角膜缘型结膜鳞状上皮乳头状瘤一例

角膜缘型结膜鳞状上皮乳头状瘤临床报告较少,现将我院收治的一例报告如下。佟××女71岁于2005年10月8日以“右眼角膜肿物生长致视力渐降4y余”就诊于我院。患者4y前右眼角结膜生长肿物,视力逐渐下降,无明显诱因,偶有异物感。门诊以右眼角膜肿物收入院。视力右眼0.6,矫正不提高,左眼0.8 2。右眼角巩膜缘见有灰白色扁平隆起、半透明的膜状肿物延伸至角膜,遮盖角膜近2/3,包括角膜上方、下方、鼻侧及1/2瞳孔区,仅剩颞侧约1/3角膜透明。肿物肥厚、无蒂,因富于血管,略带有粉红色,基底固定。在裂隙灯下可见肿物的毛细血管呈放射状向外生长。前房深…     

巨大结膜色素痣切除异体结膜角膜缘上皮移植1例

患者男 15岁生后4个月右眼球结膜出现小米粒大灰色肿物,逐渐变黑,生长缓慢,14岁才达黄豆大小.入院前3个月黑色物突然生长加速,无视力下降及其它不适.     

眼表鳞状上皮瘤研究进展

眼表鳞状上皮瘤(OSSN)是临床上少见的眼表肿瘤,由于其发病率低,且易与翼状胬肉等混淆,给诊断造成困难。近年来,各种诊断技术的提高,以及干扰素(interferon,IFN)广泛应用于OSSN治疗,大幅度降低复发率,OSSN诊断治疗手段趋于多样化。了解当前OSSN发病原因以及治疗方式,可以更好地指导OSSN研究。     

结膜上皮干细胞的研究进展

结膜上皮干细胞是结膜上皮中杯状细胞和非杯状细胞的共同祖细胞,对维持结膜上皮细胞的更新和正常眼表的生理功能有重要作用。本文综述结膜上皮干细胞的概念、存在的部位、鉴别、分化增殖特性、调控因素等的研究进展。     

有和没有结膜上皮内受侵的眼睑皮脂腺癌临床分析

目的评价26例有和没有结膜上皮内受侵的眼睑皮脂腺癌的临床表现、组织学特征、治疗和结果。方法病人分为二组,A组:有结膜上皮内受侵的眼睑皮脂腺癌病人10例,B组:没有结膜上皮内受侵的眼睑皮脂腺癌病人16例。分别分析其临床、组织学特征及治疗和结果。结果26例病人,其中女性17例(66%),男性9例(34%),就诊时的平均年龄为65.5岁(35岁～84岁)。A组10例,B组16例,A组病人常见的症状是刺激症状,B组常见的体征是眼睑肿块;A组病人常见的体征是眼睑弥漫性变厚,B组最常见的体征是明显的眼睑肿块;肿瘤组织学来源,A组均为麦氏腺来源,B组麦氏来源7例,Zeis腺来源3例,来源不确定4例,多中心来源1例,皮肤皮脂腺来源1例;术后复发,A组5例,B组10例;眼眶扩散,A组3例,B组1例;肿瘤发生转移,A组1例,B组2例。结论有结膜上皮内受侵和没有结膜上皮内受侵的眼睑皮脂腺癌有不同的临床特征,结膜上皮内受侵有较多的眼眶内容剜除危险,但肿瘤转移的危险两组类似。     

平阳霉素瘤内注射治疗结膜囊状淋巴管瘤

淋巴管瘤是小儿常见良性肿瘤之一,好发于颈胸部,以囊状淋巴管瘤多见,不能自行消退,生长快慢不一。虽眼部穹窿结膜极少发生,但压迫眼球影响其正常发育,瘤体容易破裂,继发感染、出血等并发症,处理困难,传统手术治疗不易完全切除,且损伤面积较大,后遗症较多,容易复发 [2]。笔者于1994年6月起应用平阳霉素(pingyangmycin,PYM)联合缩丙酮确炎舒松瘤内注射治疗小儿结膜囊状淋巴管瘤15例(16只眼),疗效满意,现报告如下。     

先天性巨大角膜结膜皮样瘤一例

患者,男,11岁,右眼球表面肿物11年.患儿出生时家人即发现其没有"黑眼珠".眼球表面为黄色肿物覆盖,随年龄增长而增大,眼球转动略受限,哭闹时常脱出眼外,可回纳.     

