颞侧角膜缘切口的选择及其解剖学基础

目的：探讨颞侧角膜缘的应用解剖特点,为颞侧角膜缘切口提供应用解剖学基础。方法：采用成人尸体眼球10只在体式显微镜下观察角膜缘的层次结构特点,并测量角膜缘的宽和厚以及前房角主要结构间的距离。另外选取40例青光眼术后眼压失控患者采取颞侧切口和上方常规切口二次手术,比较不同切口入路患者的术后视力及眼压,以确定颞侧角膜缘切口的治疗效果。结果：尸体测量颞侧角膜缘内界宽为（0.62±0.05）mm,厚为（0.73±0.04）mm。Schlemm管前缘与巩膜突和后弹力层止端的距离分别是（0.44±0.02）mm和（0.24±0.03）mm。青光眼患者上方切口组和颞侧切口组术后视力差异无显著性(P>0.05),眼压颞侧角膜缘切口低于上方切口(P<0.05)。结论：颞侧角膜缘切口适用于第二次青光眼及并发性白内障手术。     

干细胞移植丝裂霉素C治疗复发性翼状胬肉

目的 探讨复发性翼状胬肉干细胞移植手术的效果.方法 对48（48眼）复发性翼状胬肉,先行广泛切除,术中加用丝裂霉素C,再行自体角膜缘干细胞移植.结果 术后6个月复诊观察,48眼中,1眼复发（1.47％）,余47眼随诊1年未见复发,无并发症出现.结论 广泛切除、术中应用丝裂霉素C加自体角膜缘干细胞移植联合手术是复发性翼状胬肉有效的治疗方法.     

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。     

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.     

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。     

翼状胬肉切除术后自体角膜缘干细胞移植治疗研究

目的 研究翼状胬肉切除术后用自体角膜缘干细胞移植治疗效果。方法 在翼状胬肉112眼切除的基础上行自体角膜缘干细胞移植术，术后随访6个月～3年。结果 随访期内112眼中104眼获得临床治愈，治愈率为92．31％；8眼复发，复发率为7．69％。结论 自体角膜缘干细胞移植有利于重建角膜缘屏障功能，利用该方法治疗翼状胬肉可提高治愈率，降低复发率，是目前有效的手术方式之一。     

LASIK术中角膜缘出血的初步研究

目的研究准分子激光原位角膜磨镶术中出血对手术效果的影响及预防方法。方法观察了46例51眼接受手术时发生出血的情况及出血对术后效果的影响。结果出血部位以上方为多，共30眼，占58．8％；下方9眼，占17．6％；2个方位以上出血者12眼，占23．5％，术后半月时，过矫者30眼，欠矫11眼，不规则散光5眼。其中7眼为提高视力，接受2次手术。结论准分子激光原位角膜磨镶术术中角膜缘出血可影响手术效果，手术时应引起高度重视。     

大鼠角膜缘移植后角膜缘上皮中RANTES和MCP-1表达的意义

目的:研究RANTES和MCP-1在大鼠角膜缘移植模型中的动态表达,探讨其与移植排斥反应发生的关系. 方法:将大鼠随机分为同种异体移植组(AG组)、自体移植组(SG组),并以健康大鼠作为正常对照组(N组),用定量竞争性RT-PCR的方法,在术后(POD)1, 4, 7, 11, 14, 21和30 d分别检测各组大鼠RANTES和MCP-1 mRNA的含量,并观察大鼠眼表变化,判断排斥反应的发生. 结果:术后5 d开始AG组出现排斥反应,8~10 d达到高峰. RANTES和MCP-1 mRNA含量术后均大幅增加(P<0.05),RANTES于POD7达峰,MCP-1于POD11达峰,随后均持续下降. POD1, 4 AG组与SG组RANTES与MCP-1 mRNA含量无差异,POD7～30均有明显差异. 结论:动态检测RANTES和MCP-1 mRNA含量,可能有助于临床上对角膜缘移植排斥的诊断和对预后的估计.     

Phenotypic analyses of limbal epithelial cell cultures derived from donor corneoscleral rims

Grafted cultures of limbal epithelial cells aid repair of the corneal epithelium, but their phenotype is unclear. In this study, the phenotype of cultures that were similar in age to those used clinically were analysed. Limbal epithelial cells were isolated from donor corneoscleral rims and grown in various media, including those designed for keratinocytes. Successful cultures in each medium developed predominantly small (10 μm) tightly packed cells. Immunocytochemistry and western blotting revealed expression of keratins 3, 14 and 19. Expression of these keratins in situ was confirmed by immunohistochemistry. Basal limbal epithelial cells were positive for keratins 14 and 19, and suprabasal cells were positive for keratin 3. However, intense staining for keratin 14 was also observed at the inner cut edge of corneoscleral rims. These findings demonstrate the potential importance of keratins 14 and 19 as markers of epithelial cell differentiation in the human cornea.     

上下自体角膜缘干细胞移植治疗翼状胬肉的疗效比较

目的：比较取自上方与下方的带角膜缘干细胞的球结膜移植治疗翼状胬肉的疗效,以及术后球结膜瘢痕化对日后行青光眼滤过手术的影响。
　　方法：对182例252眼初发翼状胬肉患者随机抽签法分成两组,A组85例110眼行翼状胬肉切除联合上方自体角膜缘干细胞移植,B组97例142眼翼状胬肉切除联合下方自体角膜缘干细胞植治疗翼状胬肉,术后1~12 mo随访,观察两组的复发率和取自体角膜缘干细胞后球结膜瘢痕情况,以及对日后行青光眼滤过手术的影响。
　　结果：随访1~12mo,A组和B组术后复发率相比较,差异无统计学意义(χ2=0.015,P>0.05)。 A组取上方自体角膜缘干细胞后造成上方球结膜的瘢痕化;B组取下方自体角膜缘干细胞造成下方球结膜瘢痕化。因常规行青光眼滤过手术,通常选在正上方、鼻上或颞上方球结膜区,B组保留了上方健康的球结膜,为日后行青光眼滤过手术保留了手术区域。
　　结论：上方与下方取自体角膜缘干细胞移植均能有效地治疗翼状胬肉,但下方取自体角膜缘干细胞移植能为日后行青光眼滤过手术保留手术区域。