板层角膜移植治疗冀状胬肉及角膜皮样瘤

为观察板层角膜移植治疗冀状胬肉及角膜皮样瘤的疗效,我们对１７例（１７只眼）冀状胬肉患者及５例（５只眼）角膜皮样瘤患者进行了板层角膜移植。术后随访１～４年,冀状胬肉组和角膜皮样瘤组植片透明率分别为８２．４％及１００％,冀状胬肉组排斥反应发生率为１７．６％,角膜皮样瘤组无一例发生排斥反应,所有病例角膜中央厚度手术前后差异无显著性意义（Ｐ〉０．０５）。两组病例术后角膜散光均较术前降低,差异均有显著性意义     

局部切除联合部分板层角膜移植治疗角膜皮样瘤19例疗效分析

目的 观察局部切除联合部分板层角膜移植治疗角膜皮样瘤的临床疗效.方法 对19例角膜皮样瘤用比瘤体边缘宽0.5 mm的环钻划界,行病灶处做部分角膜及巩膜切除,采用甘油保存的供体角膜,选用比植床大0.25 mm的环钻钻取角膜植片,均匀剖切成形状、深度与植床相当的角膜植片,行部分板层角膜移植术.结果 随访6个月～3年,所有植片与植床愈合良好,植片透明13眼(68.42%),半透明6眼(31.58%).2眼出现植片下新生血管长入及植片轻度水肿,经抗排斥治疗后血管萎缩、消退,术后正常眼表结构恢复快,视力与术前相比无明显变化.所有病例均未见复发.结论 局部彻底切除联合部分板层角膜移植是治疗角膜皮样瘤较理想的方法.     

板层角膜移植治疗复发性翼状胬肉39例

翼状胬肉是眼科常见病，传统的有效治疗方法是手术，但术后复发率较高，很多学者采用很多方法希望减少复发率，但大部分效果甚微。我们近年来采用显微手术切除胬肉联合板层角膜移植治疗复发性翼状胬肉，取得了较好的疗效，现报告如下。     

板层角膜及角膜缘上皮移植术治疗翼状胬肉

目的 探讨板层角膜联合角膜缘上皮移植术治疗翼状胬肉的临床疗效。方法 对11眼翼状胬肉实施板层角膜联合角膜缘上皮移植术。结果 手术均获成功，术后平均随访1年，移植未发生排斥反应，无复发。结论 板层角膜联合角膜缘上皮移植术治疗翼状胬肉具有较好的疗效。     

角膜皮样瘤切除后应用婴儿角膜移植1例报告

患者李某,男性,22岁,因左眼球长一肿物20多年入院。患者在出生时其父母即发现左眼球长一小肿物,约绿豆大小,未能引起重视,肿物随年龄增长而长大,影响视力,近年来常有发红,流泪而入院。既往史、家族史和个人史无特殊。全身体检未见异常。眼部检查,远视力右1.5,左0.02,(不能矫正)。近视力右1.5,左0.1,右眼未见异常。左眼球结膜充血,角膜外下方角巩缘处有一淡黄色肿物,约8mm×5mm大小,其上方长有数根汗毛。其周围可见新生血管。瞳孔、晶状体和玻璃体未见明显异常,眼底窥见不理想。诊断:左角膜皮样瘤;左眼弱视。     

板层角膜及角膜缘上皮移植术治疗翼状胬肉

目的　探讨板层角膜联合角膜缘上皮移植术治疗翼状胬肉的临床疗效。方法　对 1 1眼翼状胬肉实施板层角膜联合角膜缘上皮移植术。结果　手术均获成功 ,术后平均随访 1年 ,移植未发生排斥反应 ,无复发。结论　板层角膜联合角膜缘上皮移植术治疗翼状胬肉具有较好的疗效     

