两种手术方法治疗翼状胬肉的临床观察

目的比较临床常用的角膜缘干细胞移植术和单纯胬肉切除术＋丝裂霉素C治疗原发性翼状胬肉的临床疗效。方法85例90眼患者随机分为两组,A组：44眼采用角膜缘干细胞移植术;B组46眼采用单纯胬肉切除术术中应用丝裂霉素。术后随访12月。结果A组42眼治愈,2眼复发;B组36眼治愈,10眼复发。两组治疗复发率有显著性差异（P〈0．01）。结论角膜缘干细胞移植术翼状胬肉复发率低,术后患者恢复快,是一种值得推广应用理想的手术方法。     

Structures of the corneal limbus detected by laser-scanning confocal biomicroscopy as related to the palisades of Vogt detected by slit-lamp microscopy

Purpose  To examine the relations between specific structures detected at the corneal limbus by confocal biomicroscopy with palisades of Vogt detected by slit-lamp microscopy Methods  Twenty-five eyes of 25 normal participants were examined. The presence or absence of the palisades of Vogt and limbal pigmentation were assessed by slit-lamp microscopy. The presence or absence of four structures in the corneal limbal area—hyperreflective parallel trabecular extensions, borders of bright-cell groups and dark-cell groups, hyperreflective cells and bright corpuscular particles with dendritic cell-like morphology—were assessed by confocal biomicroscopy. The relations between the presence of these four structures and the presence of either the palisades of Vogt or limbal pigmentation of the palisade ridges were evaluated by the χ-squared test. Results  Only the presence of hyperreflective parallel trabecular extensions was significantly related to the presence of the palisades of Vogt (P < 0.01). The presence of hyperreflective cells was not significantly related to the presence of limbal pigmentation. Conclusion  The hyperreflective parallel trabecular extensions observed by confocal biomicroscopy may correspond to the palisades of Vogt detected by slit-lamp microscopy. Further studies are needed to determine whether confocal biomicroscopy can be used to diagnose and monitor the clinical course of limbal stem cell deficiency.     

自体角膜缘干细胞联合羊膜移植术治疗翼状胬肉的护理

目的探讨自体角膜缘干细胞联合羊膜移植术治疗翼状胬肉的护理经验。方法回顾性分析和总结本院2006年1月～2007年10月采取自体角膜缘干细胞联合羊膜移植术治疗36例翼状胬肉患者的术前、术后护理重点和出院指导。结果36例（42只眼）植片全部成活,无1例出现排斥反应和护理并发症。随访8～11个月,无1例复发及出现并发症。结论严格进行手术前护理和准备,术后采取针对性的护理措施能有效防止植片感染,提高手术成功率。     

自体角膜缘干细胞移植治疗翼状胬肉疗效观察

目的:观察自体角膜缘干细胞移植治疗翼状胬肉的临床疗效。方法:在显微镜下采用胬肉切除联合自体角膜缘干细胞移植治疗初发性和复发性翼状胬肉270例(286眼),术后随访6~42个月。结果:259眼痊愈,27眼复发,其中原发性翼状胬肉复发率9.0%,复发性翼状胬肉复发率11.4%。结论:联合自体角膜缘干细胞移植简单易行,复发率低,是治疗翼状胬肉行之有效的方法。     

不同术式治疗原发性翼状胬肉的临床效果分析

目的:比较分析羊膜移植术、自体角膜缘干细胞移植术及术中应用0.2g/L丝裂霉素C治疗原发性翼状胬肉的临床效果。方法:回顾性分析我院232例曾行原发性翼状胬肉手术的患者,其中82例行羊膜移植术治疗,90例行自体角膜缘干细胞移植术治疗,60例在术中应用0.2g/L丝裂霉素C治疗,比较三种术式术后复发率及并发症。结果:自体角膜缘干细胞移植术和术中应用0.2g/L丝裂霉素C治疗原发性翼状胬肉的复发率低于羊膜移植术(P<0.05);而自体角膜缘干细胞移植术和术中应用0.2g/L丝裂霉素C之间复发率无差异(P>0.05)。角膜上皮缺损,流泪和畏光在0.2g/L丝裂霉素组发生比例较其他两组高(P<0.05),在自体角膜缘干细胞移植组和羊膜移植组两组间差异无统计学意义(P>0.05)。结膜充血及结膜下出血在三组间无统计学差异(P>0.05)。结论:与其他两种术式相比,自体角膜缘干细胞移植术治疗原发性翼状胬肉,有着复发率低、并发症少的优点。     

