Tseng S C, Prabhasawat P, Barton K, Gray T, Meller D
Ocular Surface and Tear Center, Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Fla 33136, USA.
Arch Ophthalmol. 1998 Apr;116(4):431-41. doi: 10.1001/archopht.116.4.431.
To examine whether amniotic membrane transplantation (AMT), in preparing the perilimbal stroma, enhances the success of allograft limbal transplantation (ALT).
Thirty-one eyes of 26 consecutive patients had cytologically proven limbal deficiency resulting from chemical burns (14 eyes); Stevens-Johnson syndrome, toxic epidermal necrolysis, or pseudopemphigoid (5 eyes); contact lens-induced keratopathy (3 eyes); aniridia (3 eyes); multiple surgical procedures (2 eyes); atopy (2 eyes); or an unknown cause (2 eyes). Based on the severity of limbal deficiency, group A (mild), comprising 10 eyes, received AMT alone; group B (moderate), comprising 7 eyes, received AMT and ALT; and group C (severe), comprising 14 eyes, received AMT, ALT, and penetrating keratoplasty. All patients except those in group A received continuous oral cyclosporine.
Except for the 2 eyes with atopy, all amniotic membrane-covered surfaces showed rapid epithelialization (in 2 to 4 weeks) and reduced inflammation, vascularization, and scarring, and the surfaces became smooth and wettable. For the mean follow-up period of 15.4 months, 25 (83%) of 30 eyes showed visual improvement, consisting of 6 or more lines (13 eyes), 4 to 5 lines (6 eyes), or 1 to 3 lines (6 eyes). Visual improvement decreased with the severity of limbal deficiency from 8 (100%) of 8 eyes in group A to 5 (71%) of 7 eyes in group B and 11 (79%) of 14 eyes in group C. In group C, corneal graft rejection occurred in 9 (64%) of 14 eyes, and reversible early limbal allograft rejection was noted in 3 (14%) of 21 eyes of groups B and C.
For partial limbal deficiency with superficial involvement, AMT alone is sufficient and hence superior to ALT because there is no need to administer cyclosporine. For total limbal deficiency, additional ALT is needed, and AMT helps reconstruct the perilimbal stroma, with reduced inflammation and vascularization, which collectively may enhance the success of ALT.
研究在制备角膜缘基质时，羊膜移植（AMT）是否能提高同种异体角膜缘移植（ALT）的成功率。
连续26例患者的31只眼经细胞学检查证实存在角膜缘缺陷，病因包括化学烧伤（14只眼）；史蒂文斯-约翰逊综合征、中毒性表皮坏死松解症或类天疱疮（5只眼）；隐形眼镜相关性角膜病变（3只眼）；无虹膜（3只眼）；多次手术（2只眼）；特应性（2只眼）；或病因不明（2只眼）。根据角膜缘缺陷的严重程度，A组（轻度）10只眼仅接受AMT；B组（中度）7只眼接受AMT和ALT；C组（重度）14只眼接受AMT、ALT和穿透性角膜移植术。除A组患者外，所有患者均持续口服环孢素。
除2只特应性眼外，所有覆盖羊膜的表面均显示快速上皮化（2至4周），炎症、血管化和瘢痕形成减少，表面变得光滑且可湿润。平均随访期为15.4个月，30只眼中有25只（83%）视力改善，包括提高6行或更多（13只眼）、4至5行（6只眼）或1至3行（6只眼）。视力改善程度随角膜缘缺陷严重程度的增加而降低，从A组8只眼中的8只（100%）降至B组7只眼中的5只（71%）和C组14只眼中的11只（79%）。在C组中，14只眼中有9只（64%）发生角膜移植排斥反应，B组和C组21只眼中有3只（14%）出现可逆性早期角膜缘同种异体移植排斥反应。
对于浅层累及的部分角膜缘缺陷，单独使用AMT就足够了，因此优于ALT，因为无需使用环孢素。对于全角膜缘缺陷，需要额外进行ALT，而AMT有助于重建角膜缘基质，减少炎症和血管化，这可能共同提高ALT的成功率。