部分板层角膜移植术治疗角膜皮样瘤临床疗效及术后屈光状态

目的：观察局部切除联合异体板层角膜移植术治疗角膜皮样瘤的临床疗效及术后屈光状态,为角膜皮样瘤的治疗提供理论依据。方法：对39例角膜皮样瘤患者采取病灶处角巩膜组织板层切除,于供体眼球相应部位钻取形状和厚度相似的板层角膜植片,角膜侧行连续缝合,巩膜侧行间断缝合。观察术后眼表结构,测定患眼术前、拆线后、术后1年及2年的裸眼视力和散光度数。结果：术后1周视力恢复不明显,甚至下降,散光严重;术后1个月散光程度减轻,与术前相似;术后1年屈光状态逐渐稳定,散光明显改善。术后随访1～2年,所有植片植床愈合良好,3眼出现植片下新生血管及植片轻度水肿,抗排斥治疗后血管萎缩、消退术后正常眼表结构恢复快,视力及角膜散光较术前明显改善(P< 0.05);肿瘤无发,无层间植入等并发症。结论：局部彻底切除联合相应部位的异体板层角膜移植是治疗角膜皮样瘤较理想的方法,术后1年角膜屈光状态稳定,可进行配镜矫正。     

部分板层角膜移植与自体角膜缘上皮移植治疗角膜皮样瘤术后屈光状态比较

目的：研究比较部分板层角膜移植与自体角膜缘上皮移植治疗角膜皮样瘤术后屈光状态。方法：选取2012年1月至2013年6月在我院进行手术治疗的80例膜皮样瘤患者,按手术方法将其分为实验组和对照组,实验组患者实施自体角膜缘上皮移植,对照组实施部分板层角膜移植,对比两组患者屈光状态、术后并发症的发生状况进行比较。结果：实验组患者视力屈光状态改善程度明显优于对照组,实验组并发症发生率为7．5％,明显低于对照组的25．00％, P＜0．05时,差异有统计学意义。结论：部分板层角膜移植治疗角膜皮样瘤,治疗效果好,术后易恢复,不良反应小,建议在临床推广应用。     

翼状胬肉连带角膜板层上皮瓣切除563例临床分析

目的探讨翼状胬肉手术中如何干净快捷切除病变组织,增加术后角膜透明度,减少术后角膜刺激症状,促进角膜上皮早期愈合,从而减少角膜感染机率,减少复发。方法对2011~2013年在我院行翼状胬肉连带板层角膜上皮瓣切除的563例患者进行回顾分析及随访观察预后情况。结果术后48h均上皮全部愈合,刺激症状消失。术后随访最长2年半,最短半年,角膜清亮,复发37例,复发率6.6%。结论翼状胬肉连带板层角膜上皮瓣切除术治疗后,术后角膜感染几率小,角膜透明度好,翼状胬肉复发率低。     

板层角膜移植治疗角膜浅表疾病

分类号Ｒ７７２．２近３年来,我科对２５例（２７只眼）患有角膜浅表疾患的眼施行了板层角膜移术,效果满意。现报告如下：１资料与方法１．１一般资料本组２５例,男性１６例（１７只眼）,女性９例（１０只眼）。年龄２～６８岁,平均（３３．５±１７．７）岁。受体对...     

自动角膜板层刀在角膜移植中的应用

介绍自动角膜板层刀应用于板层角膜移植手术的治疗效果．方法：对３例３只眼用自动角膜板层刀在受体眼上根据病变厚度及直径大小做植床,然后在供体眼上做与受体相应厚度和直径的植片,再将植片放置于植床使其自然粘附．结果：经３个月随访,３例３只眼均达到了手术的目的,其中１例视力为指数／４０ｃｍ,１例为０．２,另１例无明显改善;２只眼植片完全透明,１只眼半透明;１例１只眼术后多３天出现层间出血,经激光处理后植对透明,余均未出现术中及术后并发症,结论：用自动角度板层刀行板层角膜移植术与既往板层角度移植术相比,有明显优越性．     

In Vivo Confocal Microscopic Observation of Lamellar Corneal Transplantation in the Rabbit Using Xenogenic Acellular Corneal Scaffolds as a Substitute

Background:

The limiting factor to corneal transplantation is the availability of donors. Research has suggested that xenogenic acellular corneal scaffolds (XACS) may be a possible alternative to transplantation. This study aimed to investigate the viability of performing lamellar corneal transplantation (LCT) in rabbits using canine XACS.

