角膜基质细胞生物学活性与角膜病变

角膜基质细胞是位于角膜基质层中平行排列的胶原纤维板潜在空隙内的扁平细胞。在正常的角膜组织中,角膜基质细胞处于相当稳定的状态。然而,在角膜病变中,角膜基质细胞在发病机制、病理过程及疾病转归中扮演了重要的角色。     

角膜新生血管的治疗进展

正常角膜处于无血管状态，以维持角膜的透明。透明的角膜对眼视功能十分重要。角膜缘则具有丰富的血管网，在感染、外伤、免疫反应等病理情况下，毛细血管由角膜缘处向角膜内生长。一般认为。毛细血管进入角膜周边部1～2mm以上即为病态，或称为角膜新生血管(corneal neovascularization，CNV)。     

角膜内皮细胞体外增生、培养和鉴定

角膜内皮细胞对维持角膜透明和脱水状态具有重要作用,体外成功培养对研究角膜内皮细胞的结构和功能具有重要意义,也是角膜组织工程开展的基础工作之一。但是角膜内皮细胞体外培养受其增生能力、培养条件和细胞鉴定等多种因素限制,成为角膜生物学及角膜组织工程的研究热点,本文就角膜内皮细胞体外增生、培养和鉴定的研究进展进行综述。     

小切口深板层豚鼠角膜内皮移植伤口愈合的组织病理学研究

目的 探讨小切口深板层角膜内皮移植术后角膜伤口愈合的组织病理学特点。方法 45只豚鼠分为受体组30只（30只眼）和供体组15只（30只眼）,进行同种异体深板层角膜内皮移植。受体组豚鼠右眼为术眼,左眼的正常角膜作为组织病理学对照。于术后1、2周、1、2、3、4个月分别处死受体组2只角膜恢复透明的豚鼠,取左、右眼角膜组织经内皮细胞茜素红染色、苏木素-伊红和（或）高碘酸希夫染色后行光镜检查,计数角膜基质内细胞。结果 受体组有22只眼术后角膜透明,角膜内皮细胞经茜素红染色后显示植片上内皮细胞形态和排列正常,在植床与植片间存在环形的内皮细胞异型区域。光镜检查显示,术后早期在角膜板层分离的径路上,基质内细胞明显增多;植床与植片的交接处,后板层胶原纤维和后弹力层中断,后者的残端卷起;交接处的空隙由结构紊乱、细胞成分较多的组织填充;而板层界面上胶原排列整齐。术后1个月时,出现新生的后弹力层。术后3～4个月时,后弹力层和后板层连续性恢复。结论 小切口深板层角膜内皮移植术的基质创口愈合特点与损伤形式有关,板层界面上胶原排列整齐,纤维化的愈合方式见于植床与植片的连接处。（中华眼科杂志,2006,42：694-698）     

细胞因子在角膜新生血管形成中的作用

透明、无血管是角膜的重要特征。正常的血管状态反映了血管生成和血管抑制的内在调节的一种复杂、精细的平衡，即血管形成抑制因子与血管形成刺激因子的平衡表达维持了角膜的透明和无血管。在角膜损伤等病理状态下，这种平衡的破坏趋向于新生血管化占优势，血管形成刺激因子显著上调，与角膜新生血管形成在时间上相一致；     

RNA干扰抑制水通道蛋白-1对大鼠角膜新生血管形成的影响

角膜的无血管状态是维持角膜透明性的重要因素，其有赖于抗血管生成因素的存在和角膜基质一层抗粗管穿透屏障的形成。在感染、外伤、排斥反应和其他因素的诱导下，角膜新生血管（corneal neovascularization，CNV）的生成占主导地位，CNV的形成可导致角膜透明性下降，从而影响视力，同时也是角膜移植失败的高危因素。     

