背景：大泡性角膜病变发生率逐年升高，但是角膜移植材料来源少，手术费用较高，且有些患者症状严重，恢复机会较小，角膜移植成功率较小。角膜基质内羊膜来源广，费用低，能够有效缓解患者的症状，提高其生活质量。 目的：对比观察角膜基质内羊膜移植治疗大泡性角膜病变的效果。 方法：选择40只健康成年新西兰大白兔，雌雄各一半，40只大白兔随机分为4组，各10只。A，B， C组兔建立大泡性角膜病变模型。建模后2周A组进行角膜基质内羊膜移植；B组进行角膜表面羊膜移植；C 组进行角膜板层切开治疗，步骤与 A 组相同，但是不植入羊膜；D 组不做手术处理为空白对照。采用固定裂隙灯显微镜的裂隙宽度和光线投射角度，观察各组不同时间大白兔角膜的中央厚度、角膜中央混浊程度及角膜上皮大泡情况。 结果与结论：①移植后1 d、2周时：4组大白兔角膜中央厚度比较差异有显著性意义(P <0.05)；②移植4，8，12周时，角膜基质内羊膜移植组与角膜表面羊膜移植比较差异无显著性意义(P >0.05)，角膜板层切开治疗组与空白对照比较差异无显著性意义(P >0.05)，但与前2组比较差异有统计学意义(P <0.05)；③移植后4，8周时：角膜基质内羊膜移植组角膜混浊程度明显优于其他3组(P <0.05)。角膜板层切开治疗组切口处形成明显瘢痕，移植后角膜基质内羊膜移植组大泡改善明显高于其他3组(P <0.05)，角膜表面羊膜移植大白兔移植后2周复发，角膜板层切开治疗组、空白对照移植后12周仍然水肿，存在大泡。④结果显示，角膜基质内羊膜移植能够有效帮助大泡性病变大白兔修复角膜内皮细胞，缓解水肿症状，其具体作用机制还需进一步研究。%BACKGROUND:Bulous keratopathy has an increasing annual incidence, but its treatment is restricted by few sources of materials for corneal transplantation and high cost of operation. Additionaly, some patients who present with serious symptoms have little chance of recovery and low success in corneal transplantation. Amniotic membrane from the corneal stroma has a rich source with low cost, which can effectively relieve the symptoms and improve the quality of life in patients. OBJECTIVE:To observe the therapeutic efficacy of amniotic membrane implantation into the corneal stroma in the treatment of bulous keratopathy. METHODS: Forty healthy adult New Zealand rabbits (half male and female) were randomly divided into four groups (A, B, C, D groups), with 10 rats in each group. Rabbit models of bulous keratopathy were made in the groups A, B, C. At 2 weeks after modeling, amniotic membrane implantation into the corneal stroma and corneal surface was performed in groups A and B, respectively, and in group C, corneal lamelar dissection was done but with no amniotic membrane transplantation. In group D, there was no surgical treatment (blank control). A slit lamp microscope with constant crack width and angle of light projection was used to observe the central corneal thickness, and corneal opacification degree, corneal epithelial bula of rabbits were observed at different time in each group. Under microscope, the rabbit corneal endothelial cels and healing were observed at different time. RESULTS AND CONCLUSION: At 1 day and 2 weeks after transplantation, the central corneal thickness of rabbits had significant differences in the four groups (P< 0.05). At 4, 8, 12 weeks after transplantation, the central corneal thickness of rabbits showed no difference between groups A and B as wel as between groups C and D (both P > 0.05), but there was a significant difference between groups A, B and group C (P < 0.05). At 4 and 8 weeks after transplantation, the degree of corneal opacity was significantly better in group A than the other three groups (P < 0.05). There were obvious scars forming at the incision of rabbits in the group C. Compared with the other three groups, the bula was improved better in the group A (P < 0.05). At 2 weeks after transplantation, bulous keratopathy relapsed in the group B, and symptoms of edema with bula were stil seen in groups C and D at 12 weeks after transplantation. These findings indicate that amniotic membrane implantation into the corneal stroma can effectively repair rabbit corneal endothelial cels and aleviate the symptoms of edema, but its specific mechanism need to be further studies.
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