同一供体角膜分别用于全板层角膜移植和深板层角膜内皮移植的临床研究

目的探讨同一供体角膜分别应用于全板层角膜移植治疗严重陈旧性眼表烧伤及深板层角膜内皮移植治疗大泡性角膜病变的可行性和临床疗效。方法2008年1月—2010年1月期间8例严重陈旧性眼表烧伤患者行全板层角膜移植术,8例大泡性角膜病变患者进行不剥除后弹力层的深板层角膜内皮移植术,术后随访6～20个月,观察角膜移植片贴附、生长情况,对手术前后的视力进行比较,检查移植片透明度和角膜内皮细胞密度。结果8例严重陈旧性眼表烧伤患者术后5眼角膜基本恢复透明,3眼角膜均有不同程度细小新生血管侵人层间。8例大泡性角膜病变患者术后移植片与自体内皮面始终贴附良好,移植片均透明,其中7例患者术后最佳矫正视力均有不同程度的提高,1例术后视力同术前患者为眼外伤造成的视神经萎缩;8例深板层角膜内皮移植术后患者平均角膜内皮细胞密度为（1780±352）个／mm^2。结论全板层角膜移植及深板层角膜内皮移植技术使同一供体角膜分别治疗严重眼表烧伤和大泡性角膜病变患者成为可行,且临床疗效较好。     

早期康复护理对人工心脏起搏器植入术后患者肩功能恢复的影响

用微型角膜刀行角膜深板层内皮移植术治疗大泡性角膜病变患者18例．效果满意。认为做好充分的术前准备,密切的术中配合．特别是对微型角膜刀使用的准确配合,是提高手术成功率、减少并发症的重要保证。     

角膜深板层内皮移植术的手术配合

用微型角膜刀行角膜深板层内皮移植术治疗大泡性角膜病变患者18例,效果满意。认为做好充分的术前准备,密切的术中配合,特别是对微型角膜刀使用的准确配合,是提高手术成功率、减少并发症的重要保证。     

1例自体角巩缘干细胞联合羊膜移植术的护理

自体角巩缘干细胞移植是治疗眼表疾患的一项新技术 ,我科在开展羊膜移植术的基础上施行首例自体角巩缘干细胞联合羊膜移植术获成功。1　病例介绍女 ,46岁。因右眼复发性胬肉于 1 992年在外院行切除术 ,术后复发 ,症状逐渐加重 ,出现右眼不适、胀痛、胬肉长入角膜 3mm。 2 0 0 0年 1 1月 2 1日到我院就诊 ,2 8日在局麻下行自体角巩缘干细胞联合羊膜移植术。在显微镜下 ,先切除病变的角膜和结膜组织 ,用抗生素生理盐水冲洗后 ,于下角膜缘处取所需大小组织植片 ,移植于患眼角膜缺损处 ,用 8- 0可吸收缝线缝合固定 ,然后取病变同等大小的羊膜覆…     

自体角膜缘上皮移植治疗翼状胬肉

目的　观察自体角膜缘上皮移植术治疗翼状胬肉的疗效。　方法　在显微镜下用自体角膜缘上皮移植术对 42例 (5 0只眼 )翼状胬肉患者进行治疗 ,术后随访 6～ 3 2个月。　结果　 42例角膜上皮愈合良好 ,角膜透明、光滑 ,未见复发。　结论　自体角膜缘上皮移植可为病变区角膜及结膜提供新的干细胞来源 ,是治疗翼状胬肉的有效方法。目的　观察自体角膜缘上皮移植术治疗翼状胬肉的疗效。　方法　在显微镜下用自体角膜缘上皮移植术对 42例 (5 0只眼 )翼状胬肉患者进行治疗 ,术后随访 6～ 3 2个月。　结果　 42例角膜上皮愈合良好 ,角膜透明、光滑 ,未见复发。　结论　自体角膜缘上皮移植可为病变区角膜及结膜提供新的干细胞来源 ,是治疗翼状胬肉的有效方法。     

