《全国眼表疾病诊治专题讲座及研讨会论文汇编》简介

由中华眼科杂志编委会编辑的《全国眼表疾病诊治专题讲座及研讨会论文汇编》一书 ,内容丰富 ,主要包括 (1)眼表疾病研究进展 ;(2 )眼表炎症和损伤愈合的重要概念 ;(3)表皮细胞生长因子受体家族及白介素 1家族在眼表疾病中的作用 ;(4)角膜缘的组织结构及其潜在功能的开发应用 ;(5 )角膜上皮病的分类、命名及诊断 ;(6 )泪液学研究进展 ;(7)角膜、角膜缘组织 (干细胞 )及羊膜的保存 ;(8)羊膜移植在眼表重建术中的应用 ;(9)眼表面重建术 ;(10 )大泡性角膜病变 ;(11)结膜、角膜碱烧伤的治疗 ;(12 )角膜缘干细胞及其生物学特性 ;(13)羊膜的生物学…     

《全国眼表疾病诊治专题讲座及研讨会论文汇编》简介

由中华眼科杂志编委会编辑的《全国眼表疾病诊治专题讲座及研讨会论文汇编》一书，内容丰富，主要包括：（１）眼表疾病研究进展；（２）眼表炎症和损伤愈合的重要概念；（３）表皮细胞生长因子受体家族及白介素１家族在眼表疾病中的作用；（４）角膜缘的组织结构及其潜在性功能的开发应用；（５）角膜上皮病的分类、命名及诊断；（６）泪液学研究进展；（７）角膜、角膜缘组织（干细胞）及羊膜的保存；（８）羊膜移植在眼表重建术中的应用；（９）眼表面重建术；（１０）大泡性角膜病变；（１１）结膜、角膜碱烧伤的治疗；（１２）角膜缘…     

关于举办国家级继续教育项目“眼表疾病诊治及角膜屈光手术进展”的通知

由安徽省医学会眼科学分会、安徽医科大学第一附属医院主办,临床眼科杂志编辑部协办的国家级继续教育项目”眼表疾病诊治及角膜屈光手术进展”学习班将于2009年10月上旬在安徽省黄山市举办。学习班将邀请国内知名专家教授任教。学习内容包括：常见眼表疾病的诊断和治疗、羊膜在眼表疾病中的应用、角膜缘干细胞的保存和移植技术进展、角膜屈光手术的最新进展等。     

深低温保存同种异体角膜缘组织片羊膜移植治疗重度眼表疾病

目的应用以羊膜为载体的深低温保存的角膜缘组织片同种异体移植术治疗重度眼表疾病.方法 19例19眼重度眼表疾病患者采用羊膜移植联合深低温保存的角膜缘组织片同种异体移植,2例术后半年行穿透性角膜移植术,随访观察术后疗效.结果 14例平均随访超过一年,眼表结构恢复正常,整个角膜上皮未见结膜杯状细胞,保存了眼球,视力均有不同程度的提高,其中1例植片脱落,4例发生角膜自溶的免疫排斥反应.结论羊膜移植联合深低温保存的角膜缘组织片同种异体移植术对于重度眼表疾病患者能快速、稳定地促进角膜表面重新上皮化,是一项可采纳的技术.     

第七届全国角膜病及眼表疾病学术会议征文

由中华医学会眼科学分会角膜病学组及中华眼科杂志编委会主办的“第七届全国角膜病及眼表疾病学术会议”定于 2 0 0 3年 5月下旬在云南省昆明市召开 ,届时将邀请我国从事角膜和眼表疾病基础及临床研究的知名专家和学科带头人进行专题讲座 ,欢迎全国眼科医师踊跃报名参加。讲座内容 :(1)眼表疾病的分类、诊断及治疗 ;(2 )感染性角膜病的临床研究进展 ;(3)免疫性角膜病变的处理原则 ;(4)角膜病及眼表疾病的临床及应用基础研究方法 ;(5 )角膜病诊断及治疗的基因及组织工程技术 ;(6 )角膜病及眼表疾病治疗的药物研究进展 ;(7)角膜病及眼表疾病的…     

