春季结膜炎穹窿结膜的临床病理

证明春季结膜炎在穹窿结膜的临床病理。方法：详细记载球（角膜缘）、睑及穹窿结膜的临床表现;对３８眼（２１例）的穹窿结膜（上穹窿３４眼、下穹窿４眼）进行活检,组织切片ＨＥ染色,光学显微镜下观察病理改变。结果：结膜上皮不同程度增生,上皮下淋巴细胞、浆细胞浸润或胶元纤维增生,３８眼标本中３２眼有嗜酸性白细胞、１眼有嗜碱性白细胞浸润。一极轻病例双眼下穹窿结膜只有很少几个淋巴细胞,其中却散在个别嗜酸性白细胞。结论：春季结膜炎的临床病理改变包括穹窿结膜。     

结膜冷冻治疗春季卡他性结膜炎的疗效观察

目的:观察结膜冷冻术对春季卡他性结膜炎的疗效。方法:选取我院2008-10/2010-05收治的春季卡他性结膜炎患者80例160眼,分为A,B两组,每组40例80眼。A组采用结膜冷冻术联合妥布霉素地塞米松眼液点眼治疗;B组单纯采用妥布霉素地塞米松眼液治疗。治疗1,3mo;2a后观察并记录疗效及不良反应。治疗效果分为治愈、好转、无效。结果:A组在治疗1,3mo;2a后总有效率明显高于对照组,差异有统计学意义(P<0.05);不良反应A组7例,B组3例,两组无统计学差异(P>0.05)。结论:结膜冷冻术是一种有效的春季卡他性结膜炎的治疗方法。     

临床表现罕见的流行性角结膜炎1例：腺病毒角结膜上皮炎

腺病毒角结膜炎，由腺病毒血清型8，19，37引起。腺病毒结膜炎典型的体征包括耳前淋巴结病变，结膜充血水肿，结膜下出血，结膜滤泡。腺病毒角结膜炎角膜受累情况各不相同，多数患者有弥散的轻微的浅层角膜炎，局部隆起的点状上皮损害，随后形成上皮下混浊。我们报道一例罕见的腺病毒角结膜上皮炎，为临床表现特殊的流行性角结膜炎（EKC），并回顾相关特殊病例文献。患者，男，35岁，患腺病毒结膜炎，临床表现罕见，表现为角结膜上皮炎形式，这种病例文献未见报道。经过保守治疗患者痊愈。角结膜上皮炎可以是临床表现特殊的腺病毒角结膜炎。     

结膜瓣移植联合干扰素治疗复发性泡性角膜结膜炎

目的观察病变的结膜切除及结膜瓣移植术联合术中、术后应用干扰素治疗复发性泡性角膜结膜炎的临床疗效。方法10例复发性泡性角结膜炎,在显微镜下病变的结膜切除、结膜瓣移植联合应用干扰素。术后随访1年,观察临床疗效、复发率和并发症。结果10例术后效果均良好,无复发。结论病变的结膜切除、结膜移植联合干扰素治疗复发性泡性角膜结膜炎疗效显著。     

经巩膜固定结膜治疗结膜松弛症的疗效观察

目的 随访观察经巩膜固定结膜治疗结膜松弛症的手术效果.方法 手术治疗20例40眼,术后裂隙灯下观察结膜松弛情况,并进行泪膜破裂时间(BUT)、泪河检查和症状评估.结果 术后临床治愈36眼(90％),BUT≥10秒者28眼(70％),泪河连续完整者38眼(95％),自觉症状治愈或改善者37眼(92.5％),随访6-12月无一例复发,无一例并发症发生.结论 经巩膜固定结膜治疗结膜松弛症,效果良好稳定,操作简便,无并发症.     

睑结膜切除联合羊膜移植术在重度春季角结膜炎中的应用

目的 探讨睑结膜切除联合羊膜移植术,在重度春季角结膜炎中的治疗效果.方法 采用睑结膜切除联合羊膜移植术治疗严重春季结膜炎15例(23只眼),10d评价近期效果,随访观察3～6个月(平均4.2月),评价远期效果.结果 15例中13例(21只眼)当天眼痛消失,2例(2只眼)2d后消失.羊膜植片完整20只眼,3例(3只眼)羊膜部分溶解.2例(2只眼)再次手术后成功,1例(1只眼)复发,占4.35%.结论 采用睑结膜切除联合羊膜移植术是治疗重度春季角结膜炎一种有价值的方法.     

