Terrien角膜边缘变性板层角膜移植疗效分析

目的：评价板层角膜移植治疗Terrien角膜边缘变性的临床疗效。方法：对北京同仁医院1998年至2000年3年间经角膜板层移植治疗的73例Terrien角膜边缘变性的临床资料作回顾性分析。结果：行新月形或指环形板层角膜移植术73例，视力明显改善，角膜屈光度改变。结论：板层角膜移植手术是治疗Terrien角膜边缘变性有效。安全，理想的治疗方法，可阻止病变的继续发展和提高视力。     

板层角膜移植治疗Terrien角膜边缘变性的并发症及其处理

本文总结３５例（４１只眼）板层角膜移植术治疗边缘性角膜变性病例。其中半月形板层角膜移植３４眼，指环状角膜移植７眼。术中最常见并发症为角膜穿孔，本组７例。术后最常见并发症为角膜植片水肿，本组８例。此外尚有术中角膜创口对合不良，术后角膜层间积液、层间积血、虹膜前粘连、上皮植入性囊肿、术后植片排斥反应及病灶复发等。对术中及术后并发症的产生及机理作了初步探讨，并提出相应的预防及处理措施。     

Terrien角膜边缘变性的手术治疗

目的 观察指环状或部分指环状板层角膜移植对Terrien角膜边缘变性的治疗效果.方法 2000年1月～2003年3月角膜组病房收治Terrien角膜边缘变性患者15例共17只眼.其中男性10例,12只眼,女性5例,5只眼.年龄29～65岁.病史3～20年.患眼视力为指数～0.2不等.手术方法：根据病变的范围,作指环状或部分指环状板层角膜移植.结果 术后一周内,植片可轻度水肿,以后渐变清亮,厚度为正常角膜厚度,术后观察6月～3年,未见病变复发者.术后视力均有明显提高,术后6月,视力1.0以上5只眼,＞0.5～1.0者6只眼,0.1～0.5者6只眼.结论 指环状或部分指环状板层角膜移植术可以控制Terrien角膜边缘变性的病情发展,恢复病变区角膜正常厚度,减少散光,改善角膜曲率,提高患眼视力,预防角膜穿孔,远期疗效稳定,是治疗Terrien角膜边缘变性安全有效的疗法.     

Terrien角膜边缘性变性1例

1临床资料患者,女,67岁,因双眼轻度磨痛1月于2004年5月21日来我院就诊。视力:右0.6,左0.8;双眼睑结膜轻度充血,乳头增生,球结膜无充血,角膜上皮完整,荧光素钠染色阴性。右眼鼻上方角膜近边缘处见局限膨隆,约3.0mm×2.0mm,长轴与角膜缘平行,伴有浅层新生血管长入,呈小囊肿外观,病变区角膜变薄,内皮面呈弧形浅沟状凹陷,前房中深,瞳孔直径约3.0mm,对光反射灵敏,晶状体尚清,眼底无明显异常。左眼未见异常。眼压:右15mmHg(1kPa=7.5mmHg),左16mmHg。诊断为Terrien角膜边缘性变性(右眼)。给予氧氟沙星滴眼液及红霉素眼膏治疗,并建议行右眼板层角…     

表面角膜镜片术治疗Terrien‘s边缘角膜变性初步报告

目的：探讨用表面角膜镜片术治疗严重的Ｔｅｒｒｉｅｎ＇ｓ边缘角膜变性的效果。方法：全部病例为严重的周边角膜环形或部份变薄，厚度小于正常１／３，用带２ｍｍ环形巩膜的全角膜板层移植片移植到去除上皮的角膜植床。手术前及手术后定期行角膜曲率，散瞳验光检查。结果：本组病例随访时间３￣１３个月，平均１０个月。随访期间，镜片全部透明。术前角膜散光平均１１．５Ｄ，术后散光平均３．９Ｄ。术后矫正视力除一例稍降外，３例     

晚期Terrien角膜变性的手术治疗

目的 对晚期Terrien角膜变性病例进行板层角膜移植手术结果进行分析.方法 对34例38只眼晚期Terrien角膜变性患者行板层角膜移植手术治疗.结果 术后经过16～84个月的随访,所有术眼无复发,角膜散光减少,视力均较术前提高.32只眼植片透明,6只眼植片半透明,有少量新生血管长入.8只眼植片部分变薄,但无局部膨隆发生.结论 通过本组手术治疗发现,彻底切除病变组织,联合半环状或环状板层角膜移植,可有效地控制病变造成的高度散光,提高视力,并可抑制病变的进展和复发.     

