目的:探讨多层羊膜移植术治疗角膜穿孔的效果。方法:对用深低温保存的羊膜材料行多层羊膜移植术治疗角膜穿孔的106例118眼的临床资料进行回顾性分析,术后随访6～18(平均12)mo。对术后角膜穿孔愈合情况、羊膜情况、术后视力、眼压、并发症情况进行观察随访。结果:术后10d～3mo,所有患者角膜穿孔均愈合;内层羊膜均与角膜牢固愈合,34眼于术后10～21d脱落或溶解吸收,37眼于术后2mo内脱落或溶解吸收,47眼于术后3mo内脱落或溶解吸收;术后6mo最佳矫正视力:光感～手动者26眼,指数～0.05者31眼,0.06～0.3者39眼,0.4～0.6者10眼,0.7～0.8者7眼,≥0.9者5眼,与术前相比,视力明显提高,其差异有显著性(χ2=50.68,P<0.01);术后12mo,角膜透明2眼,角膜白斑38眼,角膜斑翳53眼,角膜云翳25眼;术前合并白内障者及术后形成角膜白斑者中的部分患者术后择期行白内障手术或光学性穿透性角膜移植术。结论:用深低温保存的羊膜行多层羊膜移植术对于治疗各种原因所致的角膜穿孔,尤其是3mm以内的角膜穿孔,效果非常显著,可有效促进穿孔愈合,明显提高视力,并为后续治疗创造有利条件。

AIM:To investigate the effect of multilayer amniotic membrane transplantation in treatment of corneal perforation.·METHODS:The clinical data of 106 patients 118 eyes with corneal perforation who underwent multilayer amniotic membrane transplantation with cryopreserved amniotic membrane materials were retrospectively analyzed. The patients were followed up for 6 to 18 months with an average of 12 months. Healing of corneal perforation,amnion,postoperative best-corrected visual acuity,intraocular pressure and complications were observed in the follow-up.·RESULTS:After 10 days to 3 months postoperatively,all patients were with healed corneal perforation; inner amniotic membranes were firmly with the corneal healing,and they were off the cornea or dissolved and absorbed 10-21 days after the operation in 34 eyes,within 2 months after the operation in 37 eyes,within 3 months after the operation in 47 eyes; after 6 months postoperatively,best-corrected visual acuity:light perception to hand movement in 26 eyes,finger count to 0.05 in 31 eyes,0.06-0.3 in 39 eyes,0.4-0.6 in 10 eyes,0.7-0.8 in 7 eyes,≥0.9 in 5 eyes,compared with preoperative ones,the visual acuity was significantly improved,the difference was significant (χ2=50.68,P<0.01); after 12 months postoperatively,corneal transparency was in 2 eyes,corneal leucoma in 38 eyes,corneal macula in 53 eyes and corneal nebula in 25 eyes; some of those patients who were combined with cataract preoperatively or with corneal leucoma postoperatively underwent cataract surgery or optical penetrating keratoplasty in selected period.·CONCLUSION:The effect of multilayer amniotic membrane transplantation in the treatment of corneal perforation due to various reasons with cryopreserved amniotic membrane,especially the range of corneal perforation within 3mm,is very significant,which can effectively promote the healing process,significantly improve visual acuity,and create favorable conditions for the follow-up treatment.

R779.6