新型冠状病毒感染患者结膜充血是否一定与新型冠状病毒有关

本文于2020年4月14日优先发布于中华眼科杂志官网。目前常见将新型冠状病毒肺炎患者与其结膜充血等症状联系在一起, 并对传播途径或眼科高危病种及高危工作状态进行猜测的报道。新型冠状病毒感染患者出现结膜充血或与结膜相关的症状等, 一定与新型冠状病毒有关吗?本文指出结膜充血是各种类型结膜炎的共同临床体征之一, 新型冠状病毒感染患者出现结膜炎的症状和体征, 可能与多种因素相关, 因此不应在无证据的情况下, 将结膜症状与新型冠状病毒联系在一起。(中华眼科杂志, 2020, 56:571-572)     

临床表现罕见的流行性角结膜炎1例:腺病毒角结膜上皮炎(英文)

腺病毒角结膜炎,由腺病毒血清型8,19,37引起。腺病毒结膜炎典型的体征包括耳前淋巴结病变,结膜充血水肿,结膜下出血,结膜滤泡。腺病毒角结膜炎角膜受累情况各不相同,多数患者有弥散的轻微的浅层角膜炎,局部隆起的点状上皮损害,随后形成上皮下混浊。我们报道一例罕见的腺病毒角结膜上皮炎,为临床表现特殊的流行性角结膜炎(EKC),并回顾相关特殊病例文献。患者,男,35岁,患腺病毒结膜炎,临床表现罕见,表现为角结膜上皮炎形式,这种病例文献未见报道。经过保守治疗患者痊愈。角结膜上皮炎可以是临床表现特殊的腺病毒角结膜炎。     

警惕冠状病毒经眼传播

目前新型冠状病毒肺炎(COVID-19)疫情在中国湖北武汉快速传播,并引起了国际社会的广泛关注。目前有线索认为结膜可能是新型冠状病毒(SARS-CoV-2)感染的入口之一。但目前缺乏SARS-CoV-2眼部感染的临床观察资料,因此了解冠状病毒经眼传播的机制和细胞受体,了解其他同源病毒感染眼部的传播特征,有助于眼科医生在COVID-19防控工作中采取合理防护措施并及时识别与眼部体征并存的COVID-19。     

新型冠状病毒感染相关蛋白ACE2和TMPRSS2在人结膜组织中的表达及意义

目的探讨新型冠状病毒肺炎(COVID-19)病毒感染相关蛋白血管紧张素转换酶2(ACE2)和跨膜丝氨酸蛋白酶2(TMPRSS2)在人眼部结膜组织中的表达及其临床意义。方法收集2019年6月至2020年6月于西安市人民医院眼科手术切除的人体结膜组织标本50例, 包括正常结膜组织10例、结膜乳头状瘤组织15例、结膜色素痣组织15例和结膜囊肿10例, 并收集10例因外伤摘除眼球的角膜组织作为对照。采用免疫组织化学法对不同眼表组织标本中ACE2和TMPRSS2阳性表达进行定位, 并对其表达强度进行比较。结果 ACE2和TMPRSS2均表达于正常结膜上皮细胞、结膜乳头状瘤上皮细胞、结膜色素痣上皮细胞和结膜囊肿囊壁细胞中, ACE2主要表达于结膜上皮的表层细胞和中间层细胞, 在基底层细胞和杯状细胞不表达, TMPRSS2表达于全层细胞, 二者在结膜组织中的阳性表达率均为100%;ACE2和TMPRSS2在正常结膜组织、结膜乳头状瘤、结膜色素痣和结膜囊肿中的表达强度比较, 差异均无统计学意义(均P>0.05);ACE2和TMPRSS2在角膜组织中均为弱阳性表达, 二者在不同结膜组织中中度阳性和...     

Risk of SARS-CoV-2 virus transmission from donor corneal tissue: A review

Since the outbreak of respiratory coronavirus disease (COVID-19) caused by the coronavirus SARS-CoV-2, there is an ongoing discussion about whether the virus could be transmitted through corneal transplantation from donor to recipient. The purpose of this review was to summarize the current knowledge in the scientific community to provide aid in risk evaluation for potential virus transfer by corneal transplants. Literature was searched in PubMed.gov for relevant articles on coronavirus in conjunction with cornea processing, cornea transplantation and eye banking. Further, guidelines of health authorities and eye banking associations were reviewed. Studies have shown that SARS-CoV-2 RNA can be detected in ocular swabs and/or fluid of patients with COVID-19. However, the risk of SARS-CoV-2 virus transmission through these ocular tissues or fluid of patients is judged differently. To date, per literature and official guidelines, no evidence of viable virus in ocular tissue and no cases of transmission of SARS-CoV-2 via tissue preparations have been reported.     