谈羊膜移植在角膜和眼表疾病应用中的问题

由于羊膜具有抗炎、抗纤维化、抗新生血管生成、促进角膜修复的作用,羊膜已经成为治疗角膜和眼表疾病的理想材料.随着羊膜广泛应用于角膜和眼表疾病,在某种程度上改变了一些角膜及眼表疾病传统的治疗方式,但随之而来的临床问题也逐渐显露,主要体现在：适应证如何把握;手术如何进行个体化设计;如何观察术后并发症和术后规范用药等问题.在此,谈些个人的经验和看法,以期使羊膜移植手术能在临床治疗角膜和眼表疾病中发挥更好的作用.     

我国眼表重建手术的特点和问题

眼表疾病(OSD)是眼科界面临的棘手疾病之一.眼表疾病主要因角膜缘干细胞的破坏所致,角膜缘干细胞缺损常导致角膜上皮缺损、角膜新生血管化、角膜结膜化、角膜的溃疡及自溶等,重症者引起患者睑球粘连,结膜囊闭锁,严重影响美容,有的甚至失明.近年来,随着角膜缘干细胞理论的完善以及组织工程领域技术的发展,对眼表疾病治疗也有了较大进...     

第七届全国角膜病及眼表疾病学术会议征文

由中华医学会中华眼科学分会角膜病学组协办及中华医学会中华眼科杂志主办的“第七届全国角膜病及眼表疾病学术会议”定于 2 0 0 3年 5月下旬在云南省昆明市召开 ,届时将邀请我国从事角膜和眼表疾病基础及临床研究的知名专家和学科带头人进行专题讲座 ,欢迎全国眼科医师踊跃报名参加。讲座内容 :(1)眼表疾病的分类、诊断及治疗 ;(2 )感染性角膜病的临床研究进展 ;(3)免疫性角膜病变的处理原则 ;(4)角膜病及眼表疾病的临床及应用基础研究方法 ;(5 )角膜病诊断及治疗的基因及组织工程技术 ;(6 )角膜病及眼表疾病治疗的药物研究进展 ;(7)角膜病…     

角膜及眼表疾病专刊导读

专家述评:角膜疾病应用基础研究的现状和策略围绕角膜三种细胞及角膜感染、营养不良和移植失功三种病理过程,结合国内外的研究现状,分析了我国角膜病基础研究领域可拓展的方向和策略。角膜及眼表疾病研究中存在的问题及建议评述我国在角膜及眼表疾病研究领域已形成自己的特色和     

羊膜移植眼表重建手术的围手术期护理

眼表疾病包括角膜、结膜及泪液的疾病。许多眼表疾病可造成视力严重减退或丧失，将病变的眼表组织消除后，用新鲜或保存72h的健康人羊膜移植到眼表层剖切面，重建正常的眼表或角膜修补是治疗眼表疾病的一项新技术。我科2001年行羊膜移植重建眼表治疗眼表疾病，取得较为满意的效果，现将护理的体会报告如下。     

Collagen cross‐linking: a new treatment paradigm in corneal disease – a review

The last 2 years has seen a marked increase in the prominence of corneal collagen cross‐linking as a treatment strategy for progressive keratoconus. This interest has arisen from a body of laboratory evidence documenting the biomechanical and cellular changes induced by cross‐linking. The findings of this research provide a plausible rationale for its use in keratoconus to retard the progression of this common disease. The rapidly growing number of clinical reports suggests, not only a consistent stabilizing effect of cross‐linking, but that a variable improvement in corneal shape and visual function may also occur in some patients. However, the marked variation in the clinical course of keratoconus, together with the challenges of accurately evaluating refractive error, visual acuity and even corneal shape in this condition, demands further evidence from randomized controlled clinical trials. The aim of this review is to summarize the theoretical basis and risks of corneal collagen cross‐linking, along with the available evidence for its use in keratoconus and other corneal disease states.     