Methods:

Fresh dog corneas were decellularized by serial digestion, and LCT was performed on rabbit eyes using xenogeneic decellularized corneal matrix. Cellular and morphological changes were observed by slit-lamp, light, and scanning electron microscopy at 7, 30 and 90 days postoperatively. Immunocytochemical staining for specific markers such as keratin 3, vimentin and MUC5AC, was used to identify cells in the graft.

Results:

Decellularized xenogenic corneal matrix remained transparent for about 1-month after LCT. The recipient cells were able to survive and proliferate into the grafts. Three months after transplantation, grafts had merged with host tissue, and graft epithelialization and vascularization had occurred. Corneal nerve fibers were able to grow into the graft in rabbits transplanted with XACS.

Conclusions:

Xenogenic acellular corneal scaffolds can maintain the transparency of corneal grafts about 1-month and permit growth of cells and nerve fibers, and is, therefore, a potential substitute or carrier for a replacement cornea.     

深板层角膜移植治疗感染性角膜炎的临床分析

目的探讨深板层角膜移植治疗感染性角膜炎的适应证、手术方法及术后处理。方法采用深板层角膜移植治疗感染性角膜炎126眼,对其疗效进行观察、分析。结果术后随访3～24个月,98眼治愈（77．78％）,好转16眼（12．69％）,复发10眼（7．93％）,其他2眼（1．60％）。术后最佳矫正视力0．1以上的有12眼,0．2以上的有21眼,0．4以上的有75眼,0．1以下的有18眼。8眼（6．35％）发生排斥反应。结论深板层角膜移植对治疗感染性角膜炎有效。     

自体角膜缘干细胞移植术治疗翼状胬肉43例临床观察

目的 评价自体角膜缘干细胞移植术治疗翼状胬肉的疗效。方法采用自体角膜缘干细胞移植术治疗54眼(43例)翼状胬肉，其中原发性翼状胬肉38眼，复发性翼状胬肉16眼。16眼复发性胬肉均经过两次以上的单纯胬肉切除术或结膜下转移术。结果 术后随访6-18个月，无术后并发症发生。49眼无胬肉组织再生，5眼在术后8—11个月复发，复发率为9．3％。结论 自体角膜缘干细胞移植术能为受损的角膜缘提供新的干细胞，是一种安全、有应用前景的治疗翼状胬肉的手术方式。     

全植床深板层角膜移植治疗真菌性角膜溃疡临床疗效观察

目的观察全植床深板层角膜移植治疗真菌性角膜溃疡的临床疗效。方法采用全植床深板层角膜移植治疗真菌性角膜溃疡21例（21眼）,分析患者的手术情况、术后末次随访时的最佳矫正视力和屈光状态、术后并发症及角膜溃疡复发情况。结果21眼中8眼（38．10％）在术中发生了角膜后弹力膜的微穿孔,但都完成了手术,术后未出现双前房。术后末次随访,平均最佳矫正视力为0．58,等效球镜度数为（-2．15±2．42）DS,散光度为（-3．23±1．75）DS。在术后随访期间,没有出现术后免疫排斥反应,均无角膜溃疡复发。结论全植床深板层角膜移植治疗真菌性角膜溃疡具有对材料要求条件低、不进入前房及术后免疫排斥反应低、治疗效果好等优点,在临床上值得推广应用。     

自体角膜缘干细胞移植与单纯切除术治疗翼状胬肉效果分析

目的：比较自体角膜缘干细胞移植法切除翼状胬肉与单纯翼状胬肉切除术对初发性翼状胬肉的疗效。方法：将69例（75眼）初发性胬肉患者随机分成A、B两组：A组36例（39眼）行自体角膜缘干细胞移植术;B组33例（36眼）行单纯性翼状胬肉切除术。术后观察比较两组患者术眼不适症状持续时间、翼状胬肉复发情况随访6-19个月。结果：A组39眼中3眼翼状胬肉复发,复发率为7.69%;B组36眼中11眼复发,复发率为30.56%,两组比较差异有统计学意义（P〈0.05）;在术后1周、2周及1月时,两组不适症状眼数差异有统计学意义（P〈0.05）。结论：自体角膜缘干细胞移植切除翼状胬肉具有创伤小,修复快,术后患者自觉症状轻,复发率低等优点。     

