Departamento de Oftalmologia, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR, Brazil.
Arq Bras Oftalmol. 2024 Mar 4;87(2):e20220341. doi: 10.5935/0004-2749.2023-2022-0341. eCollection 2024.
To evaluate the clinical results of cryopreserved amniotic membrane transplantation as a treatment option for refractory neurotrophic corneal ulcers.
This prospective study included 11 eyes of 11 patients who underwent amniotic membrane transplantation for the treatment of refractory neurotrophic corneal ulcers at Hospital de Clínicas da Universidade Federal do Paraná, in the city of Curitiba, from May 2015 to July 2021. Patients underwent different surgical techniques in which the amniotic membrane was applied with the epithelium facing upward to promote corneal re-epithelialization.
The median age of the patients was 60 years (range, 34-82 years), and 64% were men. The predominant etiology of corneal ulcers was herpes zoster (45% of cases). Approximately one-third of the patients (27%) were chronically using hypotensive eye drops, and more than half (54%) had previously undergone penetrating corneal transplantation. At the time of amniotic membrane transplantation, 18% of the eyes had corneal melting, 9% had corneal perforation, and the others had corneal ulceration without other associated complications (73%). The time between clinical diagnosis and surgical treatment ranged from 9 days to 2 years. The corrected visual acuity was worse than 20/400 in 90% of the patients preoperatively, with improvement in 36% after 3 months of the procedure, worsening in 18% and remaining stable in 36%. Of the patients, 81% complained of preoperative pain, and 66% of them reported total symptom relief after the surgical procedure. In one month, 54.6% of the patients presented a closure of epithelial defect, and half of the total group evolved with corneal thinning. The failure rate was 45.5% of the cases.
Cryopreserved amniotic membrane transplantation can be considered a good alternative for treating refractory neurotrophic corneal ulcers, as it resulted in significant improvement in pain (66%) and complete epithelial closure (60%) in many patients at 1 month postoperatively. Notably, the high failure rate highlights the need for further studies to identify patientand ulcer-related factors that may influence the outcomes of this procedure.
评估冷冻羊膜移植作为治疗难治性神经营养性角膜溃疡的一种治疗选择的临床效果。
本前瞻性研究纳入了 2015 年 5 月至 2021 年 7 月在库里蒂巴市联邦大学临床医院接受羊膜移植治疗难治性神经营养性角膜溃疡的 11 例 11 只眼患者。患者接受了不同的手术技术，其中羊膜上皮面朝上覆盖以促进角膜再上皮化。
患者的中位年龄为 60 岁（范围：34-82 岁），64%为男性。角膜溃疡的主要病因是带状疱疹（45%的病例）。约三分之一的患者（27%）长期使用降眼压滴眼液，超过一半（54%）曾行穿透性角膜移植。行羊膜移植时，18%的眼有角膜融解，9%的眼有角膜穿孔，其余的眼有角膜溃疡但无其他相关并发症（73%）。从临床诊断到手术治疗的时间范围为 9 天至 2 年。术前 90%的患者矫正视力低于 20/400，术后 3 个月时视力改善 36%，恶化 18%，稳定 36%。术前 81%的患者诉疼痛，术后 66%的患者诉疼痛完全缓解。术后 1 个月时，54.6%的患者上皮缺损闭合，总组的一半患者角膜变薄。失败率为 45.5%。
冷冻羊膜移植可作为治疗难治性神经营养性角膜溃疡的一种较好的选择，因为它可显著改善疼痛（66%），并使许多患者在术后 1 个月时完全闭合上皮缺损（60%）。值得注意的是，高失败率表明需要进一步研究以确定可能影响该手术结果的患者和溃疡相关因素。
