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。     

用干燥板层角巩膜植片修复角膜溃疡穿孔

角膜溃疡穿孔多用结膜瓣掩盖术治疗,应用角膜板层移植术修复穿孔目前报道尚少。近来我们采用干燥板层角巩膜植片修复两例角膜溃疡穿孔得到满意效果。现介绍如下: 材料与方法我们使用的材料是吉林省人民医院制备的标准干燥板层角巩膜植片。此材料是在无菌条件下在尸眼上剥取的薄、中、厚三种不同厚度的板层角巩膜,经无水氯化钙脱水后放入无菌     

自体层间板层角膜移植在角膜穿孔中应用

目的 探讨自体层间板层角膜移植在角膜穿孔中的临床应用.方法 选取6年间角膜溃疡穿孔患者7例(7只眼),切取角巩膜缘层间板层角膜瓣组织,修剪后将透明瓣植于损伤区,固定于正常角膜,缝合睑裂.结果 一例发生新生血管性青光眼,三年后给予眼球摘除,其余病人角膜愈合前房形成,其中两例患者溃疡面较大,移植瓣上给予结膜瓣覆盖,两例行绷...     

自体角膜移植术的临床观察

目的 观察采用自体穿透角膜移植术或自体游离板层角膜瓣移植治疗角膜白斑及角膜穿孔的临床疗效.方法 采用自体穿透角膜移植术治疗角膜白斑4例（4眼）.自体游离板层角膜瓣移植修补8例（8眼）角膜穿孔（中央、周边）.结果 术后前房恢复,创口愈合好.术前视力光感～0.25.术后有不同程度提高.术后视力0.06～0.25者7眼,0.3～0.4者3眼,0.5～0.8者2眼.结论 自体角膜移植不存在排斥反应,具有操作简单,取材方便,疗效好,反应轻,并发症少的优点,是治疗角膜白斑及穿孔的一种有效术式.     

自体角巩膜瓣移植治疗角膜穿孔的初步报告

角膜穿孔是眼科急症之一，若不采取及时、有效的方法，往往会导致眼内容物脱出，眼球及视力难以挽救。近年来，我们采用自体板层角膜瓣及巩膜瓣治疗角膜穿孔12例，现报告如下：     

自体板层角膜转位术治疗大泡性角膜病变

目的:观察自体板层角膜转位术治疗大泡性角膜病变(bullous keratopathy,BK)的临床疗效。方法:大泡性角膜病变患者15例15眼行自体板层角膜转位术治疗。其中白内障术后8例;白内障术后继发性青光眼4例;青光眼术后并发性白内障3例。结果:患者15例术后眼痛等刺激症状基本消失,角膜上皮完整,随访3～24mo均未发现BK的复发及并发症的出现,视力有轻度提高。结论:自体板层角膜转位术可有效缓解BK的症状,防止BK的复发,是治疗BK可供选择的有效方法。     

自体前板层角巩膜缘移植治疗角膜重度碱烧伤

目的:探讨自体前板层角巩膜缘移植治疗角膜周边部小面积重度碱烧伤的临床疗效及安全性。方法:对39例39眼角膜周边部小面积重度碱烧伤患者,行局部清创,切除病灶处前板层角膜及邻近板层巩膜、部分结膜,取健眼相对应处的前板层角巩膜及结膜移植,术后观察患者主观症状(疼痛、畏光、流泪)、视力、角膜上皮修复时间及复发情况,健眼的视力、伤口恢复及并发症。结果:术后随访2～12mo,所有患者角膜上皮全部愈合,患者主观症状恢复快,均未发生视力下降,无1例复发;健眼角巩膜缘伤口愈合良好,未出现并发症。结论:自体前板层角巩膜缘移植治疗角膜周边小面积重度碱烧伤,手术操作简单,可有效缩短角膜碱烧伤的愈合时间,促进角膜上皮修复,健眼(供体眼)恢复良好,无严重并发症发生。     