表面角膜镜片术治疗Terrienˊs边缘角膜变性初步报告

目的:探讨用表面角膜镜片术治疗严重的Terrien＇s边缘角膜变性的效果方法:全部病例为严重的周边角膜环形或部份变薄,厚度小于正常1/3,用带2mm环形巩膜的全角膜板层移植片移植到去除上皮的角膜植床。手术前及手术后定期行角膜曲率,散瞳验光检查。结果:本组病例随访时间3～13个月,平均10个月。随访期间,镜片全部透明。术前角膜散光平均11.5D,术后散光平均3.9D。术后矫正视力除一例稍降外,3例有提高。术后合并症和其它表面角膜镜片术一样,主要是镜片下混浊。本组一例因层间上皮植入性混浊位于视轴区而作了镜片更换术。结论:角膜表面镜片术治疗严重Terrien＇s边缘角膜变性,具有操作简单、方便、有效。它不但增加病变区的角膜厚度,而且手术是在角膜表面操作,不损伤Bowman氏膜,使中央角膜透明度得以保护。同时也降低角膜的散光度。眼科学报1997;13:79～81。     

胎儿角膜移植治疗角膜病

1995年4月～1996年4月本院以大月份引产胎儿供体角膜施行角膜移植术,治疗角膜病5例,取得较好的效果.现报告如下:一般资料:5例中男2例,女3例.年龄7     

角膜移植治疗角膜基质营养不良33例临床分析

本文总结了３３例４４眼角膜基质营养不良角膜移植,追踪３月～１０年。结果：４４眼中,除斑块状营养不良施行板层角膜移植４眼术后视力无改善外,其余视力均提高０．１以上,有效率为９１％;追踪２～１０年,植片透明率９３．６％;４眼于术后发生排斥反应,发生率９．１％;４眼原病复发,复发率９．１％。结论：角膜基质营养不良是角膜移植的最好适应症,并发症少,选择适当的手术方式是手术成功的关键。     

角膜移植治疗角膜穿孔

角膜移植治疗角膜穿孔河南省眼科研究所张月琴，孙秉基，丁行振，朱志忠，王印其，王丽娅采用角膜移植治疗眼部各种感染或外伤引起的角膜穿孔，国内文献报告不多，河南省眼科研究所１９８４年－１９９３年采用此法治疗７０例，取得一定的结果，现报告如下：资料和方法一、...     

Corneal hydrops in Terrien's marginal degeneration

We present four cases of Terrien's marginal degeneration that developed spontaneous ruptures in Descemet's membrane resulting in corneal hydrops. In all cases, the hydrops was characterized by a clear intracorneal pocket of aqueous humor rather than by stromal clouding. In two cases, the pocket extended peripherally to form a conjunctival filtering bleb. Although a lamellar corneal patch graft was used in one case for severe astigmatism, hypotony, and impending perforation, most cases were merely observed without treatment.     

小切口无缝线深板层角膜内皮移植术的疗效观察

目的探讨小切口无缝线深板层角膜内皮移植术的手术方法、临床疗效及并发症的预防与处理。方法对9例（9只眼）大泡性角膜病变患者行小切口无缝线深板层角膜内皮移植术,其中6例联合前段玻璃体切割术。术后观察植片与植床贴合情况、植片移位的发生和处理。随访3～5个月,观察视力、植片透明度、角膜曲率、角膜散光及角膜内皮细胞密度。结果8例患者植片与植床贴合良好,1例患者术后第1天植片移位,经再次复位后贴合良好。6例患者不同程度提高视力,3例患者因术前长期高眼压,术后视力不提高。9例患者植片均透明,角膜曲率（43．96±3．38）D,角膜散光度数（3．32±1．20）D,角膜内皮细胞密度（2124±278）个／mm^2,未出现严重并发症。结论与穿透性角膜移植或板层角膜瓣下深板层角膜内皮移植术比较,小切口无缝线深板层角膜内皮移植术治疗大泡性角膜病变更有优势,有望成为治疗该病的手术方式之一。     

