目的:观察多层羊膜移植治疗角膜溃疡性穿孔的临床效果,了解此方法的有效性、安全性和局限性.方法:对6例(6眼)角膜溃疡性穿孔的患者采用多层羊膜移植治疗,溃疡穿孔范围0.5～2mm.用羊膜填塞穿孔、铺平溃疡并覆盖于溃疡表面.术后随访5～19mo.结果:术后1d6位患者的前房均形成,随访期间深度正常且始终未消失.羊膜植片手术后3wk上皮化.手术后1mo内,穿孔区角膜厚度逐渐增加,溃疡周边的浸润也逐渐吸收.术后2mo溃疡瘢痕愈合,有新生血管长入,表面光滑;溃疡区的角膜厚度稳定,恢复正常.术后6例视力均无提高.随访期间溃疡未出现复发及严重的并发症.结论:多层羊膜移植治疗较小的角膜溃疡性穿孔是有效、安全的,但此方法术后角膜溃疡是瘢痕愈合.%AIM: To investigate the efficacy, safety and localization of multilayer amniotic membrane transplantation (AMT) for the management of corneal perforation associated with ulceration.METHODS: Six eyes (6 patients) were treated with multilayer AMT for corneal perforation associated with ulceration. The perforation size was 0.5-2mm in diameter. The amniotic membrane (AM) was applied to tamp the perforation, fill the ulcer and cover the surface of ulcer. The follow-up ranged from 5-19 months.RESULTS: The anterior chamber reformed at the first postoperative day in all patients, and kept in normal depth in the follow- up time. The epithelialization of the AM grafts was observed in about 3 weeks after surgery. During the first postoperative month, the corneal thickness at the perforation site gradually increased, and the stromal inflammatory cell invasions surrounding the corneal ulcer were gradually subsided.Two months postoperatively, the ulcer healed with scar with part neovascutarization; the corneal thickness of the ulcer area was stable and recovered almost normal. The vision was not improved in all patients after operation. During-follow up,no severe complications or recurrence of ulceration was noted.CONCLUSION: Multilayer AMT is an effective and safe method for the management of small corneal perforation associated with ulceration, but the ulcer healed with scar.
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