| Purpose:To observe the effect of amniotic membrane transplantation combined with mitomycin C to pseudopterygium and partial symblepharon as a result of corneal limbus stem cells deficiency due to chemical burn and physical injury.In the meantime to study the change of ocular surface morphology before and after operation. Methods:Eighteen eyes of 18 consecutive patients with pseudopterygium or partial symblepharon caused by chemical burn and physical injury were included in this study from February 1, 2011 to June 30, 2014.The surgery was performed at least one month after the initial injury to allow possible resolution of the inflammation. All the patients were treated with amniotic membrane transplantation in combination with mitomycin C.After surgery,all eyes were given compress bandage for two consecutive days. And antibiotic and lubricant eyedrops were used for 1 week.Then compound tobramycin eye drops(4 times per day, 2 weeks later reduced to 2 times per day) and compound tobramycin eye ointment(1 time per day)were used for a month.The sutures were removed at about 10 to 14 days postoperatively when the amniotic membrane was re-epithelialized. All participa nts were examined with slit- lamp biomicroscopy at day 1, 1 week and 1, 3, 6,12 months after surgery.Laser scanning in vivo confocal microscopy examinations were performed on the individuals and PAS staining and immunofluorescence staining were performed by gathering the shedding of epithelial cel s both of the central and limbus of cornea 3 months after surgery. Results:Among the 18 patients, seventeen of them were men and only one was women,including chemical burn with 8 eyes,thermal burn with 10 eyes.The average percentage of the area of the conjunctival fiber vascular tissue invasion of limbus to the total area of corneal limbus was 57.11 ± 18.85%(23.97-88.54%) by using Image J statistical software analysis.. Postoperative follow-up was 22.72 ± 11.43 months(9 to 47 months). 2 patients postoperative relapsed at 18 and 21 days, respectively and, the whole coneal transplant surgery were performed.Anti- inflammatory and immune rejection therapy were given postoperatively.No recurrence was observed in the other 16 patients.the results are as follows:1. Vision examination: preoperative Log MAR best corrected visual acuity was 0.74± 0.53.12 eyes(75%)visual acuity improved with,postoperative Log MAR best corrected visual acuity 0.52±0.46. There is significant difference between postoperative Log MAR best corrected visual acuity and preoperative best corrected visual acuity.(t = 2.39, P = 0.03).2. Laser scanning in vivo confocal microscopy examinations showed that the size of corneal epithelium cells were uniform, clear boundary, intensive distribution.The structure of limbus were disappeared and the limbal epithelium cells were almost normal.3. Impression cytology:PAS negative staining both in the central corneal epithelium cells and the limbal epithelium cells. Immunofluorescent staining showed that high expression of CK12 in central corneal epithelium cells and lower expression in the superficial layer of limbal epithelium cells that close the cornea epithelium cel s. Conclusion1. Amniotic membrane transplantation in combination with mitomycin C showed to be an effective way to pseudopterygium and partial symblepharon as a result of corneal limbus stem cells dificiency due to chronic chemnical injury,thermal burns or injury after an explosion,successfully reconstruction of ocular surface structure.2. The amplification of the limbal stem cells could proceed and, eventually achieved a full corneal surface epithelial phenotype by improving the ocular surface environment as long as there was a small amount of healthy limbal tissue.3. The cyto- inhibition between the limbal epithelium,corneal epithelium and the conjunctival epithelial cells might be involved in the barrier that blocked the conjunctival tissue invasion. |
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