Ultrasound biomicroscopy of corneal hydrops in Terrien's marginal degeneration

Terrien's marginal degeneration (TMD) is a rare form of corneal ectasia. Few case reports have documented hydrops of the cornea in patients with TMD. We present the first case known to us of corneal hydrops in TMD where there is stromal edema in addition to the aqueous cystic cavities, and the first case demonstrating ultrastructural anatomy of this entity by ultrasound biomicroscopy.     

Primary surgical repair of severe peripheral marginal ectasia in Terrien's marginal degeneration

We have developed a safe, successful, and simple procedure for repairing the severe peripheral marginal ectasia in Terrien's marginal degeneration. The area of ectasia is incised along its thinnest paralimbal dimension down to Descemet's membrane. Ectatic stroma along both sides of the incision is then undermined until normal-thickness stroma is reached. After excision of excess ectatic stroma, if necessary, the normal-thickness stroma is then sutured together, primarily with 9-0 Prolene. The sutures are left in place permanently, and the remaining refractive error is corrected with spectacles or contact lenses. This technique substantially improved visual acuity in three of four patients and decreased corneal astigmatism in all four. Although one eye required resuturing, there were no complications in any case.     

Terrien's marginal degeneration: case reports and literature review

Terrien's marginal degeneration (TMD) is a rare, bilateral, asymmetric disease of unknown aetiology. The peripheral cornea, predominantly superiorly, undergoes lipid deposition, vascularisation, opacification and stromal dunning leading to ‘gutter’ formation, ectasia and eventual corneal perforation. Two cases are presented which demonstrate the typical clinical features of die various stages of this disease. The disease process and its spectrum of presentation are reviewed. Differential diagnosis and management of TMD are discussed witfi particular reference to computerised corneal topographical analysis, which has a limited role for diagnosis but is valuable for monitoring disease progression.     

Corneal hydrops in Terrien's marginal degeneration: an unusual complication

Spontaneous rupture of Descemet's membrane occurred in a 76-year-old woman with a 20-year history of Terrien's marginal degeneration. This resulted in corneal hydrops characterized by a clear cystic space filled with aqueous humour that formed between the epithelium and Descemet's membrane. This case represents an unusual complication of Terrien's marginal degeneration.     

角膜后弹力层剥除内皮移植术治疗大泡性角膜病变的初步疗效观察

目的 探讨角膜后弹力层剥除内皮移植手术的适应证、手术方法以及对大泡性角膜病变的疗效与并发症的处理.方法 非随机回顾性系列病例研究.选择2006年9月至2007年10月于中山大学中山眼科中心住院的8例(8只眼)大泡性角膜病变患者行角膜后弹力层剥除内皮移植术.术中剥除患眼角膜中央部直径7.75 mm的后弹力层和病变的内皮层,再将植床周边部基质表面刮粗糙,然后按常规角膜内皮移植术的方法植入内皮植片.术后观察植片与植床贴合和植片移位等情况.随访3～9个月,记录患者视力、植片透明度、角膜散光及内皮细胞密度.结果 8例患者术后植片与植床贴合良好,未出现植片移位.术后第1天,1例患者出现继发性闭角型青光眼,术后48 h后缓解.8例患者术后植片透明,术前存在眼痛的6例患者术后眼痛缓解.8例患者术后视力均提高,最好矫正视力为0.3～0.7,平均角膜散光度数为(1.90±0.70)D,平均内皮细胞密度为(2014±192)个/mm2.结论 与深板层角膜内皮移植术比较,角膜后弹力层剥除内皮移植术的操作较简单,对受体角膜和前房的创伤更小.术中将植床周边部基质表面刮粗糙,可有效预防术后植片移位.     

