去上皮和经上皮快速角膜交联术紫外光脉冲输出模式治疗进展期圆锥角膜患者的临床效果

目的探讨去上皮快速角膜交联术紫外光脉冲输出模式(pl-快速CXL)和经上皮pl-快速CXL治疗进展期圆锥角膜患者的临床效果。方法选取2018年1月至2019年6月在河北省眼科医院行pl-快速CXL治疗的进展期圆锥角膜患者16例31眼;根据术式将患眼分为两组,去上皮pl-快速CXL组7例13眼和经上皮pl-快速CXL组9例18眼。术前及术后3个月和6个月进行随访。记录患眼最佳矫正远视力、散光度、角膜前表面最大曲率、角膜前表面最小曲率、角膜最薄点厚度、角膜内皮细胞计数、交联线深度,对各指标进行统计学分析。结果去上皮pl-快速CXL组和经上皮pl-快速CXL组患者术后3个月和术后6个月最佳矫正远视力、散光度、角膜前表面最大曲率、角膜前表面最小曲率、角膜内皮细胞计数与术前相比,差异均无统计学意义(均为P>0.05);术后3个月和术后6个月时两组角膜最薄点厚度均较术前变薄,差异均有统计学意义(均为P<0.05)。两组患者交联线深度术后3个月与术后6个月相比,差异均无统计学意义(均为P>0.05)。术后3个月和术后6个月时,去上皮pl-快速CXL组患者角膜交联线深度均较经上皮pl...     

Ex vivo expansion of limbal epithelial stem cells: amniotic membrane serving as a stem cell niche

Identification, maintenance, and expansion of stem cells for subsequent transplantation has become a new strategy for treating many diseases in most medical subspecialties. The stem cells of the corneal epithelium are located in the limbal basal layer and are the ultimate source for constant corneal epithelial renewal. Like those in other tissues, limbal stem cells are supported by a unique stromal microenvironment called the stem cell niche, which consists of certain extracellular matrix components, cell membrane-associated molecules, and cytokine dialogues. Destructive loss of limbal stem cells or dysfunction of their stromal environment renders many corneas with a clinical entity called limbal stem cell deficiency, which is characterized by variable extents of conjunctival ingrowth depending on the severity of limbal damage. A new strategy of treating limbal stem cell deficiency is to transplant a bio-engineered graft by expanding limbal epithelial stem cells ex vivo on amniotic membrane. This review summarizes the published literature data collectively explaining how amniotic membrane is an ideal biological substrate that can help maintain and support the expansion of limbal epithelial stem cells.     

自体角膜缘干细胞移植治疗角膜缘功能衰竭症

目的　探讨自体角膜缘干细胞移植在角膜缘功能衰竭症治疗中的作用。方法　将 83例 90眼初发性翼状胬肉、外伤性角膜缘板层缺损及角膜缘碱烧伤患者随机分为A、B组。A组为自体角膜缘干细胞移植组 (干细胞治疗组 ) 4 2例 4 5眼 ,其中 30眼翼状胬肉行翼状胬肉切除联合自体角膜缘干细胞移植术 ,外伤性角膜板层损伤 10眼、角膜缘碱烧伤 5眼行自体角膜缘干细胞移植术 ;B组为传统单纯翼状胬肉切除 ,外伤性角膜缘板层损伤、碱烧伤行结膜瓣移植术 (对照组 ) ,4 1例 4 5眼 ,其中翼状胬肉 30眼行单纯翼状胬肉切除 ,外伤性角膜缘板层缺损 11眼、碱烧伤 4眼行结膜瓣移植术 ,术后观察角膜上皮修复时间、角膜缘新生血管、角膜透明度、泪膜破裂恢复时间以及胬肉复发率 ,术后随诊 6～ 2 4月。结果　A组术后角膜上皮修复时间 2～ 4d、BUT(6 .7± 0 .8)d ,无角膜缘新生血管生长 ,术后翼状胬肉复发率为 0 ,角膜透明 ;B组术后角膜上皮修复时间 5～ 7d ,BUT(7.9± 0 .5 )d ,角膜缘有 3～ 8支新血管生长 ,角膜有不同程度的云翳 ,翼状胬肉复发率 13.33% ,A、B 2组各项指标比较有统计学差异。结论　自体角膜缘干细胞移植治疗角膜缘功能衰竭症是一种简单、安全、有效的手术方法。     

三种手术方式治疗翼状胬肉的临床疗效

目的:比较单纯翼状胬肉切除与翼状胬肉切除联合自体角膜缘于细胞移植与翼状胬肉切除联合羊膜移植术的临床疗效,以降低胬肉术后的复发率.方法:将164例(170眼)胬肉患者分成三组,A组39例(40眼);B组73例(74眼);C组52例(56眼).A组为单纯翼状胬肉切除术,B组为翼状胬肉切除联合自体角膜缘干细胞移植术,C组为翼状胬肉切除联合羊膜移植术治疗,随访观察6 -24月.结果:A组39例(40眼)复发12眼;B组73例(74眼)复发4眼;C组52例(56眼)复发4眼.结论:翼状胬肉切除联合自体角膜缘干细胞移植及羊膜移植术是治疗胬肉及降低术后复发率较好的方法,翼状胬肉切除联合自体角膜缘干细胞移植是治疗翼状胬肉最好的方法之一.     