Ocular Features and Associated Systemic Findings in SARS-CoV-2 Infection

ABSTRACT

Purposes

To describe the prevalence of ocular features among COVID-19 patients and their relationship with clinical data, inflammatory markers and respiratory support therapy (including CPAP); to investigate SARS-CoV-2 in ocular secretions of symptomatic patients.     

Insights on the possibility of SARS-CoV-2 transmission through the eyes

A novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or 2019-nCOV), causing coronavirus disease 2019 (COVID-19), has rapidly spread to most countries and regions worldwide since it broke out at the end of 2019. Epidemic of the virus produces a tremendous pressure on the global health systems. With progressive insight into SARS-CoV-2, the role of eye tissue has attracted wide attention in the spread of COVID-19. Whether SARS-CoV-2 can enter the human body through eyes and cause infection? The fact that unprotected exposure of the eyes to 2019-nCoV might have allowed the virus to infect the body implies that 2019-nCOV can invade eye tissue and set foot in organism. Facing the severe challenge of preventing spread of the COVID-19, combined with the high-risk environment of ophthalmology, it is crucial to investigate ocular tropism of coronavirus. This paper explores the possibility of coronavirus transmission through the eye from aspects of probable mechanisms, clinical cases, detection of coronavirus; and puts forward precautions for ophthalmologists and nurses. Consequently, this review reveals our understanding of ocular tropism of coronavirus and contributes to determining risk of ocular transmission, raising awareness of necessary eye protection among medical workers and reducing further prevalence of SARS-CoV-2.     

新型冠状病毒引起的病毒性角膜炎病例观察

目的：报告3例严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)引起的病毒性角膜炎。

方法：对3例新冠感染确诊患者行裂隙灯、眼压、角膜荧光染色、前段照相、活体共聚焦显微镜(IVCM)和常规眼底筛查。治疗包括更昔洛韦眼用凝胶、人工泪液和糖皮质激素滴眼液。

结果：3例SARS-CoV-2角膜炎(SCK)患者经标准治疗后恢复良好。

结论：SARS-CoV-2角膜炎通常表现为角膜上皮下浸润,可导致角膜上皮下神经纤维密度降低和树突状细胞(DC)增加。抗病毒治疗联合糖皮质激素已被证明是有效的。     

Expression of the SARS-CoV-2 Receptor ACE2 in Human Retina and Diabetes—Implications for Retinopathy

PurposeTo investigate the expression of angiotensin-converting enzyme 2 (ACE2), the receptor for SARS-CoV-2 in human retina.MethodsHuman post-mortem eyes from 13 non-diabetic control cases and 11 diabetic retinopathy cases were analyzed for the expression of ACE2. To compare the vascular ACE2 expression between different organs that involve in diabetes, the expression of ACE2 was investigated in renal specimens from nondiabetic and diabetic nephropathy patients. Expression of TMPRSS2, a cell-surface protease that facilitates SARS-CoV-2 entry, was also investigated in human nondiabetic retinas. Primary human retinal endothelial cells (HRECs) and primary human retinal pericytes (HRPCs) were further used to confirm the vascular ACE2 expression in human retina.ResultsWe found that ACE2 was expressed in multiple nonvascular neuroretinal cells, including the retinal ganglion cell layer, inner plexiform layer, inner nuclear layer, and photoreceptor outer segments in both nondiabetic and diabetic retinopathy specimens. Strikingly, we observed significantly more ACE2 positive vessels in the diabetic retinopathy specimens. By contrast, in another end-stage organ affected by diabetes, the kidney, ACE2 in nondiabetic and diabetic nephropathy showed apical expression of ACE2 tubular epithelial cells, but no endothelial expression in glomerular or peritubular capillaries. Western blot analysis of protein lysates from HRECs and HRPCs confirmed expression of ACE2. TMPRSS2 expression was present in multiple retinal neuronal cells, vascular and perivascular cells, and Müller glia.ConclusionsTogether, these results indicate that retina expresses ACE2 and TMPRSS2. Moreover, there are increased vascular ACE2 expression in diabetic retinopathy retinas.     

