生物羊膜联合带自体角膜缘干细胞的结膜瓣移植治疗伴睑球粘连的复发性翼状胬肉

目的:观察生物羊膜联合带自体角膜缘干细胞的结膜瓣移植治疗伴睑球粘连的复发性翼状胬肉的临床效果。方法:将68例76眼伴睑球粘连的复发性翼状胬肉患者按年龄、性别、翼状胬肉大小、睑球粘连程度分为A,B两组,A组30例34眼为翼状胬肉切除加生物羊膜移植组,B组38例42眼为翼状胬肉切除加生物羊膜联合带自体角膜缘干细胞的结膜瓣移植组。术后随访6～24mo。观察角膜透明程度,新生血管的有无,胬肉复发及睑球粘连复发情况。结果:A组有不同程度角膜云翳21眼(62%),其中9眼(26%)伴新生血管,4眼(12%)胬肉复发,1例睑球粘连复发。B组有不同程度角膜云翳9眼(21%),其中3眼(7%)伴新生血管,2眼(5%)胬肉复发,无睑球粘连复发患者。两组比较有角膜云翳及新生血管的发生率有显著性差异,复发率无显著性差异。结论:生物羊膜联合带自体角膜缘干细胞的结膜瓣移植治疗伴睑球粘连的复发性翼状胬肉是一种较理想的治疗方法。     

The limbus in developmental dysplasia of the hip: An obstacle to reduction and its images changed by the femoral head position

This study aimed to describe the shape of the limbus arthroscopically and via arthrogram and magnetic resonance imaging (MRI), and to determine whether it prevents concentric reduction of the femoral head in developmental dysplasia of the hip (DDH).Twelve patients (mean age, 10.2 months; range, 3–31 months) who underwent arthroscopic-assisted reduction for DDH were retrospectively reviewed. Limbus shapes were captured on arthrogram before reduction, after closed reduction, and after arthroscopic-assisted reduction and categorized according to the Miyake classification.On arthrogram, the superior limbus was blocked in 2 hips, inverted in 2, intermediate in 5, and everted in 3 after attempted closed reduction. After arthroscopic-assisted reduction, the limbus was everted in 7 hips and normal in 5. On arthroscopy, in all cases, the limbus appeared as a whitish, cartilage-like ring with a variably blunted edge before reduction, without inversion or eversion. On postoperative MRI, 10 of 12 superior limbi showed hypertrophy or globular compression by the femoral head with intermediate or mixed MRI signal intensities and blunted edges. The remaining 2 hips had hypertrophied superior limbi with sharp edges. On transverse plane MRI, the posterior limbus of all hips showed sharp margins with low MRI signal intensity. Residual subluxation was observed in 7 of the 12 hips with interposition of the anteroinferior limbus.The appearance of the limbus varied according to the femoral head position, and it was neither inverted nor everted. Interposed anteroinferior limbi with residual subluxation suggest impeded concentric reduction in DDH.     

新鲜羊膜联合自体角膜缘移植复发性翼状胬肉

目的：探讨新鲜羊膜联合自体角膜缘移植术在复发性翼状胬肉治疗中的作用。方法：以新鲜羊膜联合自体角膜缘移植手术治疗复发性翼状胬肉31例36眼，术后随访5－24月。结果：植片全部存活，无排斥反应发生。随访期内有2眼翼状胬肉复发。供体角膜缘区无并发症发生。结论：新鲜羊膜联合自体角膜缘移植是一种治疗复发性翼状胬肉的简单、安全、有效的手术方法。     

深低温保存角膜缘组织的结构和增殖活性研究

目的 探讨深低温保存材料角膜缘组织的结构和增殖活性。方法 应用常规切片，HE染色及电镜检查观察深低温保存4个月的角膜缘组织的结构变化。应用免疫组织化学染色法对6片深低温保存4个月的角膜缘材料在刚复温时及于培养液中放置6d后的增殖细胞核抗原(PCNA)表达进行检测，2片新鲜角膜缘材料作为对照。结果 深低温保存4个月的角膜缘材料基本保持了其形态结构的完整性。新鲜角膜缘材料PCNA呈弱阳性表达，6片深低温保存材料在复温时其PCNA呈阴性表达，但当置于培养液中6d后，其PCNA呈阳性表达。结论 深低温保存4个月的角膜缘材料结构完整，且保持其增殖活性，可用于角膜缘移植。     

角膜或角巩膜穿通伤缝合联合白内障摘除及人工晶状体植入术31例

目的探讨三联手术治疗角膜或角巩缘穿通伤并发外伤性白内障患者的手术方法及临床效果。方法采用角膜或角巩缘穿通伤清创缝合联合白内障摘除及人工晶状体植入三联手术治疗角膜或角巩缘穿通伤并发外伤性白内障患者31例(31眼),术后随访3～18月。结果术后3月视力≥0.5者5眼,0.4者6眼,0.3者8眼,0.2者6眼,0.1者5眼,指数/眼前1眼。单眼脱残率61％,单眼脱盲率96％。主要并发症:角膜水肿,局限性角膜白斑,虹膜睫状体炎,术后散光,后发障。结论经选择后的病例,采用角膜或角巩缘穿通伤清创缝合联合白内障摘除及人工晶状体植入三联手术是一种安全可靠的手术方法。     

Comparison of Toric Foldable Iris-Fixated Phakic Intraocular Lens Implantation and Limbal Relaxing Incisions for Moderate-to-High Myopic Astigmatism