翼状胬肉切除自体角膜上皮和结膜移植观察

目的观察在手术显微镜下翼状胬肉切除联合自体纯角膜上皮和纯结膜组织移植的临床效果。方法对36例(36眼)鼻侧球结膜原发性翼状胬肉行手术显微镜下切除,并将术眼的颞上侧单纯角膜上皮和单纯结膜组织分别移植到术后角膜创面和结膜缺损(巩膜裸露)处,观察角膜创面上皮修复速度及结膜植片的血管化过程。结果随访观察5～16月,平均10月。36例全部治愈无复发者。角膜上皮植片两天内修复透明光滑,结膜植片2周血管化完成。结论翼状胬肉切除联合自体纯角膜上皮和纯结膜组织移植,取材方便,无排斥反应,术后伤口愈合快,复发率低。     

结膜移植的临床应用

结膜移植作为一种修复眼表面结膜的手术，在许多难治性结膜疾病中，得到了较广泛的应用。本文就结膜移植的临床效果，应用，手术方法及实验研究进行了综述。     

Use of mitomycin C in the treatment of corneal conjunctival intraepithelial neoplasia

Purpose: To evaluate the efficacy of topical mitomycin C as a treatment of corneal conjunctival intraepithelial neoplasia.
Methods: An open prospective analysis of 20 cases of corneal conjunctival intraepithelial neoplasia with recurrent disease (17 patients) or refusing surgery (three patients) were treated with topical mitomycin C. Treatment was with mitomycin C eye drops, either 0.02% or 0.04%, four times daily for 1 week followed by a week off the cycle then repeated for a second week. Patients were examined weekly until the lesions were eradicated.
Results: Clinical resolution of disease occurred in 18/20 cases. The mean time to resolution was 4.5 weeks, the mean number of cycles of treatment was two. Average follow up was 13 months with four cases of recurrent disease. These four cases were retreated with complete resolution in two cases. Epithelial toxicity occurred in 10/20 eyes and lid toxicity in two cases. There were no long-term complications on discontinuing mitomycin C.
Conclusions: Mitomycin C is effective in inducing regression of corneal conjunctival intraepithelial neoplasia. Complications are common but self-limiting. An optimal regimen is still to be established.     

糖尿病大鼠泪腺、结膜及角膜组织病理学观察

目的 探讨糖尿病造成的泪腺、角膜、结膜组织损伤。方法 雄性SD大鼠40只。随机分为糖尿病组和对照组，各20只。分别于成模后6、8、10、12周断颈处死大鼠，每组各5只。光镜下观察泪腺、角膜、结膜组织病理学改变。结果 糖尿病组随时间依次表现为泪腺细胞水肿、增生，腺泡及导管萎缩，纤维增生及淋巴细胞浸润，角膜上皮、基质层水肿，结膜杯状细胞减少。结论 糖尿病导致的泪腺、角膜、结膜等眼组织破坏是糖尿病性眼表病变的病理基础。     

Intraepithelial and invasive squamous cell carcinoma of the conjunctiva: analysis of 60 cases

AIM—To evaluate the clinical features, treatment results, and recurrence rates in patients with either intraepithelial or invasive squamous cell carcinoma of the conjunctiva.
METHODS—Retrospective analysis of 60 cases (22 conjunctival intraepithelial and 38 invasive squamous cell carcinomas) to determine patterns of clinical presentation, aetiological factors, and treatment results. The mean patient age was 64 years old. 70% of the patients were male. Patients were treated with a variety of therapies, depending on the degree of tumour involvement; most cases were treated with frozen section controlled excision and adjunctive cryotherapy. Modified eye wall resection or enucleation was done for intraocular invasion and exenteration was done for orbital involvement.
RESULTS—Red eye (68%) and ocular irritation (57%) were the most common presenting symptoms. 44% of the patients had other eye findings consistent with extensive solar exposure. 20% of the patients had a history of malignant skin tumours. Visceral malignancies developed in 8%. Scleral involvement was present in 14 (37%), intraocular involvement in five (13%), and orbital invasion in four (11%) cases with invasive squamous cell carcinoma. After a mean follow up of 56 months (18-226 months) the rate of new or recurrent tumours was 4.5% for intraepithelial squamous carcinoma and 5.3% for invasive squamous cell carcinoma. No patient developed metastases or tumour related deaths.
CONCLUSION—Excision with intraoperative control of the surgical margins and adjunctive cryotherapy results in good tumour control rates.

