Lacorzana Javier, Campos Antonio, Brocal-Sánchez Marina, Marín-Nieto Juan, Durán-Carrasco Oswaldo, Fernández-Núñez Esly C, López-Jiménez Andrés, González-Gutiérrez Jose L, Petsoglou Constantinos, Serrano Jose L García
Department of Ophthalmology, Virgen de las Nieves University Hospital, 18006 Granada, Spain.
Doctoral Program in Clinical Medicine and Public Health, University of Granada, 18006 Granada, Spain.
J Clin Med. 2021 Jul 22;10(15):3234. doi: 10.3390/jcm10153234.
To evaluate new indicators in the efficacy of amniotic membrane transplantation (AMT) for non-healing corneal ulcers (NHCUs).
Retrospective, multicenter study. In total, 223 AMTs for NHCU in 191 patients were assessed. The main outcomes studied were the success rate of AMT (complete re-epithelization), postoperative visual acuity (VA) gain, and number of AM layers transplanted.
The overall AMT success rate was 74.4%. In 92% of our patients VA stability or improvement. Postoperative VA was significantly higher than preoperative VA in the entire cohort ( < 0.001) and in all etiological groups of ulcers (post-bacterial, ≤ 0.001; post-herpetic, ≤ 0.0038; neurotrophic ulcers, ≤ 0.014; non-rheumatic peripheral, ≤ 0.001; and ulcers secondary to lagophthalmos and eyelid malposition or trauma, ≤ 0.004). Most participants (56.5%) presented a preoperative VA equal to or less than counting fingers (≤0.01). Of these, 13.5% reached a postoperative VA equal to or better than legal blindness (≥0.05) after AMT. A higher success rate was observed in the monolayer than in the multilayer AMT (79.5% and 64.9%, respectively; = 0.018). No statistically significant values were found between the number of layers transplanted and VA gain ( = 0.509).
AMT is not only beneficial in achieving complete re-epithelialization in NHCUs but also in improving postoperative VA; these improvements are independent of etiologies of ulcers. Furthermore, the use of monolayer AMT seems to be a more appropriate option than multilayer AMT for NHCU since the multilayer AMT did not present better outcomes (success rate and VA gain) compared to monolayer AMT in the different types of ulcers studied.
评估羊膜移植术（AMT）治疗非愈合性角膜溃疡（NHCUs）疗效的新指标。
回顾性多中心研究。共评估了191例患者的223次NHCU的AMT。研究的主要结局是AMT的成功率（完全上皮化）、术后视力（VA）提高情况以及移植的羊膜层数。
AMT的总体成功率为74.4%。92%的患者视力稳定或提高。整个队列中术后视力显著高于术前视力（<0.001），在所有溃疡病因组中也是如此（细菌性溃疡后，≤0.001；疱疹性溃疡后，≤0.0038；神经营养性溃疡，≤0.014；非风湿性周边溃疡，≤0.001；以及睑裂闭合不全和眼睑位置异常或外伤继发的溃疡，≤0.004）。大多数参与者（56.5%）术前视力等于或低于数指（≤0.01）。其中，13.5%在AMT后达到术后视力等于或优于法定盲视力（≥0.05）。单层AMT的成功率高于多层AMT（分别为79.5%和64.9%；=0.018）。移植层数与视力提高之间未发现统计学显著差异（=0.509）。
AMT不仅有利于NHCUs实现完全上皮化，还能改善术后视力；这些改善与溃疡病因无关。此外，对于NHCU，使用单层AMT似乎比多层AMT更合适，因为在研究的不同类型溃疡中，多层AMT与单层AMT相比并未表现出更好的结局（成功率和视力提高）。
