Amniotic membrane graft to conjunctival flap in treatment of non-viral resistant infectious keratitis: a randomised clinical study
Amniotic membrane graft to conjunctival flap in treatment of non-viral resistant infectious keratitis: a randomised clinical study
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DOI：
10.1136/bjophthalmol-2014-305224
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发表时间：
2015-01-01
影响因子：
4.1
通讯作者：
Nagy, Ragy R. S.
中科院分区：
文献类型：
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作者：
Abdulhalim, Bahaa-Eldin Hasan;Wagih, Mostafa Mohamed;Nagy, Ragy R. S.
目的评价和比较双蒂结膜瓣（CF）和冻存羊膜移植（AMG）治疗难治性非病毒感染性角膜炎的疗效。CF组20眼，AMG组20眼。CF组真菌性角膜炎12眼，细菌性角膜炎7眼，阿米巴性角膜炎1眼。AMG组真菌性角膜炎13眼，细菌性角膜炎5眼，阿米巴性角膜炎2眼。在CF组中，3个溃疡有后弹力层膨出，4个溃疡穿孔。在AMG组中，4个溃疡有后弹力层膨出，2个溃疡穿孔。在CF中，进行360度腹膜切开术，并从Tenon囊上剥离上结膜的双蒂CF，移动以覆盖角膜并缝合到巩膜外层。在AMG中，修剪一层或两层AM以适合溃疡并缝合到角膜上。结果术后随访6个月，两组均获成功，成功率均为90%（18/20）。术后，两组之间没有显着差异，成功率（p=1.0），上皮形成时间（p=0.75）或视力改善（p=0.84）。结论CF和AMG是有效的治疗难治性感染性角膜炎。它们可以恢复眼表的完整性，并为角膜愈合提供代谢和机械支持。对于较大的角膜穿孔，最好采用另一种方法，如穿透性角膜移植术，以恢复眼球的完整性。
Purpose To evaluate and compare the results of bipedicle conjunctival flap (CF) and cryopreserved amniotic membrane graft (AMG) in the treatment of non-viral infectious keratitis resistant to medical treatment.Methods This prospective randomised interventional study included 40 eyes of 40 patients with resistant non-viral infectious keratitis. Twenty eyes received CF and 20 eyes received AMG. In the CF group, there were 12 eyes with fungal keratitis, 7 eyes with bacterial keratitis and 1 eye with Acanthamoeba keratitis. In the AMG group there were 13 eyes with fungal keratitis, 5 eyes with bacterial keratitis and 2 eyes with Acanthamoeba keratitis. In the CF group, three ulcers had descemetocele and four ulcers were perforated. In the AMG group, four ulcers had descemetocele and two ulcers were perforated. In CF, 360 degrees peritomy was done and a bipedicle CF from the upper conjunctiva was dissected from Tenon's capsule, mobilised to cover the cornea and sutured to episclera. In AMG, one or two layers of AM were trimmed to fit the ulcer and sutured to the cornea. The follow-up period was 6 months.Results Successful results were observed in 18/20 eyes (90%) in each group. Postoperatively, no significant differences between the two groups were found regarding success rate (p=1.0), epithelialisation time (p=0.75) or visual acuity improvement (p=0.84).Conclusions CF and AMG are effective in treatment-resistant infectious keratitis. They could restore ocular surface integrity and provide metabolic and mechanical support for corneal healing. For large corneal perforation, it may be better to use another procedure such as penetrating keratoplasty to restore ocular integrity.