角膜胶原交联术的远期效果

角膜胶原交联术(corneal collagen cross linking,CXL)是目前治疗角膜扩张性疾病的有效手段,经典去上皮技术长期效果肯定,但手术时间长,部分患者存在并发症.为提高安全性,CXL技术在不断改良,包括经上皮胶原交联、强紫外线光快速交联等.但这些改良CXL长期有效性尚存争议.去上皮胶原交联仍是目前最有效的胶原交联术式,目前报道的经上皮胶原交联及快速胶原交联的效果良好,但远期效果有待进一步随访研究.     

眼表成像技术在干眼患者泪膜分析评价中的应用

干眼是一种复杂的眼表疾病,主要由于泪膜不稳定或眼表微环境失衡所导致。临床上常用泪膜破裂时间、角膜荧光染色评分和泪液分泌试验等指标来评估干眼,这些指标具有较强的主观性,且侵入性的操作也会干扰患者眼表。近年来出现各种客观无创的眼表成像技术用于泪膜分析,如角膜地形图、泪膜干涉测量、泪膜蒸发速率测量、眼前节光学相干断层成像和像差测量等。这些检测手段有助于对干眼进行诊断和疗效评估。本文就眼表成像技术在干眼患者泪膜分析评价中的应用作一综述。     

Riboflavin‐ultraviolet light induced cross‐linking in endothelial decompensation

Purpose: To evaluate the potential of collagen cross‐linking in the treatment of corneal oedema caused by endothelial decompensation. Methods: Riboflavin‐ultraviolet (UV) treatment induces cross‐linking and reduces stromal swelling. Eleven patients with corneal oedema were treated. The technique comprised: epithelial abrasion; instillation of 0.1% riboflavin in saline, and 5.4 J/cm² illumination with 365 nm UV‐A light over approximately 30 mins (3 mW/cm²). Results: A reduction in corneal thickness was observed in 10 patients. The majority also experienced improvement in vision. The effect occurred over weeks and lasted for months. Conclusions: The study shows a potential application of collagen cross‐linking in the management of patients with corneal oedema. Experimental and additional clinical studies are necessary in order to define the precise indications for this type of treatment.     

Limbal stem cell transplantation in chronic inflammatory eye disease

OBJECTIVE: The goal of this study was to describe the outcome of limbal stem cell transplantation (LSCT) in patients with severe ocular surface disease caused by underlying chronic inflammatory eye disease. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Nine patients with limbal stem cell deficiency caused by an underlying ocular inflammatory disease who underwent LSCT. METHODS: The authors reviewed the records of 11 eyes of 9 patients with immunologically mediated ocular surface disease that underwent LSCT. MAIN OUTCOME MEASURES: The main outcome measures were reepithelialization of the corneal surface, restoration of corneal surface, and improvement in visual acuity. RESULTS: A total of 11 eyes underwent either autologous (n = 1) or HLA-matched living related donor (n = 10) LSCT for ocular surface disease secondary to inflammatory disease. Reepithelialization of the corneal surface in the immediate postoperative period occurred in 10 eyes (91%) within an average of 10 days (range, 3-21 days). Long-term restoration of the corneal surface was achieved in six (55%) eyes. Visual acuity improved in six eyes (55%). Reasons for poor outcomes included microbial infection, limbal stem cell graft rejection, and corneal ulceration. No donor eyes had complications. CONCLUSIONS: Patients with underlying immunologically mediated diseases, such as Stevens-Johnson syndrome, toxic epidermal necrolysis, or ocular cicatricial pemphigoid, who undergo LSCT have lower success rates than do those patients with noninflammatory ocular surface diseases.     

