羊膜移植重建急性期严重烧伤眼表的临床研究

目的探讨羊膜重建急性烧伤期眼表面的可行性,比较新鲜和保存羊膜的疗效差异,评价手术方法及其疗效.方法全角膜Ⅲ度以上烧伤且全周角膜缘坏死的临床连续病例分别接受羊膜移植(19例20只眼)或全板层角膜移植手术(22例24只眼).19例羊膜移植患者中8例8只眼接受新鲜羊膜移植,11例12只眼接受保存羊膜移植.患者术后随访12～26个月,平均(15±2)个月.结果羊膜移植后眼表迅速稳定.新鲜羊膜移植者眼表面迅即并维持上皮化.保存羊膜移植者第2或3周才完成上皮化,且12只眼中有3只眼不能完全上皮化,最后由于持续性上皮缺损而发生羊膜融解,其后接受了板层角膜移植.眼表上皮化的术眼随着时间的延长新生血管开始沿着羊膜从角膜周边长入,羊膜被逐渐吸收.新生血管多为表浅性.新鲜羊膜多数(7/8)在术后2～8(4.3±0.8)个月、保存羊膜多数(10/12)在术后1～3(2.0±0.3)个月基本被吸收或融解(t=4.22,P<0.01).羊膜移植重建的结膜眼表均获成功,仅1例发生影响眼球运动的中度睑球粘连.板层角膜移植组22例(24只眼)均保全眼球,但在术后大多发生角膜植片上皮反复脱落,最终植片新生血管化,其中4只眼由于角膜植片融解而接受植片更换,7只眼因植片上皮持续性缺损而行睑缘缝合术,5只眼发生轻中度睑球粘连.在无合并青光眼和白内障的患者中,羊膜移植术后的视力基本保留了眼前手动,而板层角膜移植者则多见眼前指数.结论羊膜尤其新鲜羊膜的移植可以减轻角膜急性烧伤期的炎症反应,阻止眼表的进行性溃烂和融解,加速眼表的稳定;同时减少角膜新生血管的形成,并在相当长的时间内将其局限在角膜周边部,从而为后续的角膜复明手术打下良好的基础.     

羊膜移植治疗急性眼表烧伤的疗效

目的:讨论羊膜移植术对治疗急性眼表烧伤的疗效。方法:用新鲜的人羊膜移植术来治疗眼部早期烧伤10例12眼。结果:患者12眼均于术后3wk内眼表重新再次上皮化;恢复透明角膜3眼,薄翳5眼,遗留角膜斑翳2眼,角膜白斑者2眼;角膜血管新生3眼,其中限于角膜周边部仅2眼,1眼进入角膜瞳孔区;睑球轻度粘连2眼。结论:羊膜移植治疗早期眼部烧伤可获得稳定的眼表,是一种有效的方法,且为日后行角膜移植术治疗创造了条件。     

羊膜移植治疗眼表烧伤的临床应用分析

目的:评价羊膜移植治疗眼表化学烧伤及热烧伤的临床疗效。方法:收集我院眼部化学及热烧伤24例28眼,行新鲜羊膜移植术治疗,随访6～24mo。术后观察视力,羊膜移植片情况,角膜恢复情况及角膜上皮修复时间,并发症。结果:术后视力提高者22眼(79%),不变者6眼(21%),无视力下降者,术前术后视力差别无统计学意义。羊膜移植片情况:28眼中羊膜覆盖成活24眼,成活率达86%。角膜恢复情况:28眼中角膜最终恢复透明8眼,角膜云翳12眼,角膜斑翳5眼,角膜白斑3眼。角膜上皮愈合时间:22眼角膜上皮1～3wk全部愈合。术前4眼睑球粘连患者,睑球粘连情况均得到改善,3眼完全分离。结论:新鲜羊膜移植术是治疗眼表化学及热烧伤的有效方法。     

羊膜移植在眼表疾病的临床应用

目的 探讨和评估新鲜羊膜移植治疗眼表疾病的疗效.方法 对结膜肿物,睑球粘连,碱烧伤,酸烧伤,热灼伤共24例(28眼)施行新鲜羊膜移植术,术后观察眼表重建情况,羊膜植片情况,术后视力情况,随访4-18个月.结果 24例(28眼)均未发生新鲜羊膜植片的排斥反应.2 5眼一次羊膜移植术后结膜、角膜上皮化痊愈,眼表重建成功.睑球粘连的患者第三眼位复视消失.1眼发生睑球粘连,2眼角膜部分上皮缺损,再次行羊膜覆盖术,术后随访完成上皮化,术后视力不同程度提高.结论 新鲜羊膜移植能有效的促进上皮细胞的分化移行、抑制局部的炎症反应、阻止新生血管和瘢痕的形成、阻止烧伤的病理发展,是治疗眼表疾病的一种积极有效的治疗方法.     