组织块培养角膜缘上皮细胞的生物学特征观察

目的观察以人羊膜为底物组织块培养角膜缘上皮细胞的生物学特征.方法取含有上皮细胞大小约2 mm×2 mm、厚约200 μm兔角膜缘组织,剪切成4个小的组织块,用消化液消化至组织块变疏松后放在去除上皮细胞的羊膜上培养,每2～3 d用倒置显微镜观察,定期取羊膜进行细胞组织学、免疫组织化学及电镜检查.结果角膜缘组织块在羊膜上培养8 d,羊膜上培养的角膜缘上皮细胞出现汇合并部分成层,培养16 d,细胞形成3～4层,并很好地附着于下面的羊膜上,羊膜上培养的细胞经广谱角蛋白(pan-keratin,PK)抗体和抗增殖细胞核抗原(proliferating cell nuclear antigan,PCNA)单克隆抗体免疫组织化学染色呈阳性反应.结论羊膜作为底物组织块培养的角膜缘上皮细胞短期内能形成多层且具有较强增殖能力,可以用来移植.     

翼状胬肉抗复发手术及机制探讨

目的：观察羊膜移植、自体结膜移植、自体板层结膜 角膜 巩膜移植3种手术方式治疗翼状胬肉后的复发情况。方法：翼状胬肉患者150例、186眼，其中50例、56眼行翼状胬肉切除 羊膜移植术，46例、62眼行翼状胬肉切除 自体结膜移植术，54例、68眼行翼状胬肉切除 自体板层结膜、角膜、巩膜移植术。结果：羊膜移植治愈45眼，治愈率为84．0％，复发11眼，复发率为19．60。自体结膜移植治愈44眼，治愈率为70．9％；复发18眼，复发率为29．1％，自体板层结膜 角膜 巩膜移植治愈65眼，治愈率为95．6％；复发3眼，复发率为4．4％。结论：翼状胬肉切除 自体板层结膜、角膜、巩膜移植术后复发率低，近期和远期效果均优于其他两种方法，可能成为翼状胬肉治疗中预防复发的更为有效的术式。     

The vascular anatomy of the spiral lamina and the spiral limbus in the adult rat

Summary A scanning electron microscope (SEM) study of corrosion cast preparations of the vessels of the spiral lamina and the spiral limbus was carried out in adult rats. This method confirms present knowledge of the modiolar vascularization and also shows its distribution in a three-dimensional model. As a result of this technique we have been able to demonstrate the modiolar vascular supply of the organ of Corti at different levels.     

角膜缘上皮移植治疗翼状胬肉疗效观察

目的　观察角膜缘上皮移植治疗翼状胬肉的疗效。方法　将 82例 (90眼 )翼状胬肉 ,随机分成A、B两组。A组 42例 (4 6眼 ) ,行翼状胬肉切除联合角膜缘上皮移植术 ;B组 40例 (4 4眼 ) ,行单纯翼状胬肉切除术。术后随访 6～ 2 4月。结果　A组 2例 (2眼 )复发 ,复发率 4 3 5 % ;B组 17例 (19眼 )复发 ,复发率 43 18%。两组比较 ,差异有非常显著意义 (P <0 0 1)。供体角膜缘区无并发症发生。结论　角膜缘上皮移植术能有效预防翼状胬肉的复发。     

现代白内障囊外摘除术中角膜缘切口的探讨

本文为探讨角膜缘切口类型对现代白内障囊外摘除手术的影响。将行白内障摘除人工晶体植入手术中角膜缘切口随意分成二组，梯形切口35眼；斜形切口39眼，并观察术后的情况。发现现代白内障囊外摘除术中角膜缘梯形切口组较斜形切口组为好，术中截囊针易于进入前房，组织损伤少，便于缝合，而且术后切口的愈合也较牢固，角膜平均散光较轻。由此可见，角膜缘梯形切口是初学现代白内障囊外摘除人工晶体植入术者值得提倡使用的。     

The blood vessels of the limbus spiralis

Summary The capillaries of the spiral limbus in the cochlea of the laboratory rat were investigated under light and electron microscopy. A stereological examination of the capillary volumes of specimens injected with horseradish peroxidase was performed. The volume of capillaries amounted to 2.87%, and, as such, is very high. The ultrastructure of the capillaries showed continuous endothelial cells and basal laminae, discontinuous pericytes and varying relations towards the surrounding tissue. Morphological criteria, such as microvilli and plasmalemmal vesicles, suggest a significant transendothelial transport. The causes for the abundance of vessels in the spiral limbus are discussed: the transport of oxygen to the perilymph and the need of substances for the formation of the tectorial membrane seem to be important factors. The transport processes are obviously controlled by the endothelial cells as well as by the spiral limbus cells.