大角膜缘移植瓣术在翼状胬肉中的应用

目的：观察大角膜缘移植瓣术在翼状胬肉中的应用效果。方法选取2013年1月至2014年12月我院眼科收治的100例（100眼）翼状胬肉患者为研究对象，根据随机数字表法随机分为对照组50例(50眼)和观察组50例(50眼)。观察组给予大角膜缘移植瓣术治疗，对照组给予小自体角膜缘移植瓣术。比较两组患者治疗前后的视力、屈光度、泪液基础分泌量及泪膜破裂时间；同时比较两组患者的治疗总有效率、复发率及并发症发生率。结果治疗前，两组患者的视力、屈光度、泪液基础分泌量及泪膜破裂时间比较差异均无统计学意义(P>0.05)；治疗后4周，观察组与对照组患者的上述观察指标分别为(0.72±0.07)、(0.97±0.65) D、(9.68±2.17) mm、(11.7±2.88) s和(0.49±0.10)、(1.70±0.48) D、(6.85±2.04) mm、(7.90±2.13) s，均较治疗前显著改善，差异均有统计学意义(P<0.05)，且观察组的改善程度优于对照组，组间比较，差异均有统计学意义(P<0.05)。观察组患者治疗有效率为96.0%(48/50)，明显高于对照组的78.0%(39/50)，差异有统计学意义(P<0.05)。随访13~37个月，观察组患者的复发率为2.0%(1/50)，对照组为18.0%(9/50)，观察组低于对照组，差异有统计学意义(P<0.05)。观察组术后并发症发生率为12.0%(6/50)，高于对照组的6.0%(3/50)，但差异无统计学意义(P>0.05)。结论采用大角膜缘移植术治疗翼状胬肉能够有效改善患者的视功能及泪膜稳定性，降低复发率，其具有疗效确切、安全性高等特点，值得临床推广应用。     

Different Cellular and Genetic Basis of Noise-Related Endocochlear Potential Reduction in CBA/J and BALB/cJ Mice

The acute and permanent effects of noise exposure on the endocochlear potential (EP) and cochlear lateral wall were evaluated in BALB/cJ (BALB) inbred mice, and compared with CBA/J (CBA) and C57BL/6 (B6) mice. Two-hour exposure to broadband noise (4–45 kHz) at 110 dB SPL leads to a ~50 mV reduction in the EP in BALB and CBA, but not B6. EP reduction in BALB and CBA is reliably associated with characteristic acute cellular pathology in stria vascularis and spiral ligament. By 8 weeks after exposure, the EP in CBA mice has returned to normal. In BALBs, however, the EP remains depressed by an average ~10 mV, so that permanent EP reduction contributes to permanent threshold shifts in these mice. We recently showed that the CBA noise phenotype in part reflects the influence of a large effect quantitative trait locus on Chr. 18, termed Nirep (Ohlemiller et al., Hear Res 260:47–53, 2010b). While CBA “EP susceptibility” alleles are dominant to those in B6, examination of (B6 × BALB) F1 hybrid mice and (F1 × BALB) N2 backcross mice revealed that noise-related EP reduction and associated cell pathology in BALBs are inherited in an autosomal recessive manner, and are dependent on multiple genes. Moreover, while N2 mice formed from B6 and CBA retain strong correspondence between acute EP reduction, ligament pathology, and strial pathology, N2s formed from B6 and BALB include subsets that dissociate pathology of ligament and stria. We conclude that the genes and cascades that govern the very similar EP susceptibility phenotypes in BALB and CBA mice need not be the same. BALBs appear to carry alleles that promote more pronounced long term effects of noise on the lateral wall. Separate loci in BALBs may preferentially impact stria versus ligament.     

