甘油脱水保存板层角膜植片治疗真菌性角膜炎

目的探讨甘油脱水保存的板层角膜植片行板层角膜移植术治疗真菌性角膜炎的临床疗效。方法对临床和实验室确诊的21例药物治疗无效的真菌性角膜炎采用甘油脱水保存的板层角膜植片施行板层角膜移植手术。术后随访3~12月,平均6.5月,比较手术前后视力,观察植片存活情况并进行临床效果分析。结果保存植片复水透明合格率100%。术后19例角膜植片保持透明,溃疡愈合。1例排斥反应,1例植片融解行穿透角膜移植,所有病例均无复发。总治愈率95.24%。结论甘油脱水方法保存板层角膜植片用于板层角膜移植治疗真菌性角膜炎方便、安全、可靠,是一种简单易行及成功率很高的有效方法。     

Lamellar corneal autograft for corneal perforation

BACKGROUND: Corneal perforation secondary to exteriorization of the haptic foot of the anterior chamber intraocular lens (IOL) is a rare complication in IOL surgery. CASE REPORT: A superior penetrating corneal defect developed in the right eye of a 74-year-old woman associated with exteriorization of the superior haptic of an anterior chamber IOL. METHODS: We describe the technique of repositioning and successful patching of the defect using a lamellar cornea-sclera rotational autograft. CONCLUSIONS: This technique is useful for small perforations when cornea donor tissue is not available.     

Tacrolimus (FK506) in the management of high-risk corneal and limbal grafts

OBJECTIVE: To assess the efficacy and side effects of tacrolimus in the management of patients with high-risk corneal and limbal grafts. DESIGN: Noncomparative case series. PARTICIPANTS: Seventeen patients (23 grafts) were treated with tacrolimus; 15 patients (20 host corneas) had two or more quadrants of stromal vascularization, 6 patients had stem cell deficiency, and 6 patients had glaucoma. Seven patients had received one previous graft, six patients had two previous grafts, and four patients had three previous grafts. INTERVENTION: Patients with high-risk corneal and limbal grafts were treated with systemic tacrolimus at a mean optimum dosage of 4.4 mg daily (range, 2-12 mg daily). MAIN OUTCOME MEASURES: Graft survival, visual acuity. RESULTS: No patient has had irreversible graft rejection while receiving tacrolimus. The follow-up period ranges from 12 to 46 months, with a mean of 24 months. Three patients have had reversible graft rejection associated with low tacrolimus levels. Nine patients have stopped treatment; two had reversible rejection within 2 months of stopping, and five grafts remain clear. The other four patients stopped treatment because of graft failure, which was not considered to be rejection related. Eight patients remain on treatment, and all have clear grafts. CONCLUSIONS: Tacrolimus (FK506) is effective in prevention of rejection in patients with high-risk corneal and limbal grafts.     

Repeated melting of corneal grafts in a patient with rheumatoid arthritis and Sj?gren's syndrome.

We present a case of corneal melting in a patient with severe rheumatoid arthritis and Sj?gren's syndrome. The melting appeared in the area of a bacterial corneal ulcer that healed after treatment with antibiotics. No signs of scleritis were present. Repeated melting of two corneal grafts was seen after surgery.     

Immune-mediated corneal melting disease

Corneal melting disease is, as illustrated, a very severe problem for patients. Correct diagnosis and aggressive management is critical. Help from general physicians and rheumatologists as required is essential, given that the medications used have significant toxic effects.     

板层角膜移植联合自体角膜瓣填垫治疗边缘性角膜穿孔

目的:探讨用自体角膜瓣封闭角膜穿孔,联合板层角膜移植治疗边缘性角膜溃疡穿孔的临床疗效。方法:对17例(17眼)不同病因引起的边缘性角膜溃疡穿孔患者行自体角膜瓣填垫及板层角膜移植,术后对植片愈合、虹膜前粘连、继发青光眼、视力、免疫排斥反应进行观察。结果:随访3～12(平均6)mo,所有患者植片透明,未见排斥反应,层间积液2例至术后1mo吸收,前房轴深正常,虹膜粘连于角膜穿孔处3例,无继发青光眼。随访>3mo,视力较术前提高12眼,无进步5眼。结论:板层角膜移植联合自体角膜瓣填垫是治疗边缘性角膜穿孔的有效方法。     

自体角膜瓣翻转联合板层角膜移植治疗边缘性角膜穿孔

目的探讨用自体角膜瓣翻转封闭角膜穿孔重建前房，并联合板层角膜移植治疗边缘性角膜溃疡穿孔的临床疗效。方法对11例11眼不同病因引起的边缘性角膜溃疡穿孔患者行自体角膜瓣翻转封闭角膜穿孔口重建前房后，再行板层角膜移植术(lamellar keratoplasty，LK)治疗，术后对并发症如层间积液、虹膜前粘连、继发青光眼以及视力和免疫排斥反应等进行观察。结果平均随访12个月(范围6～18)，所有患者植片透明，未发现层间积液，前房深度正常，无虹膜前粘连和继发青光眼。大于6个月随访，裸眼视力较术前平均提高4行，最佳矫正视力提高7行。平均散光4．3D。1例患者术后8个月出现基质型免疫排斥反应，抗排斥治疗后排斥反应控制。结论自体角膜瓣翻转联合LK是治疗边缘性角膜穿孔的有效方法。