Amniotic membrane in ophthalmology: indications and limitations
Amniotic membrane in ophthalmology: indications and limitations
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DOI：
10.1038/eye.2008.410
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发表时间：
2009-10-01
期刊：
影响因子：
3.9
通讯作者：
Dua, H. S.
中科院分区：
文献类型：
--
作者：
Rahman, I.;Said, D. G.;Dua, H. S.
羊膜仍然是治疗几种眼科疾病的有用工具，特别是那些与眼表相关的疾病。然而，在个别病例报告和病例系列中报告的“成功”在少数已发表的随机对照试验中未得到证实。通常情况下，它不如现有的替代方案好，充其量也是一样好，但成本可能会增加。可变结果可能与膜中的供体间和供体内变化以及处理和储存后其成分的消耗或改变有关。因此，该膜是一种相当“非标准化的产品”，难以比较不同的应用和适应症。潜在的“流行病”感染，如艾滋病毒、B和C型肝炎，是一个严重的问题，因为在世界许多地方，正在使用新鲜的未经检疫的膜，有时没有对上述传染性病原体进行测试。膜的确切作用机制尚不清楚，但共识是它充当宿主细胞的基质或支架，从而促进愈合和修复。正在考虑开发一种标准的“合成膜”，使用胶原蛋白或聚合物基质浸渍假定的有益成分，如生长因子和抗菌剂，并可能被证明是朝着正确方向迈出的一步。Eye（2009）23，1954-1961; doi：10.1038/eye.2008.410; 2009年1月23日在线发表
The amniotic membrane remains a useful tool in the treatment of several ophthalmic conditions, especially those related to the ocular surface. However, the 'success' reported in individual case reports and case series is not substantiated in the few published randomised controlled trials. More often than not, it is not as good as existing alternative options and, at best, is as good but with probably an increased cost. The variable outcomes could be related to inter and intra donor variations in the membrane and the depletion or alterations in its constituents subsequent to processing and storage. The membrane thus is a fairly 'non-standardised product' making comparisons of different applications and indications difficult. The potential for 'epidemic' infections, such as HIV, hepatitis B and C, is a serious issue as, in many parts of the world, fresh unquarantined membrane, at times with no tests for the above infectious agents, is being used. The exact mechanism of action of the membrane is not known but the consensus is that it acts as a substrate or scaffold for host cells to populate and thus facilitate healing and repair. The development of a standard 'synthetic membrane' using collagen or polymer matrices impregnated with putative beneficial ingredients, such as growth factors and antimicrobials, is being considered and may prove to be a step in the right direction. Eye (2009) 23, 1954-1961; doi:10.1038/eye.2008.410; published online 23 January 2009