板层角膜移植镶嵌术治疗角膜穿孔

目的：通过对角膜深层异物剔除术后发生角膜穿孔的患者实施板层角膜移植镶嵌术的临床观察总结，探讨角膜穿孔的临床治疗方法。方法：对1999年～2002年间5例因角膜深层异物剔除术后发生角膜穿孔、经保守治疗一周无效的患者进行板层角膜移植镶嵌术，对术后一年的临床随访观察资料进行总结讨论。结果：5例患者角膜穿孔均获得良好愈合，术后前房形成良好，眼前节炎症迅速控制，视力恢复快，经一年后视力达0．15～1．0，平均视力0．51。裂隙灯下检查角膜穿孔区轻度瘢痕性浑浊呈半透明状，余处角膜透明，均无新生血管。5例患者虹膜均无前后粘连。角膜曲率及角膜地形图显示轻度陡峭或扁平，无显著改变。结论：板层角膜移植镶嵌术是治疗角膜深层异物剔除术后角膜穿孔的有效方法。     

个性化治疗角膜穿孔的临床观察

目的:探讨应用不同手术方法治疗角膜穿孔的适应证及疗效。方法:采用非随机回顾性系列病例研究,选择2005-10/2007-08在沈阳军区总医院住院的20例20眼角膜穿孔患者,分别选择穿透性角膜移植术(6例,30%)、眼前节重建术(4例,20%)、板层角膜移植术(6例,30%)、羊膜移植术(4例,20%),术后随访6～30mo,观察患者穿孔愈合情况、术后视力、角膜植片透明度及并发症。结果:所有病例均在手术后封闭穿孔。术后增视者有16眼,手术增视率为80%;穿透性角膜移植者植片7例透明,1例半透明,1例混浊。眼前节重建术植片半透明或混浊(Ⅱ期行新鲜角膜移植)。板层角膜移植术3例透明,3例混浊。并发症:虹膜粘连4例;继发性青光眼3例;排斥反应2例;原病复发1例;双前房1例。结论:根据角膜穿孔的原因、位置、大小等综合因素,对角膜穿孔患者灵活选用不同手术方法,能够达到保存眼球完整性、增进视力的要求。     

角膜多发异物的角膜移植

目的：探讨角膜移植治疗角膜多发异物的临床疗效。方法：因爆炸伤所致角膜多发性异物10例（12眼）。其中异物未达角膜后弹力层者4例（4眼），行部分板层角膜移植。较多异物达角膜全层者6例（8眼），行穿透性角膜移植。后者中对合并外伤性白内障者3例（4眼），联合白内障 摘出术。术后随访1－3年，观察术眼异物感等刺激症状、视力及免疫排斥等情况。结果：所有患者术后眼部刺激症状均有明显改善，视力明显提高，随访1－3年，植片透明率100％。结论：角膜移植是治疗角膜多发异物的有效方法。     

爆炸伤所致严重多发性角膜异物3例

我们就收治的 5例爆炸伤所致严重的多发性角膜异物 (除 2例眼球穿孔伤及严重眼球钝挫伤外 )将角膜浅层异物彻底剔除 ,深层尤其瞳孔区者未剔除 ,全身给予抗炎对症治疗并进行长期随访取得满意疗效 ,现报告如下 :例 1:李×× ,男 ,2 7岁 ,工作中不慎将雄黄和氯酸钾混合时引起爆炸致双眼多发性角膜异物。因爆炸伤作用力强 ,致伤面积大 ,故异物细小布满角膜不同位置及深度。右眼即根据异物在角膜位置及深浅的不同 ,给予分次、分批彻底剔除 ,同时给予消炎、对症治疗。反复多次对角膜异物 (尤其瞳孔区 )剔除 ,加重角膜损伤 ,增加角膜瘢痕的形成 ,致…     

深板层角膜移植治疗严重角膜真菌感染

临床研究表明，部分板层角膜移植治疗中浅层真菌性角膜炎具有较好的临床效果。我们于1999年8月～2001年10月对角膜大面积的深层真菌感染患者进行角膜深板层切除探查，对14例角膜后弹力层透明者行板层角膜移植，获得了良好的临床效果，现将其适应证、手术方法和临床结果报告如下。     