酒精分离联合自体带蒂角膜缘结膜瓣转位移植治疗翼状胬肉

目的探讨酒精分离联合自体带蒂角膜缘结膜瓣转位移植治疗翼状胬肉的手术技巧和临床疗效。方法对初发和复发性翼状胬肉120例（140眼）采用加％酒精浸泡胬肉头部后,剥离、切除胬肉,再联合自体带蒂角膜缘结膜瓣转位移植手术。术后随访3-12月,平均10月。比较术前术后视力、BUT情况,观察角膜上皮修复及自体带蒂角膜缘结膜瓣转位移植后存活情况,胬肉复发情况。结果酒精分离法使胬肉纤维血管组织与其下角膜基质分离更加容易。术后角膜上皮修复快,带蒂角膜缘结膜瓣转位移植后100％存活,视力、BUT值较术前不同程度的提高,胬肉治愈138眼（98．57％）,胬肉复发2眼（复发倾向1眼,真性复发1眼）。结论酒精分离联合自体带蒂角膜缘结膜瓣转位移植治疗翼状胬肉术式简单、易操作,安全、可靠,手术损伤小、术后反应轻、恢复快、复发率低,无严重并发症,是值得临床推广的有效方法。     

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。     

蚕蚀性角膜溃疡角膜移植术后复发原因及治疗方法的初步研究

目的分析蚕蚀性角膜溃疡角膜移植术后复发的主要原因,并探讨术后复发的治疗手段。方法回顾性分析蚕蚀性角膜溃疡行角膜移植术后的30例（30只眼）患者的病例资料（其中外院13例,本院17例）,研究复发与眼别、全身免疫因素、术后药物维持治疗之间的关系;据复发溃疡累及角膜植片的面积及深度制定治疗方案。结果共17例复发（56.7%）（其中外院术后复发13例,本院术后复发4例）。复发组中双眼发病者6例（35.3%）,未复发组中双眼发病者2例（15.4%）。复发组中7例免疫学指标部分阳性（41.2%）,未复发组中6例免疫学指标部分阳性（46.2%）。3例试行药物治疗,无效后改行板层角巩膜移植术联合羊膜移植术（AMT）后治愈。3例复发溃疡浅行AMT,术后1例因未定期复诊溃疡复发行结膜瓣遮盖术后治愈。8例复发溃疡深或范围大行板层角巩膜移植联合AMT,术后2例因未规律药物治疗复发,再次行板层角巩膜移植术治愈。3例复发至植片溃疡穿孔,自体板层角膜组织修补穿孔后,再行板层角巩膜移植联合AMT,随访无复发。结论蚕蚀性角膜溃疡角膜移植术后复发与双眼发病、免疫因素、术后是否规律药物治疗相关。如药物治疗不能治愈该病,再次板层角巩膜移植联合羊膜移植术是治疗蚕蚀性角膜溃疡复发的有效方法。     

Ring-shaped corneoscleral lamellar keratoplasty guided by high-definition optical coherence tomography and Scheimpflug imaging for severe Terrien’s marginal corneal degeneration

Background

To evaluate the clinical efficacy of ring-shaped corneoscleral lamellar keratoplasty under guidance of high-definition optical coherence tomography (HD-OCT) and Scheimpflug imaging for severe Terrien’s marginal corneal degeneration.

Methods

Twenty-five patients (25 eyes) with Terrien's marginal corneal degeneration and?≥?6 diopters of astigmatism were treated at the Shandong Eye Institute from January 2008 through December 2010. In these patients, the diseased area was?>?1 quarter of the cornea, and the thickness at the thinnest corneal area was?<?150?μm with residual corneal stroma. Ring-shaped corneoscleral lamellar keratoplasty was performed, and the depth and width of dissection was set according to the HD-OCT and Pentacam examinations. Data of complications, surgical effects, visual acuity, and astigmatism were collected.

Results

No intraoperative corneal perforation occurred. No patients had liquid accumulation between the graft and the recipient. At 1?year after surgery, the average best-corrected visual acuity improved to 6/9 from preoperative 6/36, and the average astigmatism reduced to 4.37 (2.04) diopters from preoperative 13.39 (7.52) diopters. There was no recurrence of the disease or corneal graft rejection in the follow-up period.

