was achieved in 157 eyes, of which 102 eyes (86%) received an amniotic membrane and 55 eyes (79%) were treated with the patch graft technique. In 63 eyes (33%), more than one amnion or graft treatment was necessary to close the corneal perforation.
The success of medical and surgical management depends on the cause of corneal melting, and amniotic membrane applications often require further intervention; nevertheless, patch grafts deliver better tectonic reconstruction than amniotic membrane alone.
报告在角膜溶解和穿孔中使用羊膜应用和补片移植的手术方法。还将探讨解剖学和功能结果，包括干预措施的优缺点。
对189例角膜溶解伴穿孔的手术治疗进行了为期五年的回顾性分析。在一种评估的治疗类型中，将通常折叠一至三次的羊膜移植片缝合，上皮面朝向先前机械清创的角膜组织。然后将一个更大的单层羊膜补片缝合，上皮面朝向第一张膜的顶部，至角巩膜缘结膜。对于角膜补片移植，采用移植片环钻的尺寸适配技术，供体-受体交界处用间断缝线缝合。对所有手术进行评估，记录手术结果和并发症、术前和术后视力、术后眼压、移植排斥反应以及其他晚期合并症和并发症。
我们进行了119次羊膜应用（63%）和70次角膜补片移植（37%）。157只眼实现了前房的解剖重建，其中102只眼（86%）接受了羊膜移植，55只眼（79%）采用补片移植技术治疗。在63只眼（33%）中，需要不止一次羊膜或移植治疗来封闭角膜穿孔。
药物和手术治疗的成功取决于角膜溶解的原因，羊膜应用通常需要进一步干预；然而，补片移植比单独使用羊膜能提供更好的结构重建。