Keywords: squamous cell carcinoma; conjunctiva     

10. Hereditary Benign Intraepithelial Dyskeratosis: A Report of Two Cases from Texas

Hereditary benign intraepithelial dyskeratosis (HBID) is a rare disorder characterized by autosomal dominant inheritance, onset in childhood, bilateral limbal conjunctival plaques, chronic relapsing course of ocular irritation and photophobia, and oral lesions resistant to medical and surgical therapy. The lesions are characterized histologically by dyskeratosis, acanthosis, parakeratosis, and a variable amount of subepithelial inflammation. The patients in all previously reported cases have been descendants of Halowar Indians from North Carolina. This report illustrates the typical clinical and histologic findings of HBID in two siblings who, along with their parents and grandparents, were born in Texas.     

电焊弧光引起角、结膜改变的临床观察

目的:观察电焊弧光对角、结膜的影响。方法:对168例从事电焊工作人员行裂隙灯下角、结膜检查,记录翼状胬肉、睑裂斑、光性角膜炎的发生情况。结果:从事电焊工作10a以下者31例,翼状胬肉6眼(9.7%),睑裂斑8眼(12.9%),光性角膜炎8眼(12.9%);10～20a者84例,翼状胬肉27眼(16.1%),睑裂斑31眼(18.4%),光性角膜炎22眼(13.1%);20a以上者53例,翼状胬肉25眼(23.6%),睑裂斑27眼(25.5%),光性角膜炎14眼(13.2%)。结论:翼状胬肉及睑裂斑的发生与接触电焊弧光照射时间的长短有关,时间越长,发生率越高;光性角膜炎则与一次过量电焊弧光照射有关。     

OCT对急性闭角型青光眼治疗前后角结膜结构的改变

目的：利用光学相干光断层扫描技术(optical coherence tomography,OCT)观察急性闭角型青光眼治疗前后角膜和结膜厚度及形态的变化。

方法：收集急性闭角型青光眼患者25例,对初诊、治疗第1、2、3d的眼压与角膜结膜特征对比分析。

结果：急性闭角型青光眼发作时角膜上皮厚度、全层厚度分别为72.76±11.95、589.40±66.91μm; 结膜上皮层厚度、结膜固有层厚度和结膜全层厚度为58.88±12.87、299.76±94.86、358.64±102.55μm; 治疗第1d角膜上皮厚度、全层厚度分别为69.28±12.65、579.04±67.88μm; 结膜上皮层厚度、结膜固有层厚度和结膜全层厚度为57.04±12.05、282.44±91.47、339.48±100.28μm; 治疗第2d角膜上皮厚度、全层厚度分别为66.76±11.42、563.32±63.87μm; 结膜上皮层厚度、结膜固有层厚度和结膜全层厚度为54.76±11.01、267.00±98.54、322.16±106.12μm; 治疗第3d角膜上皮厚度、全层厚度分别为65.16±12.25、550.36±71.48μm; 结膜上皮层厚度、结膜固有层厚度和结膜全层厚度为53.36±10.29、252.76±99.32、306.52±107.31μm; 治疗前、治疗第1、2、3d时4个测量时间点的眼压、角膜上皮厚度、角膜全层厚度、结膜上皮厚度、结膜固有层厚度和结膜全层厚度差异都有统计学意义(P<0.05)。

结论：青光眼急性发作时角膜结膜水肿厚度增加,并随眼压的降低而变薄。