Conclusions

Ring-shaped corneoscleral lamellar keratoplasty guided by HD-OCT and Pentacam imaging appears to be effective in the treatment of severe Terrien’s marginal corneal degeneration. Surgical perforation can be significantly reduced.     

Tectonic deep anterior lamellar keratoplasty in impending corneal perforation using cryopreserved cornea

We report a case of tectonic corneal transplantation for impending corneal perforation to preserve anatomic integrity using cryopreserved donor tissue. An 82-year-old woman exhibiting impending corneal perforation suffered from moderate ocular pain in the left eye for one week. After abnormal tissues around the impending perforation area were carefully peeled away using a Crescent blade and Vannas scissors, the patient received tectonic deep anterior lamellar keratoplasty using a cryopreserved cornea stored in Optisol GS® solution at -70℃ for four weeks. At six months after surgery, the cornea remained transparent and restored the normal corneal thickness. There were no complications such as corneal haze or scars, graft rejection, recurrent corneal ulcer, and postoperative rise of intraocular pressure. Cryopreserved donor lamellar tissue is an effective substitute in emergency tectonic lamellar keratoplasty, such as impending corneal perforation and severe necrotic corneal keratitis.     

用深低温保存的角膜材料行板层角膜移植术治疗边缘性角膜变性

目的:探讨用深低温保存的角膜材料行板层角膜移植术治疗边缘性角膜变性的效果。方法:对角膜边缘已经很薄,接近穿孔或已经穿孔的27例边缘性角膜变性患者,用深低温保存的角膜材料行板层角膜移植术治疗,观察术后视力,眼压,植片愈合及并发症等情况,随访时间为2a。结果:术后角膜边缘病变均未发展,术后1wk视力基本与术前相同,1.0者11例,0.6～0.8者6例,0.3～0.5者8例,0.05～0.25者2例。原穿孔的病例有术后一过性高眼压、前房反应、瞳孔欠圆等并发症。2a内只有3例发生了术后排斥反应。结论:用深低温保存的角膜材料完全可以用来进行板层角膜移植治疗边缘性角膜变性,弥补了新鲜角膜的来源限制与时效限制,是治疗边缘性角膜变性的理想材料。     

Femtosecond laser-assisted intracorneal keratoprosthesis implantation: a laboratory model

PURPOSE: To demonstrate femtosecond laser-assisted intracorneal keratoprosthesis implantation and determine the mechanical stability as a function of intraocular pressure. METHODS: Eight human corneoscleral rims were mounted on an artificial anterior chamber. The femtosecond laser microkeratome was used to create a 2.5-mm diameter posterior corneal cap. A 7.2-mm-diameter lamellar stromal pocket was then created at mid-corneal depth. Finally, a 6-mm arc opening to the corneal surface was created at the periphery of the lamellar cut. The posterior lenticule was removed using corneal forceps and a 7.0-mm biopolymer keratoprosthesis was inserted into the stromal pocket. The surface wound was sealed using two 10-0 nylon sutures. A 3.0-mm anterior corneal opening was trephined to expose the keratoprosthesis. Intrachamber pressure was raised until wound leak was observed. RESULTS: Seven of the 8 implants withstood pressures of at least 135 mm Hg without implant extrusion. CONCLUSION: Femtosecond laser corneal dissection provides an alternative to more challenging manual dissection methods for keratoprosthesis implantation. Use of the femtosecond laser microkeratome will further refine keratoprosthesis surgical technique and may allow rapid and easy execution of the surgery.     