嵌合角膜移植有利于移植物的预后

在同种异体移植中，受者对移植角膜的上皮（epithelium，EPI）和内皮的排斥效应不相等。内皮是主要的靶向组织，而EPI具有抑制炎症反应的特性，可以抑制同种异体免疫反应。美国Schepens眼科研究所的研究人员假设经体外整合的嵌合角膜移植后，第三方角膜EIP不会使受者对供体角膜内皮表达的异源抗体产生免疫反应，从而有利于移植角膜的存活。     

角膜缘干细胞移植的临床研究进展

自角膜缘干细胞的概念提出之后,很多学者对角膜缘于细胞及角膜缘干细胞移植术进行了研究,用自体或同种异体角膜缘干细胞替换功能受损的角膜缘组织,试图通过供体干细胞的增生分化及上皮细胞的向心移行来修复受损的眼表。现将近年来对角膜缘干细胞移植的临床研究进展综述如下。     

拓展眼库角膜来源，重视供体材料检测

角膜病是眼科主要的致盲性疾病，目前解决角膜盲的根本手段是角膜移植。角膜供体材料的匮乏及其安全性成为限制角膜移植手术开展的问题。因此，要加强眼库建设，倡导全民捐献角膜，建立规范的器官捐献公证系统，开辟新的角膜供体材料来源，合理使用有限的角膜供体材料；同时重视角膜供体材料检测项目的选择及其检测方法的改进，寻找并建立一种简便快速、行之有效、可以对血液和组织进行多种致病微生物检测的供体材料检测方法。     

自体角膜缘干细胞移植治疗翼状胬肉

目的观察自体角膜缘干细胞移植术治疗翼状胬肉的临床效果。方法翼状胬肉11例12只眼，采用手术显微镜下切除局部病灶，然后行自体角膜缘干细胞移植术，术后随访6～15个月（平均11个月）。结果术后角膜上皮愈合良好，无排斥反应或其他并发症发生。随访期间1只眼复发，复发率为8．3％。结论应用自体角膜缘干细胞移植术为受损的角膜缘提供新的健康干细胞，可有效地防止翼状胬肉复发，起到美容的效果。     

低渗水肿钝性分离法在深板层角膜移植中的应用（附视频）

目的评价应用低渗水肿钝性分离法的深板层角膜移植术治疗部分角膜疾病的临床疗效。方法回顾性分析2007年11月-2010年5月期『日J在温州医学院附属眼视光医院接受深板层角膜移植术患者109例（109眼）临床资料。所有患者在移植术中均采用无菌注射用水和钝性器械辅助分离的方法,移植供体为甘油冷冻保存的角膜移植片。术后随访6个月～1年,观察角膜移植片愈合情况、末次随访最佳矫正视力,分析术中植床穿孔率、术后双前房现象、移植片排斥反应率、原发病复发、高眼压及青光眼等并发症情况。结果所有患者术后最佳矫正视力均较术前有所提高,达到或超过0．4者89眼,0．1～0．3者16眼,低于0．1者4眼。有4眼发生后弹力层微小穿孑L（3．67％）,术后双前房现象在1～2周内消退。角膜上皮延迟愈合2眼,原发病复发4眼（单纯疱疹病毒性角膜炎2眼、细菌性角膜炎1眼、真菌性角膜炎1眼）,一过性高眼压1眼,经治疗均得到良好控制。无内皮型排斥反应、继发性青光眼和自内障发生。结论低渗水肿钝性分离法在深板层角膜移植中对治疗凶角膜基质混浊而致盲的角膜疾病疗效确切,手术难度降低,并发症减少,故而更易推广。     