飞秒激光辅助的DLK治疗角膜碱烧伤后角膜组织病理学及超微结构观察

背景眼表结构与功能的正常与稳定是维持角膜透明及视功能的重要保证,在眼化学烧伤传统治疗的基础上对早期眼化学烧伤提出新的治疗理念、掌握合适的手术时机和娴熟的手术技巧可减少碱性物质对角膜及眼内组织的进一步损害。目的观察飞秒激光辅助的深板层角膜移植术（DLK）治疗角膜急性碱烧伤的组织病理学及超微结构变化,探讨角膜碱烧伤早期DLK治疗的可行性及疗效。方法采用12只成年健康新西兰白兔,将浸有1mol／LNaOH溶液30斗l的直径6mm无菌滤纸片置于中央角膜30s,建立角膜碱烧伤模型。模型兔用随机数字表法分为2个组,飞秒激光辅助的DLK治疗组（治疗组）于角膜碱烧伤后24h采用飞秒激光辅助的DLK将家兔角膜植片移植到新西兰白兔模型眼,模型对照组不施加任何干预和治疗。分别于术后第1、2、4周各组各处死2只实验兔,将获取的角膜组织进行常规固定和包埋,然后制作切片,行苏木精一伊红染色,分别在光学显微镜和透射电子显微镜下观察角膜的组织病理学变化和超微结构变化。结果造模后可见烧伤区域角膜立刻变为瓷白色,结膜充血。术后4周,裂隙灯显微镜下可见治疗组兔眼角膜植片透明,而模型对照组兔眼角膜水肿,可见角巩膜缘结膜充血和少量新生血管。角膜组织病理学检查可见模型对照组角膜基质层水肿,胶原纤维排列疏松,纤维间可见大量空泡和少量新生血管,并有大量炎性细胞浸润,治疗组仅见角膜植片轻度水肿、透明,组织间未见炎性细胞浸润。透射电子显微镜观察可见,术后第1周治疗组兔角膜上皮细胞层中细胞间桥粒连接较多,细胞核完整;术后第4周角膜中央透明,基质中胶原纤维排列整齐,可见成纤维细胞;而模型对照组术后第4周可见角膜上皮表层扁平细胞的存在,部分上皮细胞脱落,形成     

白内障乳化手术不同切口效果比较

目的　探讨白内障超声乳化人工晶状体植入手术的两种切口(透明角膜切口和改良巩膜角膜切口)的效果。方法143例(179眼)分别采用两种切口,分析比较其术中操作、术后视力、术后散光、切口愈合、角膜状态。结果　改良巩膜角膜切口术后视力、角膜散光、并发症等均比透明角膜切口有明显优势,x2=24.04,P<0.05。结论　改良巩膜角膜切口具有自闭性好、术后恢复快、角膜散光小及并发症少等优点。     

小分子亮氨酸重复蛋白聚糖家族在维持角膜透明性中的作用

小分子亮氨酸重复蛋白聚糖(SLRPs)为角膜的重要结构成分, 在角膜透明性的形成和维持方面发挥重要作用。SLRPs大量分布于角膜基质层中, 主要分为Ⅰ型、Ⅱ型和Ⅲ型。各成员之间存在补偿性和协同性作用, 共同调控基质层胶原纤维的形成和装配, 维持胶原纤维排列的高度有序性, 奠定角膜透明性的基础。Decorin和lumican分别是Ⅰ型和Ⅱ型SLRPs的主要功能成分, 二者基因表达改变或核心蛋白结构异常均会影响角膜基质层其他细胞外基质成分的正常含量和排列关系, 导致胶原纤维的形成、装配和排列异常, 造成角膜混浊。SLRPs可通过结合促纤维化细胞因子及其受体等调控角膜创伤修复和基质重塑, 为治疗角膜疾病和研究角膜透明性的分子机制提供依据。本文就SLRPs家族成员生物学活性及其在角膜透明性中的作用研究进展进行综述。     

角膜光密度在临床中的应用

角膜光密度是角膜组织的一种生物学性质,与角膜的透明性有关,可以用来描述角膜的透明程度。目前角膜光密度已经应用于角膜疾病的辅助诊断与严重程度评估,还用于角膜手术疗效的评估和术后病情的随访,同时也可用于全身系统性疾病的角膜状态评估。Pentacam角膜光密度测定是一种客观、无创、可重复评估角膜透明性的方法,对角膜以及全身健...     

Spatial and temporal alterations in the collagen fibrillar array during the onset of transparency in the avian cornea

In the latter stages of development, the embryonic avian cornea undergoes significant changes in structure, composition and transparency. The rearrangement of stromal collagen fibrils at this time is important because it is believed to play a key role in the acquisition of corneal transparency. Here, we investigate spatial alterations in the internal fine structure of the avian cornea during development. Chicken corneas at developmental days 14, 16 and 18 were examined by transmission electron microscopy and quantitative image analysis. For anterior and posterior regions we determined fibril number densities, two-dimensional distribution functions, and, where appropriate, radial distribution functions. Stromal collagen fibrils became more closely spaced over the developmental range studied here. Changes in fibril number density indicated that fibrils became compacted first in the anterior stroma, and later (i.e. after day 16) in the posterior stroma. By day 18 collagen fibril number densities were essentially the same in superficial and deep tissue regions. At day 14, two-dimensional distribution functions of collagen fibrils in the posterior stroma pointed to a fibrillar array that was unlike that in the anterior stroma because there was no clear radial symmetry. Rather, in the deep stroma at day 14 there was evidence of different nearest neighbour spacings in two orthogonal directions. By day 18, fibril distributions in the anterior and posterior stroma were spatially homogeneous and radially symmetric, with radial distribution functions typical of those ordinarily found in mature cornea. Corneal transparency requires the stromal matrix to have some degree of regularity in the arrangement of its uniformly thin collagen fibrils. The chicken cornea becomes progressively transparent between days 14 and 18 of development as the stroma dehydrates and thins. We show that over this time period collagen fibrils in the anterior stroma become configured in advance of fibrils in deeper stromal regions, leading to questions over the potential roles of sulphated proteoglycans in different regions of the corneal stroma during morphogenesis.     

