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目的:(1)研究羊膜移植在治疗兔眼大面积结膜碱烧伤,重建健康结膜表面中的作用。(2)探讨碱烧伤急性期施行羊膜移植术的可行性。方法:选用30只家兔,制作角膜缘上方球结膜至穹隆部的碱烧伤的动物模型。实验组于碱烧伤后1wk时(急性期)行保存的人羊膜移植术及穹隆成形术。术后1,2,3,4,8,12wk时做光镜观察移植部位的结膜上皮生长情况,并于术后1,4,8wk时取移植区结膜做电镜观察其超微结构,同时与碱烧伤后行结膜下注射维生素C及应用抗生素眼药水点眼治疗的对照组结膜作对照观察。并在上述相应时期摄眼外观像、做上角膜缘至上方穹隆部宽度的测量。结果:(1)羊膜移植术后1wk时,光镜、电镜可见羊膜上有结膜上皮细胞长入,4wk时,含有杯状细胞的结膜上皮完全覆盖羊膜,接近于正常的结膜组织,12wk时,羊膜上结膜上皮细胞排列整齐,穹隆部结膜上皮下纤维结缔组织较为疏松,无增生。而对照组1wk时见结膜上皮细胞坏死脱落,未见有含杯状细胞的结膜上皮长入,4～8wk时所见为大量纤维结缔组织增生,伴炎性细胞浸润。12wk时,穹隆部纤维结缔组织增生明显,未见有正常结膜上皮覆盖。(2)外观眼表可见,12wk时实验组移植区结膜光滑无瘢痕,上穹隆形成良好,穹隆深达7.6～8.2mm,接近正常穹隆深度8.0～8.5mm。而对照组结膜表面不光滑,有结膜肉芽肿形成,瘢痕增生明显,上方穹隆明显变浅,穹隆深度为1.0～4.5mm。结论:以甘油保存的羊膜可作为一种底物载体,提供健康的基底膜,有利于周围正常结膜上皮的粘附、移行和分化,进而重建正常结膜表面。结膜碱烧伤后早期行羊膜移植可重建正常结膜表面,有效地防止睑球粘连的发生。
Objective: (1) To study the role of amniotic membrane transplantation in the treatment of large area conjunctival alkali burn in rabbit eyes and reconstruction of healthy conjunctiva surface. (2) To investigate the feasibility of amniotic membrane transplantation in the acute phase of alkali burn. Methods: 30 rabbits were selected to make the animal model of alkali burns from the conjunctiva to the dome of the corneal limbus. In the experimental group, human amniotic membrane transplantation and vault plasty were performed at 1wk after alkali burn (acute phase). At 1, 2, 3, 4, 8, and 12 weeks after operation, the growth of conjunctival epithelium at the transplanted site was observed under light microscope. The ultrastructure of the conjunctiva at the transplantation site was observed by electron microscopy at 1, Subconjunctival injection of vitamin C after alkali burn and control group conjunctiva treated with antibiotic eye drops were used as controls. And in the above period of time take a look at the appearance of the image, do the limbus to the top of the vault width measurement. At 1wk after amniotic membrane transplantation, conjunctival epithelial cells were observed on the amniotic membrane by light and electron microscopy. At 4wk, the conjunctival epithelium with goblet cells completely covered the amniotic membrane, close to the normal conjunctiva tissue. At 12wk, Amniotic conjunctival epithelial cells arranged in neat, subfornical conjunctival subformal fibrous connective tissue is more loose, no proliferation. The control group 1wk see conjunctival epithelial necrosis, conjunctival epithelial cells containing no goblet cells seen in 4 ~ 8wk see a large number of fibrous connective tissue proliferation, with inflammatory cell infiltration. 12wk, the vault of fibrous connective tissue hyperplasia obvious, no normal conjunctival epithelium covered. (2) The appearance of ocular surface shows that, 12wk experimental group transplantation area smooth and scarless conjunctiva, the formation of a good dome, the dome deep 7.6 ~ 8.2mm, close to the normal dome depth 8.0 ~ 8.5mm. The control group conjunctiva surface is not smooth, there is the formation of conjunctival granuloma, scar hyperplasia significantly above the shallow dome, the dome depth of 1.0 ~ 4.5mm. CONCLUSION: Amniotic membrane preserved with glycerol can be used as a substrate carrier to provide a healthy basement membrane, which is conducive to the adhesion, migration and differentiation of the surrounding normal conjunctival epithelium, thus reconstructing the normal conjunctival surface. Early amniotic membrane transplantation after conjunctival alkali burn can reconstruct the normal conjunctiva surface, effectively preventing the occurrence of symblepharon.