角膜移植术治疗真菌性角膜炎临床疗效分析

目的观察角膜移植术治疗真菌性角膜炎的效果,探讨手术的方式和时机。方法对临床确诊为真菌性角膜炎且经抗真菌药物治疗无效的患者33例（33眼）行角膜移植术。对病变侵及深度〈1／2角膜厚度的19例患者,实施板层角膜移植术（lamellar keratoplasty,LKP）18例,行结膜瓣掩盖1例;溃疡深度〉1／2角膜或出现内皮斑、伴有前房反应的9例患者,行穿透性角膜移植术（penetrating keratoplasty,PKP）;全角膜溃疡的5例行带部分巩膜的跟前节重建术。结果5例于LKP术后2～4周复发,包括2例曲霉菌属感染者和1例镰刀菌属感染者,均改行PKP。其中,4例治愈,1例于PKP术后7个月时发生内皮型排斥反应。3例行PKP者于术后2周出现全眼球炎而行眼球摘除术,手术成功率为72．7％（24／33）。至随访结束时,手术成功病例中矫正视力0．05～0．1者17眼,0．1～0．2者8眼,0．2～0．5者3眼,2例患者仅保留眼球而无有用视力。结论角膜移植术是治疗药物控制不良的真菌性角膜炎的有效方法。应根据感染的不同菌种和生长方式、病灶的浸润范围和深度等特点选择手术方式,以提高手术成功率。     

Corneal edema following argon laser iridotomy.

Laser iridotomy is generally a safe and effective procedure for narrow-angle glaucoma. However, since surgical success with the argon laser depends on a focal thermal effect, a corneal burn is a possible complication. I describe five patients with occludable anterior chamber angles and bilateral corneal guttata who developed uniocular progressive corneal edema with visual loss following argon laser iridotomy. These five patients underwent iridotomy with a total laser energy of 63, 48.5, 7, 25, and 25 J, respectively, and began to lose vision due to corneal edema immediately, and 5, 2, 4, and 2 years later, respectively. Following penetrating keratoplasty with cataract surgery, histopathology of the corneal buttons showed generalized endothelial cell loss in all five. Microstructural findings of guttata and thickened Descemet's membrane implied that prior endothelial dystrophy had predisposed these patients to laser-induced damage. Risk factors for immediate or delayed-onset bullous keratopathy after argon laser iridotomy include prior angle closure, preexisting endothelial guttata, and high laser energy with multiple applications. Recognizing the potential of this complication offers opportunities for preventive strategies.     

Epidermal growth factor and insulin in use in corneal preservation: study design and objectives of a multi-center trial

This study determines whether endothelial survival after penetrating keratoplasty is improved by adding the mitogens, human epidermal growth factor (hEGF), and human insulin to a chondroitin-sulfate-based corneal storage medium. It is a multicenter, prospective, double-masked, randomized trial that compares endothelial survival of human corneal transplants using donor corneas that have been stored in one of two media: DexSol (CSM with 1% dextran) or DexSol containing recombinant hEGF and human insulin. This article describes the study design and entry characteristics of the 105 recipient pairs. Each donor pair of corneas is transplanted on the same day into recipients who are matched by diagnosis and procedure. Clinical parameters assessed on day 1, week 1, and 3, 6 and 12 months postoperatively include graft clarity, epithelial integrity, corneal thickness, visual acuity, and intraocular pressure. Postoperative endothelial survival for both groups will be determined by morphometric analysis of endothelial cell images before storage and at 3, 6, and 12 months postoperatively. Such analysis will also identify differences in polymegathism (cell size) or pleomorphism (cell shape).     

Basic surgical principles of penetrating keratoplasty

Surgical techniques of keratoplasty continue to be modified in an attempt to achieve ideal results, but basic surgical principles remain constant. Proper alignment of the donor graft is an important and consistent surgical principle in all types of keratoplasty. Closure of keratoplasty wounds should provide the most optimal environment for a secure water-tight wound, minimize contour distortion, and promote tissue healing. One provides the most ideal opportunity for desired surgical results by understanding and utilizing basic surgical principles.     

Tissue adhesives: new perspectives in corneal perforations.