欢迎订阅《眼科研究》

临床研究表明，部分板层角膜移植治疗中浅层真菌性角膜炎具有较好的临床效果。我们于1999年8月～2001年10月对角膜大面积的深层真菌感染患者进行角膜深板层切除探查，对14例角膜后弹力层透明者行板层角膜移植，获得了良好的临床效果，现将其适应证、手术方法和临床结果报告如下。     

自体穿透性角膜移植术2例

例 1　王××　男　 5 0岁　工人　 2 0 0 2年 10月 15日入院。患者 8个月前在修路放炮时不慎崩伤双眼 ,右眼行眼球摘除术 ,左眼行角膜伤口缝合和外伤性白内障摘除术。入院时 ,右眼无眼球 ,左眼视力指数 / 2 0cm (+10 0 0D .S= (0 0 4 ) ,角膜中央区 4mm× 4mm大小白斑 ,角膜多个细小深层异物 ,周边角膜透明 ,前房深 ,瞳孔散大 ,无晶体 ,后囊膜破裂 ,玻璃体轻度混浊 ,眼底正常。诊断 :左眼角膜白斑、白内障术后无晶体眼。治疗 :左眼自体角膜移植术。手术方法 :球后及眼轮匝肌麻醉 ,上、下直肌缝线固定眼球。用 8mm环钻 ,将上方近角膜缘至…     

部分板层角膜移植治疗真菌性角膜炎

目的：探讨部分板层角膜移植术治疗真菌性角膜炎的适应证及临床效果。方法：对临床确诊的23例（23只眼）中浅层真菌性角膜炎患者用新鲜尸眼角膜供体行部分板层角膜移植术。结果：23例患者22例治愈,21例植片透明,成功率91．3％,随访2－10个月,植片全部透明。矫正视力0．3－0．8,2例复发。结论：部分板层角膜移植术是治疗中浅层真菌性角膜炎的有效方法。     

板层和穿透性联合角膜移植术的临床观察

目的：回顾性研究板层和穿透性联合角膜移植术治疗角膜病的效果。方法：对12例全角膜病变实施板层和部分穿透性联合角膜移植。手术将板层角膜巩膜病变切除，作中央部分穿透的植床，取新鲜尸体眼球，制作相应的角膜植片，植片与植床对应间断缝合。术后跟踪随访。结果：12例角膜植片术后均保持或恢复透明，裸眼视力0．1～0．2者4例，0．2以上者8例。术后免疫排斥反应被控制，没有虹膜前粘连和继发性青光眼并发症出现。结论：板层和部分穿透性联合角膜移植术，对大范围严重的角膜病变有较好的治疗效果，能治愈常规方法难以治愈的患者。     

应用临时人工角膜行眼前后节联合手术

目的　评价应用临时人工角膜进行穿透性角膜移植联合眼后节手术的安全性及治疗效果。方法　对复杂性眼球穿通伤所致角膜混浊同时伴有玻璃体视网膜病变 10例患者 11眼 ,施行临时人工角膜下的经睫状体平坦部的闭合式玻璃体切除、球内异物取出、视网膜复位、硅油充填、穿透性角膜移植等联合手术。结果　术后随访 2～ 14月 ,11眼均得到保留 ,9眼角膜植片透明 ,10眼视网膜复位 ,9眼视力较术前提高。其中 3眼矫正视力≥ 0 1,矫正视力在 0 0 5～ 0 1的 4眼 ,1眼术后再次视网膜脱离 ,1眼角膜混浊并萎缩。结论　应用临时人工角膜进行玻璃体手术联合穿透性角膜移植术是治疗严重眼前后节受伤患者的一种有效手术方法     

Deep anterior lamellar keratoplasty combined with autologous limbal stem cell transplantation in unilateral severe chemical injury