角膜交联术新进展与临床运用

紫外光核黄素角膜交联术(corneal collagen cross-linking,CCL)是一种二十一世纪初应用于临床的最新的角膜成形技术。以核黄素作为光敏剂应用370nm紫外线对角膜进行局部照射,刺激胶原纤维交联,增加角膜硬度。该技术已经在临床崭露头角,有望成为人们比较熟悉的角膜成型技术如传导性角膜成形术和角膜基质环植入术的辅助治疗手段。这些被称为角膜成形学的治疗或手术技术,可望开辟一个新的领域,治疗以往无法治疗的某些角膜疾病。利用CCL,眼科医生可重塑角膜结构,而不需使用如穿透性角膜移植术或板层角膜移植术等创伤性技术。用这种方法代替角膜基质环植入术,或与之相结合,可显著提高圆锥角膜的治疗效果。经过几年的苦心研究,CCL的技术方法得到了改进,治疗范围也有所扩大。不仅用来治疗进展性圆锥角膜,同时也为难治性角膜溃疡、角膜变性、术后角膜扩张病等角膜疾病的治疗带来希望。     

胶原交联对兔角膜碱烧伤后基质融解的影响

目的研究角膜胶原交联治疗对兔角膜碱烧伤后基质融解的影响。方法选取25只新西兰大白兔随机分为正常对照组(5只10眼)、模型对照组(10只10眼)、胶原交联治疗组(10只10眼)。正常对照组不做处理,模型对照组和胶原交联治疗组右眼制备角膜中度碱烧伤模型。造模成功后,胶原交联治疗组采用胶原交联治疗后涂红霉素眼膏,模型对照组滴核黄素眼液30min后涂红霉素眼膏;三组均应用抗生素眼液滴眼。观察角膜融解及混浊等情况,28d后处死动物,对兔角膜进行组织病理学检查和免疫组织化学检测。结果正常对照组未发生变化,模型对照组6眼造模后(14±4)d角膜融解,2眼角膜穿孔;胶原交联治疗组1眼造模后23d角膜融解,无角膜穿孔发生;两组角膜融解发生率间比较,差异有统计学意义(P<0.05)。病理检查结果显示胶原交联治疗组角膜水肿程度轻,角膜胶原纤维破坏轻,炎性细胞浸润明显少于模型对照组。免疫组织化学结果显示胶原交联治疗组角膜胶原纤维较模型对照组排列整齐,深层角膜组织影响小。结论胶原交联治疗可抑制和延迟兔角膜碱烧伤后角膜融解的发生和发展,减轻角膜胶原纤维的破坏及减少角膜组织中炎性细胞的浸润。     

Experimental study on the treatment of rabbit corneal melting after alkali burn with Collagen cross-linking

AIM: To evaluate the effect of Collagen cross-linking on the prevention of melting in rabbit corneas after alkali burn. METHODS: Twenty New Zealand white rabbits were randomly divided into model control group and collagen cross-linking treatment group. The second group of rabbits received collagen cross linked treatment. Both groups were applied with antibiotic eye drops to prevent infection. The corneas were evaluated for melting, opacity, pathological and immunohistochemistry, record the changes when 28 days after the animals were killed. RESULTS: In the control group, 6 out of 8 rabbits showed corneal melting after injury (14±4) days, while two corneal perforated. In collagen cross-linking treatment group, one rabbit showed corneal melting after injury 23 days, without corneal perforation; corneal dissolution rate between the two groups was significantly different (P <0.05). Pathological examination suggested that in the treatment group, mild corneal edema, mild damage to collagen fibers, inflammatory cell infiltration was significantly less than the control group. Immunohistochemistry showed that corneal collagen fibers arranged in neat rows in the control group. CONCLUSION: Collagen cross-linking treatment not only can prevent and delay the corneal melting after alkali burn, but also can reduce the destruction of corneal collagen fibers and infiltration of inflammatory cells in the corneal tissue.     