Corneal lenticule harvest using a microkeratome and an artificial anterior chamber system at high intrachamber pressure

PURPOSE: To evaluate the safety and accuracy of a manual microkeratome and an artificial anterior chamber used at high intrachamber pressure to harvest corneal lenticules for lamellar keratoplasty. SETTING: Department of Ophthalmology, University of California, Irvine, California, USA. METHODS: Forty-seven human eye-bank corneoscleral rims were mounted on an artificial anterior chamber. A manual microkeratome was used to perform lamellar keratectomy at a mean intrachamber pressure of 95.8 mm hg +/- 4.8 (sd). Two thicknesses (300 microm and 360 microm microkeratome heads) and diameters (8.0 mm and 9.0 mm) were attempted, and the resultant lenticules were analyzed by pachymetry and digital photography. RESULTS: In the 9.0 mm/360 microm group, corneal perforation occurred in 12 of 17 lenticules (71.2%). Except for this group, 24 of 30 corneas (80.0%) showed a less than 0.5 mm deviation from the expected diameter. Neither the horizontal nor the vertical diameter differences were statistically significant (P >.05). The difference between the horizontal and vertical diameters was within +/-0.2 mm in 23 corneas (76.7%). Three (10.0%) corneal beds contained a slightly uneven keratectomy margin. CONCLUSIONS: This system provided accurate and smooth lenticules for lamellar keratoplasty. The precision and accuracy of the obtained corneal lenticules were better than those in previous reports. However, the 9.0 mm diameter/360 microm thickness head with high intrachamber pressure should not be applied in the clinical setting without further testing. In this laboratory study, a minimal corneal thickness of 588 microm was required to avoid perforation.     

Tectonic lamellar keratoplasty utilizing a microkeratome and an artificial anterior chamber system

PURPOSE: To describe a technique and report results of tectonic lamellar keratoplasty using tissue harvested with a microkeratome from a corneoscleral rim mounted in an artificial anterior chamber system. METHODS: A donor lenticule was prepared from a corneoscleral rim utilizing the Moria LSK-1 (Moria/Microtek Inc., Doylestown, PA, U.S.A.) microkeratome and artificial anterior chamber. This tissue was used in the procedures of 6 eyes of 6 patients requiring tectonic lamellar keratoplasty. Three eyes were in danger of imminent perforation due to corneal ulceration. Other indications for lamellar engraftment include persistent wound leak following cataract extraction, persistent epithelial defect following a Grade 4 chemical burn, and limbal dermoid. RESULTS: A successful outcome, defined as restoration or preservation of globe integrity, vision, and intact epithelium, was achieved in all patients. Follow-up ranged from 2-8 months with a mean of 4.5 months. CONCLUSIONS: Donor lenticules prepared with the ALTK (Moria/Microtek Inc.) system can be used in the successful management of eyes requiring tectonic lamellar keratoplasty.     

Preliminary report of 10 cases of anterior segment eyeball reconstruction

We performed anterior segment reconstruction by total penetrating Keratoplasty with scleral rim in 10 patients who had infectious ulceration with total corneal necrosis and perforation and prolapse of intraocular contents of the severely damaged 10 eyes, 9 were salvaged and retained a semi-transparent corneal graft with improvement in vision for 6 months or longer. It suggested that, for eyes with severe corneal damage that would otherwise be enucleated, anterior segment reconstruction by corneoscleral transplantation is of value.     

拉坦前列素对闭角型青光眼眼压和角膜中央厚度及内皮细胞密度的影响

目的:探讨拉坦前列素对闭角型青光眼患者眼压和角膜厚度及角膜内皮细胞密度的影响。方法:选取60例60眼原发闭角型青光眼患者住院行患眼小梁切除术期间,对对侧眼进行研究,30眼应用拉坦前列素滴眼1次/d,30眼用透明质酸钠滴眼1次/d作为对照,用药前测定眼压、角膜厚度和内皮细胞密度,用药后4wk内每周测定眼压、角膜厚度和上皮细胞密度。结果:用药4wk后,拉坦前列素组眼压显著降低(P<0.05),拉坦前列素与透明质酸钠对角膜厚度平均值变化统计学无显著性差异,对角膜内皮细胞密度无影响。结论:拉坦前列素显著降低眼压,且对角膜厚度及内皮细胞数无影响。