PurposeTo compare the effectiveness of toric foldable iris-fixated phakic intraocular lens (pIOL) implantation and non-toric foldable iris-fixated pIOL implantation with limbal relaxing incisions (LRIs) for correcting moderate-to-high astigmatism in myopic eyes.ResultsThe uncorrected distance visual acuity was at least 20/25 in 100% and 98% of the toric and LRI group eyes, respectively. The toric group had lower mean residual cylindrical error (-0.67±0.39 D vs. -1.14±0.56 D; p<0.001) and greater mean cylindrical error change (2.17±0.56 D vs. 1.63±0.72 D; p<0.001) than the LRI group, regardless of the preoperative astigmatic severity. The mean correction index (1.10±0.16 vs. 0.72±0.24; p<0.001) and success index (0.24±0.14 vs. 0.42±0.21; p<0.001) also differed significantly between the groups.ConclusionBoth surgical techniques considerably reduced astigmatism and had comparable visual outcomes. However, toric foldable iris-fixated pIOL implantation was more reliable for correcting moderate-to-high astigmatism in myopic eyes.     

Epicorneal Polypoidal Lipodermoid: Lack of Association of Central Corneal Lesions with Goldenhar Syndrome Verified with a Review of the Literature

It is remarkable to uncover a new aspect of congenital epibulbar solid dermoids and lipodermoids. We describe a dramatic central epicorneal polypoidal lipodermoid coloboma accompanied by an upper eyelid coloboma that was not associated with Goldenhar syndrome. Histopathologically the excised lesion displayed superficial layers of epidermis and a thin dermis with eccrine glands, vestigial hair structures, and bundles of arrector pili smooth muscle that extended from the undersurface of the epidermis to the bulge area of the primitive hairs. This last feature is not present in normal eyelid skin nor in the conjunctiva, and has not been previously documented to occur in epibulbar dermoids and lipodermoids. S-100-positive dendritic melanocytes and CD1a-positive Langerhans cells were both observed intraepidermally, indicating a complete complement of normal cells in this layer. Beneath the dermis was a massive collection of lobules of mature adipose tissue that fused with the corneal stroma. A virtually identical pedunculated limbal tumor has been previously reported that was associated with Goldenhar syndrome. Review of earlier published cases of epibulbar dermoids and lipodermoids establishes that central corneal lesions are not a stigma of Goldenhar syndrome, in contrast to limbal masses. Other epibulbar choristomas that can be confused with lipodermoids are described.     

原代培养角膜缘干细胞与ΔNp63蛋白表达的年龄相关性研究

目的建立兔角膜缘干细胞（LSCs）原代培养体系,了解年龄的增长对兔LSCs的ΔNp63蛋白表达的影响。方法选取3月龄、1.5年龄及3年龄新西兰白兔各10只,用含10%胎牛血清的DMEM/F12培养液对LSCs的细胞悬液进行体外原代培养。应用逆转录聚合酶链反应（RT-PCR）技术和间接免疫荧光法分别检测培养细胞中ΔNp63蛋白的表达量。结果接种3d后大部分细胞贴壁,6d左右形成良好的细胞单层,细胞呈圆形、椭圆形或多边形,类似角膜上皮细胞。年龄越大,ΔNp63的表达量越低。不同年龄组之间ΔNp63表达量的差异有统计学意义（P〈0.05）。结论含10%胎牛血清的DMEM/F12培养液能作为LSCs培养的基础液;ΔNp63蛋白的表达具有明显的年龄相关性,随年龄的增长ΔNp63表达量的下调可能是LSCs老化的分子机制之一。     

逆行切除联合自体角膜缘干细胞移植治疗翼状胬肉的疗效观察

目的观察逆行切除联合自体角膜缘干细胞移植术治疗翼状胬肉的临床疗效。方法将100例患者（160眼）随机分为翼状胬肉逆行切除联合自体角膜缘干细胞移植术组（观察组）,翼状胬肉行逆行切除联合羊膜移植术（对照组）,每组各50例患者（80眼）,分别实施手术并随访6-12个月,观察术后翼状胬肉复发情况,并统计、比较两组复发率。结果观察组完成全部随访的80眼中,复发2眼,复发率2．5％,对照组完成全部随访的80眼中,复发16眼,复发率20％,两组复发率有统计学差异（P〈0．05）。结论逆行切除联合自体角膜缘干细胞移植术治疗翼状胬肉较单纯翼状胬肉逆行切复发率低。     

不同术式治疗翼状胬肉的疗效分析

目的:比较巩膜暴露法、带球结膜瓣的角膜缘干细胞移植术、带球结膜瓣的角膜缘干细胞移植术联合术中封闭球结膜与Tenon囊之间间隙的手术方式治疗翼状胬肉的临床疗效。方法:翼状胬肉患者130例138眼,分为三组:A组(45例,48眼):采用巩膜暴露法行翼状胬肉切除术;B组(42例,45眼):带球结膜瓣的角膜缘干细胞移植术;C组(43例,45眼):翼状胬肉切除联合带球结膜瓣的角膜缘干细胞移植术及封闭球结膜与Tenon囊之间间隙。术后随访12mo。结果:三组复发率分别为27.1%,8.9%,4.4%。A组与其余两组比较存在显著差异(P<0.05),B组与C组存在差异,但无统计学意义。肉芽肿形成:A组3眼,B组2眼,C组未见。C组泪阜的形态及位置明显优于A组及B组。结论:带球结膜瓣的角膜缘干细胞移植术联合术中封闭球结膜与Tenon囊之间间隙能显著降低翼状胬肉术后复发率,减轻炎症反应,预防肉芽肿的形成,有助于恢复泪阜的正常形态及位置,是目前治疗翼状胬肉的较理想手术方式。