PURPOSE: To evaluate the efficacy of deep anterior lamellar keratoplasty combined with autologous limbal stem cell transplantation for ocular surface reconstruction and visual rehabilitation in eyes with unilateral, late-stage, severe chemical injury. METHODS: This was a retrospective, noncomparative, interventional case series that included 7 eyes of 7 patients, with severe unilateral late stage chemical injury, exhibiting corneal vascularization, conjunctivalization, and extensive corneal scarring were treated at the C. J. Shah Cornea Service, Sankara Nethralaya, a tertiary care center. Surgical procedures included releasing symblepharon adhesions, excising epibulbar fibrous tissue, superficial keratectomy to remove fibrovascular tissues over cornea, deep anterior lamellar dissection, grafting a lamellar corneal button, and transplanting autologous limbal graft, with or without amniotic membrane transplantation. The main outcome measures were relief of patient symptoms, postoperative recovery of the ocular surface, corneal clarity, corneal epithelial stability, and best corrected visual acuity. RESULTS: The mean duration between the injury and surgery was 24.4 +/- 21.8 months. No intraoperative complications were noted. Successful epithelialization was achieved in all eyes. The reconstructed corneal surface remained stable during the entire follow-up period (mean follow-up, 16.57 +/- 5.12 months). All patients had resolution of ocular symptoms. Remarkable improvement in vision was noted in all (85.7%) except 1 eye in which recovery was limited due to amblyopia. The average best corrected visual acuity at last follow-up was 20/50. No complications were noted in the donor fellow eye. CONCLUSIONS: DALK combined with autologous limbal transplantation can restore a healthy, stable ocular surface, besides providing a clear cornea that remarkably improves the visual acuity, in patients with unilateral, late stage, severe chemical injury.     

板层角膜移植在眼科急诊中的应用

目的观察不同原因所致角膜缺损行板层角膜移植的临床效果，探讨板层角膜移植在眼科急诊中的应用。方法7例（7眼）系因角膜异物剔出、角膜溃疡穿孔及严重的角膜穿孔伤等不同原因引起组织缺损者，缺损直径2mm以内，均急诊施行板层角膜移植，术后随访3月以上。结果7例（7眼）角膜穿孔均获良好愈合，术后前房形成良好，角膜透明。结论角膜组织缺损急诊手术施行板层角膜移植是可行的。     

全板层角膜移植羊膜移植治疗严重眼表损伤

目的观察带角膜缘的全板层角膜移植联合新鲜羊膜移植，治疗严重眼表损伤的临床效果。方法12例（13眼）严重眼表损伤行带角膜缘的全板层角膜移植联合新鲜羊膜移植的回顾性分析。其中，碱烧伤4例（5眼）、酸烧伤5例（5眼）、热烧伤3例（3眼）。术后均予以抗感染、抗炎、抗排斥等治疗。术后随访12～24月。结果所有患眼治疗后均形成了稳定的眼表，保住了眼球，视力均有不同程度的提高。3例（3眼）因严重的眼干燥症，需长期滴用人工泪液。结论带角膜缘的全板层角膜移植联合新鲜羊膜移植，能有效地修复严重的眼表损伤，具有较好的疗效。     

角膜移植治疗角膜及眼表疾病98例临床分析

目的分析穿透性角膜移植及板层角膜移植治疗角膜疾病及眼表疾病的临床特点。方法回顾性研究穿透性角膜移植、板层角膜移植及板层角膜移植联合羊膜移植手术共98例（101眼）,观察术后视力、排斥反应、继发青光眼及原发病复发。随访6～24月,平均12．8月。结果穿透性角膜移植术79例（82眼）巾,62例（78．48％）术后视力较术前有提高,排斥反应11例（12眼）,原发病复发3例（3眼）,继发青光眼10例（10眼）。板层角膜移植术后视力无明显变化,排斥反应1例（1眼）,未见原发病复发及继发青光眼。结论角膜移植是治疗严重角膜疾病及眼表疾病有效手术方式,积极预防及治疗术后并发症可以提高角膜移植成功率。     