羊膜移植治疗眼表损伤

目的 观察羊膜移植术在急性期及瘢痕期眼表损伤中的治疗效果。方法 选择眼表理化生物损伤急性期10例(14眼)，及瘢痕期6例(7眼)，行新鲜及保存羊膜移植，部分联合板层或穿透性角膜移植，随访6～22月：结果 急性期者无一例发生角膜融解或睑球粘连；瘢痕期严重睑球粘连者中1例术后部分复发；联合角膜移植者均未见新生血管长入。结论 羊膜移植对急性期和瘢痕期眼表损伤防止角膜融解、睑球粘连，改良眼表基底及重建眼表上皮均有肯定效果。     

化学及热烧伤后睑球粘连的手术治疗

目的评价眼化学及热烧伤所致睑球粘连，行睑球粘连分离后单纯羊膜移植术及羊膜移植同时联合板层角膜移植手术的疗效。方法44例(44眼)化学及热烧伤后睑球粘连行睑球粘连分离，对18眼结膜缺损处行单纯羊膜移植术；对26眼睑球粘连牵涉角膜或角膜有大量新生血管者，行羊膜移植联合板层角膜移植术，其中12眼联合新鲜大板层角膜移植术，14眼联合干燥保存供体板层角膜移植术。结果44眼术后睑球粘连治愈16眼(36．4％)，好转20眼(45．5％)，无效8眼(18．1％)。结论对于化学及热烧伤后睑球粘连，单纯羊膜移植术或羊膜移植联合板层角膜移植术，可有效地缓解睑球粘连或部分达到治愈。     

羊膜移植联合角膜缘干细胞移植治疗严重眼烧伤

目的观察羊膜移植联合上下角膜缘干细胞移植治疗严重眼烧伤的效果。方法采用新鲜羊膜移植联合上下角膜缘干细胞移植治疗严重眼烧伤患者15例（17眼）。术后随访平均2月，观察其效果。结果视力大于0．05者12眼占70．59％，10眼角膜无明显新生血管，2眼角膜中央留有薄翳，12眼角膜稍有浑浊。17眼全部瘢痕愈合，眼表稳定。结论烧伤早期行羊膜移植联合上下角膜缘干细胞移植可明显减少睑球粘连并可使早期眼表稳定。     

冻存羊膜移植治疗早期中度及重度眼表烧伤的临床研究

目的探讨冻存羊膜移植在治疗早期中、重度眼表烧伤中的疗效。方法对28例（33眼）中、重度眼表烧伤施行羊膜移植术。随访6～12月,观察临床疗效。结果术后大部分患者保存了眼球,1眼发生角膜穿孔。角膜恢复透明12眼,角膜斑翳7眼,角膜白斑3眼,角膜新生血管9眼,睑球粘连1眼。13眼视力提高〉3行。无急性排斥反应和继发感染发生。结论羊膜移植是治疗早期中、重度眼表烧伤的一种较安全有效的方法。     

保存人羊膜移植治疗难治性眼表疾病的临床效果

目的　探讨保存人羊膜移植治疗难治性眼表疾病的临床效果。方法　采用保存人羊膜移植治疗 49例 5 6眼难治性眼表疾病 ,其中翼状胬肉 2 6例 3 3眼 ,急性碱烧伤 3例 ,慢性化学性烧伤13例 ,大泡性角膜病变 4例 ,眼表良性肿瘤 3例。结果　术后无一例眼发生感染 ,除一例急性碱烧伤患者于术后第 5天羊膜溶解、脱落外 ,其余患者术后羊膜植片平伏 ,术后 1～ 4周内正常上皮沿羊膜表面生长 ,成功重建眼表。经过平均 11 2± 5 6个月的随访观察 ,翼状胬肉者中 5眼复发 ,手术成功率为 84 8% ,复发率为 15 2 % ,3例急性碱烧伤者出现角膜结膜化 ,未能获得长期稳定的眼表 ,慢性化学性烧伤者角膜新生血管明显减轻 ,睑球粘连松解 ,视力有不同程度改善 ,大泡性角膜病变者主观症状得以改善 ,眼表良性肿瘤者未见复发及并发症发生。结论　保存的人羊膜移植能安全、有效地重建部分难治性眼表疾病患者的眼表 ,但对急性严重碱烧伤患者的远期疗效不理想。     