角膜胶原蛋白研究进展

角膜的透明性对角膜而言很重要,一旦受到破坏,必将影响物体在视网膜上成像的清晰度,而角膜的透明性主要取决于基质层中胶原纤维的有序排列。本文简要概括了角膜胶原的分子结构、分布、生理生化和病理改变等方面的研究。     

角膜胶原交联治疗角膜融解的研究进展

角膜胶原交联( corneal collagen cross-linking,CXL)技术是通过紫外光A和感光剂核黄素的光化学反应使角膜基质内胶原纤维形成共价键,从而增加胶原纤维机械强度、生物学稳定性及角膜抗扩张能力。角膜融解( corneal melting)是一种与自身免疫相关的非感染性角膜溃疡。我们对角膜融解发病机制、目前主要治疗手段及紫外光 A核黄素介导角膜胶原交联术基本原理、在角膜融解方面的实验和临床研究现状等问题进行综述。     

bFGF对角膜成纤维细胞增殖及胶原合成的影响

目的 探讨碱性成纤维细胞生长因子（bFGF)对兔角膜基质成纤维细胞增殖及胶原合成的影响。方法 （1）分组培养正常和切除前板层的角膜成纤维细胞，分别于细胞贴壁后的3、6、9、12、15天观察细胞生长情况，以及bFGF对细胞增殖的影响，并计数。（2）将兔眼分为对照组和实验组，等面积，等深度切除角膜板层后，对照组滴生理盐水，实验组滴bFGF滴眼液，15天后取材，常规电镜制片，观察并比较角膜基质层胶原合成的状况。结果 （1）bFGF可显著促进正常和受损角膜成纤维细胞的增殖。（2）实验组与对照组相比，前者胶原纤维密度高。纤维结构排列明显有序，规律。结论 bFGF可促进角膜成纤维细胞增殖和胶原的合成，使基质层纤维排列更有序。     

角膜基质结构与其力学特性的研究进展

角膜基质层是构成角膜的主要结构,近年来对角膜基质层结构的研究主要采用X线衍射、电子显微镜及非线性光学技术.研究者利用这些技术,从轴方向和子午线方向上探究角膜基质层胶原纤维的分布规律,从而探讨这些分布规律与角膜基质层力学特性关系.研究表明,临床上常见的角膜扩张症（如圆锥角膜、准分子激光原位角膜磨镶术术后角膜扩张症）也被证实与病变角膜的结构改变导致力学特性改变有关.利用这一结果,研究者积极探讨治疗这类角膜扩张症的方法.     

紫外光核黄素诱导角膜交联治疗感染性角膜炎的研究进展

角膜交联(corneal collagen cross-linking,CXL)技术是一种近年来兴起的应用于临床最新的角膜成形技术。它通过A段紫外光和感光剂核黄素,诱导角膜基质内胶原纤维相互交联而提高角膜硬度,增强角膜基质的力学和生物化学稳定性,从而阻止圆锥角膜等角膜扩张性和难治性角膜溃疡等角膜疾病的进展。     

Corneal collagen cross-linking and liposomal amphotericin B combination therapy for fungal keratitis in rabbits

AIM: To observe the therapeutic effect of corneal collagen cross-linking (CXL) in combination with liposomal amphotericin B in fungal corneal ulcers. METHODS: New Zealand rabbits were induced fungal corneal ulcers by scratching and randomly divided into 3 groups, i.e. control, treated with CXL, and combined therapy of CXL with 0.25% liposomal amphotericin B (n=5 each). The corneal lesions were documented with slit-lamp and confocal microscopy on 3, 7, 14, 21 and 28d after treatment. The corneas were examined with transmission electron microscopy (TEM) at 4wk. RESULTS: A rabbit corneal ulcer model of Fusarium was successfully established. The corneal epithelium defect areas in the two treatment groups were smaller than that in the control group on 3, 7, 14 and 21d (P<0.05). The corneal epithelium defect areas of the combined group was smaller than that of the CXL group (P<0.05) on 7 and 14d, but there were no statistical differences on 3, 21 and 28d. The corneal epithelium defects of the two treatment groups have been healed by day 21. The corneal epithelium defects of the control group were healed on 28d. The diameters of the corneal collagen fiber bundles (42.960±7.383 nm in the CXL group and 37.040±4.160 nm in the combined group) were thicker than that of the control group (24.900±1.868 nm), but there was no difference between the two treatment groups. Some corneal collagen fiber bundles were distorted and with irregular arrangement, a large number of fibroblasts could be seen among them but no inflammatory cells in both treatment groups. CONCLUSION: CXL combined with liposomal amphotericin B have beneficial effects on fungal corneal ulcers. The combined therapy could alleviate corneal inflammattions, accelerate corneal repair, and shorten the course of disease.