In corneal perforations associated with extensive progressive corneal disease, a technique using tissue adhesive closure of the perforation site and reformation of the anterior chamber before penetrating keratoplasty or conjunctival flap mobilization has been described. Over the past year, six eyes have been successfully treated in this manner. This method allows reformation of the eye under local anesthesia as an emergency procedure without incarceration or injury of the intraocular contents and without pain to the patient. The definitive surgical procedure can then be performed safely under retrobulbar anesthesia.     

Adjunctive intracameral application of corticosteroids in patients with endothelial immune reactions after penetrating keratoplasty: a pilot study

This study was performed to gain first experiences with a new adjunctive measure in the treatment of endothelial immune reactions after penetrating keratoplasty, i.e., intracameral injections of corticosteroids. In eight penetrating keratoplasty patients with mild endothelial immune reactions (IM1), 10 patients with moderate endothelial immune reactions (IM2) and 10 patients with severe endothelial immune reactions (IM3) intracameral injections of corticosteroids were performed within 24 h after referral to the clinic, following informed consent. All patients (IM1-3) received basic therapy of steroid eye drops and subconjunctival steroid injections; patients in group IM3 also received oral steroids. In IM1 patients eight of eight grafts, in IM2 eight of 10 grafts and in IM3 five of 10 grafts remained clear during a mean follow-up of 9.9 (1-20), 10.7 (3-17) and 9.6 (1-20) months after intraocular intervention. Only one of the 28 patients developed a further immune reaction during follow-up. No complications of intracameral injection were observed. Intracameral steroid injections thus seem to be a safe and helpful therapeutic measure in the treatment of moderate and severe endothelial immune reactions after penetrating keratoplasty. Further investigations in controlled randomized trials are necessary.     

Human corneal endothelial cell expansion for corneal endothelium transplantation: an overview

The monolayer of cells forming the human corneal endothelium is critical to the maintenance of corneal transparency and is not known to regenerate in vivo. Thus, dysfunction of these cells constitutes the most often cited reasons for the 150,000 or so corneal transplants performed yearly. Although current corneal transplantation is more than 90% successful at 1 year, longer term results are not as encouraging with approximately 70% success at 5 years. Nonimmunologic graft failure and allograft endothelial rejection are the main problems. Furthermore, the global shortage of donor corneas greatly restricts several corneal transplantations performed. With advances in understanding corneal endothelial cell biology, it is now possible to cultivate human corneal endothelial cells (HCECs) in vitro, thus providing new opportunities to develop novel tissue-engineered human corneal endothelium. This review will provide an overview of (a) the characteristics of human corneal endothelium; (b) past and present HCECs isolation and culture protocols; (c) various potential carriers for the generation of tissue-engineered corneal endothelium, together with some of the functional studies reported in various animal models; and (d) the current rapid advancements in surgical techniques for keratoplasty. A successful combination of tissue-engineered human corneal endothelium coupled with innovative and groundbreaking surgical procedures will bridge basic research involving cultured HCECs, bringing it from bench to bedside.     

Corneal decompensation following acute angle-closure glaucoma

Ten eyes of nine patients with endothelial dystrophy requiring iridectomy for acute angle-closure glaucoma developed corneal edema sufficient to require penetrating keratoplasty. Because of the proximity of iris to cornea, simultaneous lens extraction was carried out to prevent malignant glaucoma. Penetrating keratoplasty using techniques presented here provided improved visual acuity and control of glaucoma in all cases.     

Early pseudophakic keratopathy: revealing macrophage reaction in endothelial layer

The pathology of early pseudophakic keratopathy is demonstrated in a corneal button obtained at penetrating keratoplasty for persisting corneal edema and bullous keratopathy 4 months following extracapsular cataract extraction with a posterior chamber lens implant. Histological examination revealed a distinct cell loss and a macrophage reaction that was centered on degenerating endothelial cells in the corneal endothelium.