翼状胬肉联合角膜缘干细胞移植术后视力及角膜散光变化观察

目的探讨就患者在行翼状胬肉联合角膜缘干细胞移植术后的角膜散光以及视力变化的相关情况。方法选择该院眼科2011年1月—2013年1月所收治的100例患者144只眼作为研究对象,对该研究所有患者的胬肉进入角膜的长度、角膜曲率、屈光度以及视力进行常规测定,对所有患者的患眼在治疗前后的屈光度进行比较。结果该研究的144只患眼存在不同程度的散光,患者的此种情况与胬肉进入角膜的具体长度有关,且以顺规性散光为主。经过1个月的治疗后,患者的散光度数明显下降,其视力也得以提高,该组患者在治疗前后的屈光度差异有统计学意义(P<0.05)。结论翼状胬肉可以引起顺规性散光,胬肉的大小与散光程度密切相关,对此类患者行胬肉切除术可以使患者的散光情况得到明显的改善,以此来提高患者的视力。     

Clinical evaluation of Deep Anterior Lamellar Keratoplasty (DALK) for stromal corneal opacities

Background

Corneal scars are commonly formed following many diseases of the eye like trauma, inflammation and infections. They lead to permanent diminution of vision which can be managed by Penetrating Keratoplasty (PK). PK is removing diseased as well as healthy tissues and is associated with many post-operative complications. Deep Anterior Lamellar Keratoplasty (DALK) is a relatively newer procedure which replaces only the diseased stroma, leaving the original corneal endothelium intact. This procedure is associated with lesser incidence of post-operative complications.

Methods

The study was conducted at a large tertiary care centre. 10 patients with stromal corneal scars were subjected to DALK and results were analysed after 06 months. Poor quality donor corneal tissue of B− and C grade was used in all cases.

Results

7 out of 10 patients (70%) undergoing DALK had post-operative visual acuity of 6/24 or better. 03 patients who did not have adequate recovery of visual acuity were due to over-riding of the graft in 01 case (10%), fungal keratitis in 01 case (10%) and interface haze in 01 case (10%).

Conclusion

DALK is a promising new technique for management of superficial corneal stromal scars using poor quality donor corneal tissue. Initial results are encouraging with minimal complications.     

准分子激光联合兔板层角膜移植的组织学观察

目的探讨１９３ｎｍ准分子激光在板层角膜移植中的应用价值。方法实验组兔单眼用准分子激光制作植床、植片,再将植片间断缝合于植床。对照组兔单眼施行常规板层角膜移植术。术后观察１２周,在１、２、４、８、１２周取角膜作光镜及电镜检查。结果实验组术后角膜基质透明度较对照组高,组织学检查示实验组植床、植片界面光滑,１２周时纤维排列整齐,似正常角膜。结论在板层角膜移植中运用准分子激光,有助于减少界面间瘢痕增生,提高手术效果。     

Clinical evaluation of Deep Anterior Lamellar Keratoplasty (DALK) for stromal corneal opacities

Background

Corneal scars are commonly formed following many diseases of the eye like trauma, inflammation and infections. They lead to permanent diminution of vision which can be managed by Penetrating Keratoplasty (PK). PK is removing diseased as well as healthy tissues and is associated with many post-operative complications. Deep Anterior Lamellar Keratoplasty (DALK) is a relatively newer procedure which replaces only the diseased stroma, leaving the original corneal endothelium intact. This procedure is associated with lesser incidence of post-operative complications.

Methods

The study was conducted at a large tertiary care centre. 10 patients with stromal corneal scars were subjected to DALK and results were analysed after 06 months. Poor quality donor corneal tissue of B− and C grade was used in all cases.

Results

7 out of 10 patients (70%) undergoing DALK had post-operative visual acuity of 6/24 or better. 03 patients who did not have adequate recovery of visual acuity were due to over-riding of the graft in 01 case (10%), fungal keratitis in 01 case (10%) and interface haze in 01 case (10%).

Conclusion

DALK is a promising new technique for management of superficial corneal stromal scars using poor quality donor corneal tissue. Initial results are encouraging with minimal complications.