Anterior segment optical coherence tomography in eye injuries

Background  To evaluate the usefulness of anterior segment optical coherence tomography (AS OCT) for initial diagnosis and for monitoring treatment results in eye injury cases. Methods  We examined 38 eyes of 34 patients with different types of ocular injuries: penetrating injury (eight eyes), perforating injury (two eyes), intraocular foreign body (four eyes), ocular burn (nine eyes), contusion (13 eyes), and lamellar laceration (two eyes). The mean age of the patients was 33.8 years. AS OCT examination was performed at the initial visit, directly after injury, and repeated as treatment progressed. Both anterior chamber components and corneal pachymetry were evaluated. Results  Slit-lamp examination did not provide a clear diagnosis in three eyes after contusion because of a nontransparent cornea. In one case of a 44-year-old male patient, only corneal edema was noticed during slit-lamp examination, whereas AS OCT revealed Descemet’s membrane detachment. In a 17-year-old male patient with blood infiltrating the cornea, OCT revealed acute angle closure with a pupillary block. In patients with corneal burns, OCT was valuable for monitoring the corneal healing progress after amniotic membrane application. OCT was also useful for determining whether a lamellar or penetrating technique should be applied in patients that qualified for corneal transplantation. In patients with foreign bodies, AS OCT was helpful in establishing the localization and size of the foreign body. Conclusions  AS OCT is a very valuable tool in ophthalmic departments dealing with ocular trauma, for early diagnosis and for monitoring treatment progress. Financial disclosure: none.     

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.     

Removal of semitranslucent cactus spines embedded in deep cornea with the aid of a fiberoptic illuminator

PURPOSE: To report a rare case of multiple cactus spines embedded deep in the cornea that were removed with the aid of a fiberoptic illuminator. DESIGN: Interventional case report. METHODS: A 20-year-old man had an accidental ocular injury of the right eye when he hit a household miniature cactus plant. There were 80 to 90 spiculated foreign bodies embedded in the cornea, some of them even penetrating the anterior chamber. RESULTS: Removal of the foreign bodies was performed with the aid of a fiberoptic illuminator, which was chosen because it provides superior visualization of the semitranslucent spines. No residual corneal spines were found postoperatively. CONCLUSIONS: Household miniature cactus plants can cause corneal injury, with multiple foreign bodies that can be difficult to localize and remove. The use of a fiberoptic illuminator in such a situation is simple and effective.     

准分子激光治疗性角膜切削术治疗角膜弥漫性火药伤

目的:探讨准分子激光治疗性角膜切削术在角膜浅层弥漫性火药伤中的应用,为角膜弥漫性火药伤提供一种新的有效的治疗方法。方法:收集1999年12月至2003年12月期间在我院就诊的25例(39只眼)角膜浅层弥漫性火药伤患者,采用准分子激光治疗性角膜切削术进行异物清除。术后观察视力、角膜上皮恢复时间、眼压、远视状态和Haze等状况。结果:该手术与常规手术相比,缩短了手术时间,一只眼激光手术过程在10min以内。一次手术即可完成绝大部分的异物剔除,手术损伤小,一般在1周内角膜上皮可以完全恢复。术后在角膜光学区基本不残留角膜斑翳,术后视力显著提高。术后10d平均视力为0.6。术后患者轻度远视38例,中度远视1例。该手术产生的并发症在术中和术后也能得到良好的控制,安全性和预测性较高。结论:准分子激光治疗性角膜切削术在角膜浅层弥漫性火药伤中是一种方便、效果好、费用低廉并值得推广的治疗方法。     

Therapeutic deep lamellar keratoplasty for cornea perforation

PURPOSE: To present the efficacy of performing deep lamellar keratoplasty as an emergency measure following perforation of the cornea. DESIGN: Interventional case report. METHOD: Deep lamellar keratoplasty was performed in two cases of perforated cornea. Following incarceration of the iris within the perforated area, The Descemet membrane was exposed except for strands of stroma surrounding the perforation. A fresh donor cornea stripped of the Descemet membrane was then sutured in place. RESULTS: Both cases have attained clear corneas in areas other than the original perforation. CONCLUSIONS: Deep lamellar keratoplasty is a safe technique for the treatment of cornea perforation.     

改良甘油长期冷冻保存角膜的超微结构及板层角膜移植

目的:研究改良甘油长期冷冻保存角膜的超微结构及板层角膜移植。方法:将涂有透明质酸钠(sodium hyaluronate,SH)的角膜片在-45℃以下长期甘油低温冷冻保存,保存12mo之后,用于15例板层角膜移植并进行透射电镜检查。结果:15例手术均顺利,术后随访6～24mo,13例植片透明,1例植片呈半透明状,1例植片部分新生血管化。透射电镜检查显示角膜超微结构保存良好。结论:甘油长期冷冻保存角膜有一定活性,适合应用板层角膜移植。