Treatment of an 8-mm Myxoma Using Acellular Corneal Tissue

A myxoma is a benign tumor found in the heart and in various soft tissues; however, a corneal myxoma is rare. A mucinous mass of unknown etiology was observed on the left cornea of a 32-year-old male patient. We performed deep anterior lamellar keratoplasty using acellular corneal tissue and concurrent amniotic membrane transplantation. Hematoxylin and eosin staining revealed vacuolation of the parenchyma and myxoid change in the corneal tissue that occurred in the anterior half of the corneal parenchyma. We identified a myxoid stroma by Alcian blue staining and observed collagen fibers with denatured stroma by Masson trichrome staining. The patient''s visual acuity improved from light perception to 20 / 200, and the intraocular pressure remained within the normal range for one year after surgery. The transplanted cornea survived successfully with well-maintained transparency, and recurrence was not observed one year after surgery.     

Comparison of Clinical Outcomes of Same-size Grafting between Deep Anterior Lamellar Keratoplasty and Penetrating Keratoplasty for Keratoconus

Purpose

To compare the clinical outcomes between deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP) with same-size grafts in patients with keratoconus.

Methods

Medical records of 16 eyes from 15 patients treated from June 2005 through April 2011 were retrospectively reviewed. Patients with contact lens intolerance or who were poor candidates for contact lens fitting due to advanced cone underwent keratoplasty. The transplantations consisted of 11 DALK and 5 PKP with same-size grafting for keratoconus. Best-corrected visual acuity (BCVA), refractive error, corneal topographic profiling, and clinical course were compared between DALK and PKP groups.

Results

The follow-up period was 30 ± 17 months in the DALK group and 45 ± 20 months in the PKP group (p = 0.145). At final follow-up, the DALK and PKP groups achieved a BCVA (logarithm of the minimum angle of resolution) of 0.34 and 0.52, respectively (p = 0.980). Postoperative refractive error and mean simulated keratometric index showed myopic astigmatism in both groups without any statistical difference. Corneal irregularity index measured at 5 mm in the DALK group was less than that of the PKP group at 1-year follow-up (p = 0.021); however, at final follow-up, there was no longer a statistically significant difference. Endothelial cell counts were lower in the PKP group than in the DALK group at final follow-up (p = 0.021).

Conclusions

The optical outcomes of DALK with same-size grafts for keratoconus are comparable to those of PKP. Endothelial cell counts are more stable in DALK compared to PKP.     

Terrien角膜边缘退行性变56例的临床特征分析

目的：分析Terrien角膜边缘退行性变（ TMD）的临床特征。方法：选取我院2013－01／2015－01收治的56例90眼TMD患者作为观察组,选取同期进行眼角膜健康检查的健康人56例88眼作为对照组,分析Terrien角膜边缘退行性变患者的临床特征,使用免疫组织化学术及酶联免疫法（ELISA）对两组研究对象血液中HLA－DR、HLA－DQ以及肿瘤坏死因子－α（ tumor necrosis factor－α,TNF－α）的表达量进行分析。结果：TMD患者早期、进展期、膨隆期、穿孔期的眼部透光程度、脂质沉积程度有统计学差异（χ2＝10．85、65.32,均P＜0．05）;TMD患者早期、进展期、膨隆期、穿孔期的眼部散光有统计学差异（ P＜0．05）;观察组患者的炎性因子TNF－α的表达量显著高于对照组,差异有统计学意义（t＝19.86,P＜0．05）;HLA－DQ、HLA－DR表达差异有统计学意义（ t＝23．564、45．326,均P＜0．05）。结论：Terrien角膜边缘退行性变是一种以外周血TNF－α升高,伴有HLA－DQ、HLA－DR水平增高,以眼透明度下降,散光及脂质沉着为主要临床特征的炎症性病变,本研究为进一步解释Terrien角膜边缘退行性变发病机制提供试验依据。