The Chemokine Receptor CCR7 Expressed by Dendritic Cells: A Key Player in Corneal and Ocular Surface Inflammation

Dendritic cells (DCs) are highly potent stimulators of the immune system, and their contribution as such to the pathogenesis of corneal and ocular surface inflammatory disease has been well established. These vigorous antigen-presenting cells are reliant upon their effective migration from peripheral tissues (e.g., those of the ocular surface) to the lymphoid organs, where immune responses are triggered and can then cause disease. The chemokine receptor CCR7 expressed on DCs has emerged as the master mediator of this highly complex migratory process, and thus it is important in causing corneal and ocular surface inflammation. Furthermore, CCR7 has received considerable attention as a potential therapeutic target, as topically instilled antagonists of this receptor are quite effective therapeutically in a mouse model of ocular allergy. These findings and more are reviewed in the current article. In addition, the understanding regarding CCR7 function in mice and humans, and the biology of DCs that populate the ocular surface are also detailed herein. The involvement of DCs and their expression of CCR7 in corneal and ocular surface diseases such as in ocular allergy, dry eye disease, immune rejection and more, are also reviewed here.     

Concept and clinical application of cultivated epithelial transplantation for ocular surface disorders

Corneal epithelial replacement using a tissue engineering technique holds much promise for ocular surface reconstruction in cases of corneal epithelial stem cell deficiency. However, even though an autologous cultivated corneal epithelial stem cell sheet is the safest and most reliable form of sheet, bilaterally affected ocular surface disorders cannot be treated by this method. To treat bilateral cases, we must choose either an allogeneic cultivated corneal epithelial sheet or an autologous cultivated oral mucosal epithelial sheet. In the case of the former, immunological reaction is a threat. Thus, understanding of the immunological background of ocular surface reconstruction using allogeneic tissues is essential. In the case of the latter, the transplanted sheet is not exactly the same as corneal epithelium, and understanding ocular surface epithelial biology is important. In this review, we summarize and explain the concept and clinical application of cultivated mucosal epithelial transplantation for ocular surface disorders.     

Tear film and ocular surface changes in a rabbit model of neurotrophic keratitis

The authors studied the tear film and ocular surface in a rabbit model of neurotrophic keratitis to determine the extent to which the surface disease of neurotrophic keratitis resembled keratoconjunctivitis sicca. After denervation, tear film osmolarity increased and remained significantly elevated for 14 weeks. The ocular surface developed decreased conjunctival goblet cell density, decreased corneal epithelial glycogen, and morphologic changes similar to those seen in keratoconjunctivitis sicca. Although the conjunctival changes were consistent with the increases in tear film osmolarity and the surface disease of keratoconjunctivitis sicca, the corneal changes observed with denervation, including slit-lamp findings, morphologic changes, and decreases in glycogen, were too severe and rapid in onset to be accounted for by osmolarity alone. Neurotrophic "keratitis" is an ocular surface disease composed in part of the surface disease of keratoconjunctivitis sicca. However, the data also support an additional mechanism for corneal disease that could be due to the trophic influence of the trigeminal nerve.     

Successful transplantation of bioengineered tissue replacements in patients with ocular surface disease

PURPOSE: To bioengineer a corneal surface replacement using ex vivo expanded, cultured corneal epithelial stem cells seeded on a matrix derived from amniotic membrane and use this bioengineered graft to manage difficult ocular surface disease. METHODS: Fourteen patients with ocular surface disease unresponsive to standard medical and surgical treatments, including seven patients with presumed limbal stem cell deficiency were chosen for transplantation of a bioengineered composite corneal surface in eye each. Presumed corneal stem cells were harvested from either the patient's or related donor's limbus, expanded ex vivo, and cultivated on a carrier of modified human amniotic membrane. The resulting composite cultured tissue was transplanted to the ocular surface of the diseased eye, from which the abnormal tissue had been surgically removed. Ten patients received autologous grafts, and four received allogeneic grafts. RESULTS: A successful outcome, defined as restoration or improvement of vision, along with maintenance of corneal re-epithelialization and absence or recurrence of surface disease was obtained in 6 of the 10 patients with autologous procedures and in all 4 allogeneic transplants. Follow-up ranged 6-19 months with a mean of 13 months. CONCLUSIONS: This novel technique documents that presumed corneal epithelial stem cells can be harvested safely from the limbus, expanded successfully in vitro, and grown on denuded amniotic membrane. The resultant composite cultured tissue can be transplanted and appears to successfully manage eyes with difficult ocular surface disease, including those with stem cell deficiency. This technique minimizes the threat of damage or depletion to the contralateral or donor limbus.