The ocular surface changes of moderate alkali burns patients by biological amniotic membrane transplantation on confocal microscopy

Abstract

Objective To investigate the clinical effect of biological amnion transplantation on moderate ocular surface alkali burns.To evaluate the possibility of biological amnion treatment for ocular alkali bums during early stage. Methods Thirty-two alkali bums patients who classified as Ⅱ ～Ⅲ degree according to Roper-Hall classification were enrolled in this study.They were divided into two groups to the course of disease:group A had 24 eyes (24 hours-2 weeks),group B had 18 eyes (2 weeks-1 month).All patients underwent biological amnion transplantation by the same surgeon.The limbus and bulbar conjunctiva were observed by laser scanning confocal microscope before and after the surgery,and the densities of the inflammatory cells and goblet cells were calculated.All patients were given clinical exam and value the scores of acuity vision,corneal fluorescent staining,degree of symblepharon and corneal neovascularization.Matching t test was used to compare the changes between two groups. Results The corneal epithelia of the patients in group A manifested irregular features.There were numerous small inflammatory cells beneath the superficial epithelia and very few goblet cells.The images of the endothelial layer were unclear,and it was hard to discriminate the morphology of each cell.In group B,it was still hard to discriminate the morphology of the corneal epithelia.The inflammatory cells beneath the superficial epithelia decreased,and there were few goblet cells.The morphology of the corneal epithelia was improved,and the inflammatory cells decreased with the goblet cells increasing in both groups.The densities of inflammatory cells beneath the superficial epithelia were (5409±302) cell/field,(3814±286) cell/field in group A and B respectively before operation,that were (2854±307) cell/field,(2018±198) cell/field in group A and B respectively after operation.The P value was ＜0.05 by matching t test.The densities of goblet cells were (5±2) cell/field,(10±6) cell/field in group A and B respectively before operation,that were (15±4) cell/field,(17±3) cell/field in group A and B respectively after operation.The P value was ＜0.05 by matching t test.There wasn't a significant difference in the scores of corneal fluorescent staining between the two groups; however,there were significant changes in the degree of moderate symblepharon and score of corneal neovascularization. Conclusions Early amniotic membrane transplantation is effective for reconstruction of ocular surface and decreasing the related complications.The laser scanning confocal microscopy is a useful tool to clearly show that the morphology of the ocular surface of moderate alkali burns patients among and evaluated the effect of the operation. Key words: Ocular surface; Alkali burns; Biological amnion; Transplantation; Effect