Comparison Of The Efficacy Of AMT Combined With Freezing And LKP Treatment Of Mooren's Ulcer

Purpose:Comparative study of clinical efficacy between AMT(Amniotic membrane transplantation)combined with freezing and LKP(Lamellar keratoplasty)in the treatment of patients with Mooren's ulcer.Method:Retrospective analysis of patients diagnosed with Mooren's ulcer in our hospital from January 2010 to January 2019 and not effective with conventional drug treatment,a total of 40 cases(42 eyes),of which 15 cases(16 eyes)were males and 25 cases(26eyes)were females,with an average age of 57.35 to 9.60(37 to 76)years old.According to the surgical method is divided into amniotic membrane transplantation combined with freezing group(AMT group)and lamellar keratoplasty group(LKP group),of which AMT group was included in a total of 20 eyes(Male 9 eyes,Female 11eyes),LKP group was included in a total of 22 eyes(Male 7 eyes,Female 15 eyes).To observe the best corrective visual acuity(Log MAR),relapse of the original disease,corneal epithelial healing time,corneal epithelialization time,ulcer lesions healing,corneal transparency,corneal graft transparency,corneal neovascularization,corneal graft neovascularization,follow-up time of 1 year.Statistical analysis was carried out by SPSS25.0 software,and the rank and inspection of the two sets of data were completed by t-test,chi-square test and nonparametric rank sum test,P < 0.05 was considered statistically significant.Results:1.Average of the best corrective visual acuity(Log MAR)for 1,3,6,and 12 monthsafter surgery: the AMT groups were 0.720±0.385,0.595±0.301,0.555±0.264 and0.625±0.318.the LKP groups were: 0.968±0.095,0.623±0.177,0.336±0.121 and0.311±0.137.Significant differences between groups of 1,6 and 12 months after surgery(all P value <0.05,were 0.037,0.005 and 0.000).No significant difference between the two groups during 3 months after surgery.(P value >0.05,was 0.507).2.Recurrence: the recurrence of the original disease in the AMT group and LKP group were 15 cases in total.4 cases in the AMT group,11 cases in the LKP group,significant difference between two groups(P value <0.05,was 0.044).3.Ulcer healing: ulcer healing after first surgery in the AMT group and LKP group were 20 cases in total.6 cases in the AMT group,14 cases in the LKP group,significant difference between two groups(P value <0.05,was 0.029).4.AMT group:(1)Corneal transparency: Level 0: 7 cases,Level I: 10 cases,Level II: 3 cases(2)Cornea epithelial healing time: 13.50±2.21(days)(3)Corneal neovascularization: 3(+),17(-)5.LKP group:(1)Corneal graft transparency: Level 0: 9 cases,Level I: 13 cases(2)Corneal epithelialization time: 9.50±1.26(days)(3)Corneal graft neovascularization: 4(+),18(-)Conclusions:1.Lamellar keratoplasty is a safe and effective method of corneal transplantation to make surgical operation easier by implanting cornea graft.2.On average BCVA(Best Corrected Visual Acuity)postoperative,the LKP group was significantly better than the AMT group,and the vision stabilized over time.3.On BCVA postoperative,vision improved significantly in both groups compared to preoperative,and postoperative vision in LKP group was significantly better than in AMT group.4.Ulcer lesions healing,LKP group was significantly better than AMT group.First unhealed patients in the LKP group:5 cases adopted conservative treatment,3 casesadopted LKP.First unhealed patients in the AMT group:10 cases adopted conservative treatment,4 cases were not effective after conservative treatment,and ulcers were healed after LKP.5.For patients were failed in drugs or first-time surgery and with more complex immediate conditions,such as shallow anterior chamber,combined with cataract,LKP technology can also achieve good postoperative results.