Amniotic membrane transplantation for acute chemical or thermal burns
Amniotic membrane transplantation for acute chemical or thermal burns
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DOI：
10.1016/s0161-6420(00)00024-5
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发表时间：
2000-05-01
期刊：
影响因子：
13.7
通讯作者：
Tseng, SCG
中科院分区：
文献类型：
--
作者：
Meller, D;Pires, RTF;Tseng, SCG
目的：探讨保存人羊膜能否用于眼烧伤急性期的治疗。设计：前瞻性、非对照、干预性病例系列。研究对象：急性烧伤II级患者13只眼，化学烧伤10只眼，热烧伤II-III级7只眼，IV级6只眼。方法：烧伤后2周内行羊膜移植。主要观察指标：9个月内眼表上皮细胞完整性及视力。结果：男10例，女1例；大多数是年轻人(38.2+/-10，6岁)。随访8.8±4.7个月，11只眼(84.63%)在2~5周(23.7±9.8天)出现上皮化，最终视力>6行(6眼)、4~5行(2眼)、1~3行(2眼)，仅1眼出现睑粘连，II~III度烧伤患者视力改善(7.3±3行)明显高于IV度烧伤患者(2.3±3.0行)；P<；0.05，非配对t检验)。在II级或III级烧伤组中，无一例角膜缘干细胞缺乏。结论：羊膜移植能有效地促进再上皮化，减轻炎症反应，从而预防晚期瘢痕形成。在轻度到中度烧伤中，单用AMT可以迅速恢复角膜和结膜表面。然而，在严重烧伤时，它可以在不削弱眼球粘连的情况下恢复结膜眼表，并减少角膜缘基质炎症，但不能防止角膜缘干细胞缺乏，这需要进一步的角膜缘干细胞移植。这些结果强调了在眼表严重受损的急性期立即进行干预的重要性。需要进一步的前瞻性随机研究，包括对照组，以确定AMT对眼睛急性化学和热烧伤的有效性。(C)2000年由美国眼科学会授予。
Purpose: To determine whether preserved human amniotic membrane (AM) can be used to treat ocular burns in the acute stage.Design: Prospective, noncomparative, interventional case series.Participants: Thirteen eyes from II patients with acute burns, 10 eyes with chemical burns and 3 with thermal burns of grades II-III (7 eyes) and grade IV (6 eyes), treated at 7 different facilities.Methods: Patients received amniotic membrane transplantation (AMT) within 2 weeks after the injury.Main Outcome Measures: Integrity of ocular surface epithelium and visual acuity during 9 months of follow-up.Results: Ten patients were male and one patient was female; most were young (38.2 +/- 10,6 years). For a follow-up of 8.8 + 4.7 months, 11 of 13 eyes (84.63%) showed epithelialization within 2 to 5 weeks (23.7 +/- 9.8 days), and final visual acuity improved greater than or equal to 6 lines (6 eyes), 4 to 5 lines (2 eyes), and 1 to 3 lines (2 eyes); only one eye experienced a symblepharon, Eyes with burns of grade II to III showed more visual improvement (7.3 +/- 3 lines) than those with burns of grade IV (2.3 +/- 3.0 lines; P < 0.05, unpaired t test). In the group with grade II or III burns, none had limbal stem cell deficiency. All eyes in the group with grade IV burns did experience limbal stem cell deficiency.Conclusions: Amniotic membrane transplantation is effective in promoting re-epithelialization and reducing inflammation, thus preventing scarring sequelae in the late stage. In mild to moderate burns, AMT alone rapidly restores both corneal and conjunctival surfaces. In severe burns, however, it restores the conjunctival ocular surface without debilitating symblepharon and reduces limbal stromal inflammation, but does not prevent limbal stem cell deficiency, which requires further limbal stem cell transplantation. These results underscore the importance of immediate intervention in the acute stage of eyes with severely damaged ocular surface. Further prospective randomized studies including a control group are required to determine the effectiveness of AMT in acute chemical and thermal burns of the eye. (C) 2000 by the American Academy of Ophthalmology.