羊膜移植术联合佩戴绷带镜治疗持续性角膜上皮缺损的疗效
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摘要
目的探讨羊膜移植术(amnitotic membrane transplantation,AMT)联合佩戴绷带镜(bandage contact lens,BCL)治疗持续性角膜上皮缺损(persistent corneal epithelial defects,PCEDs)的可行性及疗效。方法选择2015-02至2017-02收治的多种原因所导致PCEDs患者50例(53只眼),随机分为治疗组和对照组,治疗组采用AMT联合角膜BCL治疗,对照组采用药物治疗或(和)结膜瓣遮盖治疗,比较两组术后视力,角膜溃疡或上皮愈合情况,羊膜转归,前房炎性反应情况和并发症等。结果治疗组视力改善情况高于对照组。治疗组25例27眼,有效25眼,有效率92. 5%;对照组25例26眼,有效17眼,有效率65. 4%,两组比较差异有统计学意义(P <0. 05)。治疗组术后2周羊膜大部分溶解,术后1个月羊膜基本完全溶解,术后3个月治疗组中25眼获得稳定眼表面,无排斥和继发感染发生。结论羊膜移植手术联合佩戴治疗用BCL有利于角膜上皮修复,加速伤口关闭,减少角膜新生血管等并发症的形成,促进恢复视力。
Objective To investigate the feasibility of persistent corneal epithelial defects( PCEDs) being treated with amnitotic membrane transplantation( AMT) combined with bandage contact lens( BCLs). Methods Patients with PCEDs treated between February 2015 and February 2017 were selected and randomly divided into the treatment group and control group. The treatment group received AMT combined with BCLs,while the control group received medication or conjunctival flap covering surgery. Visual recovery、corneal healing、amnitotic membrane outcomes and complications were compared between the two groups. Results Visual recovery was better in the treatment group than in the control group. Among the 27 eyes of 25 cases of patients in the treatment group,25 eyes were effectively treated,so the efficacy rate was 92. 5%. Among the 26 eyes of 25 cases in the control group,17 were effectively treated,so the efficacy rate was 65. 4%. There was significant difference in efficacy between the two groups( P < 0. 05). After two weeks,most of the amnitotic membrane was dissolved in the treatment group,compared with one month in the treatment group. The ocular surface became stable and was epithelized immediately after the transplantation of amniotic membrane. Conclusions AMT surgery combined with BCL can effectively reduce the inflammation of the cornea,prevent corneal ulcer and deliquescing and accelerate stabilization.
Objective To investigate the feasibility of persistent corneal epithelial defects( PCEDs) being treated with amnitotic membrane transplantation( AMT) combined with bandage contact lens( BCLs). Methods Patients with PCEDs treated between February 2015 and February 2017 were selected and randomly divided into the treatment group and control group. The treatment group received AMT combined with BCLs,while the control group received medication or conjunctival flap covering surgery. Visual recovery、corneal healing、amnitotic membrane outcomes and complications were compared between the two groups. Results Visual recovery was better in the treatment group than in the control group. Among the 27 eyes of 25 cases of patients in the treatment group,25 eyes were effectively treated,so the efficacy rate was 92. 5%. Among the 26 eyes of 25 cases in the control group,17 were effectively treated,so the efficacy rate was 65. 4%. There was significant difference in efficacy between the two groups( P < 0. 05). After two weeks,most of the amnitotic membrane was dissolved in the treatment group,compared with one month in the treatment group. The ocular surface became stable and was epithelized immediately after the transplantation of amniotic membrane. Conclusions AMT surgery combined with BCL can effectively reduce the inflammation of the cornea,prevent corneal ulcer and deliquescing and accelerate stabilization.
引文
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[10]Astyrakakis J B.The use of contact lenses in the treatment of persistent epithelial defects Contact Lens[J].Anterior Eye,2010,33(5):239-244.
[11]Achyut M,Antonis I,Ioannis A.Comparative evaluation of comfilcon a and senofilcon a bandage contact lenses after transepithelial photorefractive keratectomy[J].Optom,2015,8(1):27-32.
[12]Danna S,Hang S,Tong D,et al.Evaluation of the safety and efficacy of therapeutic bandage contact lenses on post-cataract surgery patients[J].Int J Ophthalmol,2018,11(2):230-234.
[13]李洁,卢红,邢丽娜.两种接触镜导致角膜基质浸润发生率的Meta分析[J].武警医学,2017,28(10):1012-1015.
[2]陈家祺,周世有,黄挺,等.新鲜羊膜移植治疗严重的急性炎性反应期及瘢痕期眼表疾病的临床研究[J].中华眼科杂志,2000,36(1):13-17.
[3]杨银萍.绷带镜治疗眼表疾病的临床观察[D].重庆医科大学硕士论文,2013.
[4]史伟云.我国角膜上皮损伤临床诊治专家共识(2016年)[J].中华眼科杂志,2016,52(9):644-646.
[5]曹淑娟,骆晓琴,姜爱新.硅水凝胶软性角膜接触镜治疗持续性角膜上皮缺损的疗效[J].国际眼科杂志,2018,18(8):1436-1438.
[6]么娆,柯碧莲.持续性角膜上皮缺损的治疗进展[J].世界临床药物,2017,38(7):496-498.
[7]Quilling J P,Vines J B,Mowry K C.In vitro assessment of a novel,hypothermically stored amniotic membrane for use in a chronic wound environment[J].Int Wound J,2017,14(6):993-1005.
[8]Adzick N S,Lorenz H P.Cells,matrix,growth factors,and the surgeon.the biology of scarless fetal wound repair[J].Ann Surg,1994,220(1):10-18.
[9]Grentzelos M P,Astyrakakis N I,Diakonis V F,et al.Efficacy of 2 types of silicone hydrogel bandage contact lenses after photorefractive keratectomy[J].J Cataract Refract Surg,2009,35(12):2103-2108.
[10]Astyrakakis J B.The use of contact lenses in the treatment of persistent epithelial defects Contact Lens[J].Anterior Eye,2010,33(5):239-244.
[11]Achyut M,Antonis I,Ioannis A.Comparative evaluation of comfilcon a and senofilcon a bandage contact lenses after transepithelial photorefractive keratectomy[J].Optom,2015,8(1):27-32.
[12]Danna S,Hang S,Tong D,et al.Evaluation of the safety and efficacy of therapeutic bandage contact lenses on post-cataract surgery patients[J].Int J Ophthalmol,2018,11(2):230-234.
[13]李洁,卢红,邢丽娜.两种接触镜导致角膜基质浸润发生率的Meta分析[J].武警医学,2017,28(10):1012-1015.
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