基层医院治疗眼表重度烧伤的困境和对策的探讨

目的探讨在缺乏异体角膜供体情况下治疗Ⅲ度以上眼表烧伤的手术方式及疗效。方法眼表重度烧伤35例（37眼）。其中28例（29眼）Ⅲ度烧伤,行自体带角膜缘干细胞结膜瓣移植联合新鲜羊膜遮盖术;7例（8眼）IV度烧伤采取双层羊膜遮盖术,二期行带角膜缘干细胞结膜瓣移植联合新鲜羊膜遮盖。术后若羊膜脱落则再次行羊膜遮盖直至角膜上皮完全修复。结果术后随访3～20个月,35例（37眼）中19眼角膜恢复透明,11眼角膜薄翳（共30眼判断为治愈）,4眼瘢痕愈合（角膜白斑、新生血管长入）,2眼石灰烧伤角膜溃疡无法愈合需行结膜瓣遮盖,1眼爆炸伤最终角膜穿孔、感染需眼球摘除（共7眼判断为无效）,治愈率81．08％。共需羊膜遮盖1～4次。结论带角膜缘干细胞结膜瓣移植联合多次新鲜羊膜遮盖术治疗重症眼烧伤,在基层综合医院取材方便,价廉,具可操作性,对Ⅲ度烧伤有减轻炎症、促进眼表上皮化、提高视力等效果;对Ⅳ度烧伤有保存眼球、防止睑球粘连的治疗意义,在缺乏异体角膜供体情况下可选择应用。     

Strabisme Alternant - Etude clinique - traitement

The author defines motor and sensory alternation: the term alternation should not be used in isolation, it should always be accompanied by the name of the parameter concerned. Sensory alternation is always found together with motor alternation but the reverse is not true.The examining criteria for a diagnosis of sensory alternation are given, sensory alternation must not be confused with alternating inhibition. Working from clinical observations of cases of motor alternating strabismus, the author selects 2 types of binocular sensory relations which allow one to differentiate between:- cases of primary alternating strabismus- cases of secondary alternating strabismusThese forms will develop in different ways; in both cases a cure is possible providing that the right treatment is prescribed and once prescribed carefully followed, etc. It is always a case of serious forms of strabismus whose developmental period is spread over several years.According to the authors, the frequency of cases of true primary strabismus is from 1–3%, the frequency of cases of secondary alternating strabismus varies according to the type of therapy practised on cases of monocular strabismus with amblyopia. These latter will become cases of alternating strabismus under the influence of certain types of therapy carried out over several years (penalization, rocking, alternated occlusion, etc...).Experimental data on kittens confirm clinical data; kittens placed in abnormal environments during the sensitive period will show modification in the distribution of cortical cells and the absence of binocular cells (either because the excitation of the two eyes was not simultaneous, or not identical: artificial strabismus, occlusion, opaque glasses). This disturbances become irreversible after a certain period of exposure (a function of age, length of exposure, etc...).It is thus necessary to bear in mind: 1) the iatrogenic risks of certain orthoptic treatments, 2) the necessity for a binocular form of treatment as soon as possible, as once a certain stage is passed, cortical plasticity diminishes and the elaboration of normal binocular relations becomes impossible.

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Effects of Adenosine Agonists on Intraocular Pressure and Aqueous Humor Dynamics in Cynomolgus Monkeys

The effects of single or multiple topical doses of the relatively selective A₁adenosine receptor agonists (R)-phenylisopropyladenosine (R-PIA) and N⁶-cyclohexyladenosine (CHA) on intraocular pressure (IOP), aqueous humor flow (AHF) and outflow facility were investigated in ocular normotensive cynomolgus monkeys. IOP and AHF were determined, under ketamine anesthesia, by Goldmann applanation tonometry and fluorophotometry, respectively. Total outflow facility was determined by anterior chamber perfusion under pentobarbital anesthesia. A single unilateral topical application of R-PIA (20–250 μg) or CHA (20–500 μg) produced ocular hypertension (maximum rise=4.9 or 3.5 mmHg) within 30 min, followed by ocular hypotension (maximum fall=2.1 or 3.6 mmHg) from 2–6 hr. The relatively selective adenosine A₂antagonist 3,7-dimethyl-1-propargylxanthine (DMPX, 320 μg) inhibited the early hypertension, without influencing the hypotension. Neither 100 μg R-PIA nor 500 μg CHA clearly altered AHF. Total outflow facility was increased by 71% 3 hr after 100 μg R-PIA. In conclusion, the early ocular hypertension produced by topical adenosine agonists in cynomolgus monkeys is associated with the activation of adenosine A₂receptors, while the subsequent hypotension appears to be mediated by adenosine A₁receptors and results primarily from increased outflow facility.