- 期刊
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Serial Multilayer Amniotic Membrane Transplants for Graft-Versus-Host Disease-Associated Bilateral Corneal Perforations: Case Report
重複多層羊膜移植治療移植體對抗宿主疾病引起之兩眼角膜穿孔
摘要
目的：我們報告一個以重複多層羊膜移植人與人之間免疫抑制劑治療移植體對抗宿主疾病引起之兩眼角膜穿孔的成年男性病患。 方法：病例報告 結果：一位50歲男性病患因白血病接受過骨髓移植，術後産生慢性移植體對抗宿主疾病且引起兩眼乾眼症、角膜潰瘍及角膜溶解，經人工淚液、治療型隱形眼鏡、全身性類固醇及淚管阻塞手術仍産生兩眼角膜穿孔，經右眼兩次及左眼三次多層羊膜移植手術合併免疫抑制劑治療，追蹤二十個月後角膜狀況穩定。 結論：在部分嚴重病例，單次羊膜移植治療無法完全阻止慢性移植體結抗宿主疾病造成的角膜穿孔，重複多層羊膜移植合併免疫抑制劑始可達成有效病情控制及治療。
關鍵字
無資料並列摘要
Purpose: To report a case of bilateral corneal perforations associated with graft-versus-host disease (GVHD) that was successfully treated with serial multilayer amniotic membrane (AM) transplants (AMT) and systemic immunosuppressants. Methods: Interventional case report. Results: A 50-year-old Chinese male with leukemia was referred for evaluation of dry eyes and corneal ulcers, manifested by intractable central corneal melting bilaterally, secondary to chronic GVHD after bone marrow transplantation. He failed treatment with a preservative-free lubricant, soft contact lens bandages, topical and systemic steroids, and bilateral permanent punctal occlusion. Bilateral corneal perforations resulted and he was treated urgently with multi-layer AM grafting at the perforation site (inlay) and the entire cornea (overlay), 2 times for the right eye and 3 times for the left eye, combined with systemic immunosuppressants. Over a follow-up period of 12 months, stability of the corneal epithelium and stroma was verified. Conclusions: A single AMT did not arrest the corneal melt and rescue his corneas. Immunosuppressants played a role in the success of treatment. Serial multilayer AMT should be combined with systemic immunosuppressants to treat corneal perforations and reconstructing the ocular surface in cases of severe ocular GVHD.