翼状胬肉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

目的观察翼状胬肉切除联合自体角膜缘干细胞移植治疗翼状胬肉的临床疗效。方法将80例(92眼)翼状胬肉患者随机分为治疗组38例(45眼)和对照组42例(47眼)。对照组采用传统胬肉切除治疗,治疗组采用翼状胬肉切除联合自体角膜缘干细胞移植治疗。比较2组角膜上皮愈合情况及术后复发情况。结果治疗组角膜上皮愈合速度显著快于对照组;且12个月内,治疗组复发率为2.6%显著低于对照组的31.0%,差异有统计学意义(P<0.01)。结论翼状胬肉切除联合自体角膜缘干细胞移植治疗翼状胬肉疗效可靠,复发率低,无严重手术并发症,值得推广应用。     

Effects of illumination and observation angle on the van Herick procedure

Background: This study reports how illumination and observation angles affect assessments of the openness of the anterior chamber angle using the van Herick technique. Methods: The angle of the tangent to the corneal surface at the temporal limbus was measured for 50 participants. The effect on anterior chamber depth to corneal thickness (AC : C) ratio of varying the illumination angle away from the perpendicular to this tangent was measured. The effect of varying observation angle was also evaluated. An optical model was constructed to simulate the parameters likely to affect measurement of the AC : C ratio. Results: The average angle of the tangent to the corneal surface at the temporal limbus was 43.1 ± 5.4° (SD). With illumination perpendicular to the limbal‐corneal surface, varying the observation angle caused clinically unimportant (less than 0.1 ratio difference) but statistically significant changes in AC : C ratios (F = 7.235, p < 0.0001; repeated measures ANOVA). With observation 60° away from illumination, varying the illumination angle away from the perpendicular to the limbal‐corneal surface caused clinically important and statistically significant changes in AC : C ratios (F = 75.981, p < 0.0001; repeated measures ANOVA). The optical model confirmed the experimental results and predicts that the conclusions are applicable outside our study population. Conclusions: Illumination should be within 10° either side of the perpendicular to the corneal surface at the limbus for measurements of the AC : C ratio. The observation angle away from the illumination direction is not critical and 60° is appropriate, but smaller angles can be used.     

Long-term effectiveness of autologous cultured limbal stem cell grafts in patients with limbal stem cell deficiency due to chemical burns

Background: Chemical burns cause depletion of limbal stem cells and eventually lead to corneal opacity and visual loss. We investigated the long‐term effectiveness of autologous cultured limbal stem cell grafts in patients with limbal stem cell deficiency. Design: Prospective, non‐comparative interventional case series. Participants: Sixteen eyes from 16 patients with severe, unilateral limbal stem cell deficiency caused by chemical burns. Methods: Autologous ex vivo cultured limbal stem cells were grafted onto the recipient eye after superficial keratectomy. Main Outcome Measures: Clinical parameters of limbal stem cell deficiency (stability/transparency of the corneal epithelium, superficial corneal vascularization and pain/photophobia), visual acuity, cytokeratin expression on impression cytology specimens and histology on excised corneal buttons. Results: At 12 months post‐surgery, evaluation of the 16 patients showed that 10 (62.6%) experienced complete restoration of a stable and clear epithelium and 3 (18.7%) had partially successful outcomes (re‐appearance of conjunctiva in some sectors of the cornea and instable corneal surface). Graft failure (no change in corneal surface conditions) was seen in three (18.7%) patients. Penetrating keratoplasty was performed in seven patients, with visual acuity improving up to 0.8 (best result). For two patients, regeneration of the corneal epithelium was confirmed by molecular marker (p63, cytokeratin 3, 12 and 19, mucin 1) analysis. Follow‐up times ranged from 12 to 50 months. Conclusions: Grafts of autologous limbal stem cells cultured onto fibrin glue discs can successfully regenerate the corneal epithelium in patients with limbal stem cell deficiency, allowing to perform successful cornea transplantation and restore vision.