Prevalence of SARS-CoV-2 in human post-mortem ocular tissues

BackgroundSARS-CoV-2 is found in conjunctival swabs and tears of COVID-19 patients. However, the presence of SARS-CoV-2 has not been detected in the human eye to date. We undertook this study to analyze the prevalence of SARS-CoV-2 in human post-mortem ocular tissues.MethodsThe expression of SARS-CoV-2 RNA was assessed by RT-PCR in corneal and scleral tissues from 33 surgical-intended donors who were eliminated from a surgical use per Eye Bank Association of America (EBAA) donor screening guidelines or medical director review or positive COVID-19 test. Ocular levels of SARS-CoV-2 RNA (RT-PCR), Envelope and Spike proteins (immunohistochemistry) and anti-SARS-CoV-2 IgG and IgM antibodies (ELISA) in blood were evaluated in additional 10 research-intent COVID-19 positive donors.FindingsOf 132 ocular tissues from 33 surgical-intended donors, the positivity rate for SARS-CoV-2 RNA was ~13% (17/132). Of 10 COVID-19 donors, six had PCR positive post-mortem nasopharyngeal swabs whereas eight exhibited positive post-mortem anti-SARS-CoV-2 IgG levels. Among 20 eyes recovered from 10 COVID-19 donors: three conjunctival, one anterior corneal, five posterior corneal, and three vitreous swabs tested positive for SARS-CoV-2 RNA. SARS-CoV-2 spike and envelope proteins were detected in epithelial layer of the corneas that were procured without Povidone-Iodine (PVP–I) disinfection.InterpretationsOur study showed a small but noteworthy prevalence of SARS-CoV-2 in ocular tissues from COVID-19 donors. These findings underscore the criticality of donor screening guidelines, post-mortem nasopharyngeal PCR testing and PVP-I disinfection protocol to eliminate any tissue harboring SARS-CoV-2 being used for corneal transplantation.     

Fulminant fungal endogenous endophthalmitis following SARS-CoV-2 infection: A case report

Systemic corticosteroids and immunocompromised state following SARS-CoV-2 infection can predispose individuals to endogenous endophthalmitis. A 66-year-old gentleman presented with complaints of diminution of vision and redness one week post discharge after hospitalization for COVID-19 infection. Clinical examination suggested fulminant endogenous endophthalmitis which responded poorly even after aggressive treatment requiring evisceration. Culture and gene sequenced analysis confirmed Aspergillus fumigatus to be the causative organism. A high degree of suspicion is warranted in the presence of recent onset of floaters in COVID-19-infected individuals to facilitate early diagnosis and outcomes.     

从SARS冠状病毒探讨新型冠状病毒眼途径传播的可能机制

新型冠状病毒(SARS-CoV-2)自2019-12爆发以来,传播速度极快,了解其流行病学特征,尤其是切断传播途径对于控制疾病传播至关重要。在传播途径的研究中,SARS-CoV-2是否通过眼表组织进行传播的问题也引起关注,但目前尚缺乏其通过眼表组织感染的临床确诊病例和实验室证据。最新研究认为SARS-CoV-2与SARS冠状病毒(SARS-CoV)属于同一种属,并且其与SARS-CoV进入细胞的途径是一样的。本文通过回顾SARS-CoV的研究,探讨SARS-CoV-2眼途径传播的可能机制。     

The evidence of SARS-CoV-2 infection on ocular surface

This is a cross-sectional study of patients who received a COVID-19 diagnosis between December 30, 2019 and February 7, 2020 at Tongji Hospital. A total of 102 patients (48 Male [47%] and 54 Female [53%]) with clinical symptoms, Rt, and chest Computed Tomography (CT) abnormalities were identified with a clinical diagnosis of COVID-19. Patients had a mean [SD] gestational age of 57.63 [14.90] years. Of a total of 102 patients identified, 72 patients (36 men [50%] and 36 women [50%]; mean [SD] age, 58.68 [14.81] years) were confirmed to have COVID-19 by laboratory diagnosis with a SARS-CoV-2 RT-PCR assay. Only two patients (2.78%) with conjunctivitis were identified from 72 patients with a laboratory confirmed COVID-19. Of those two patients, SARS-CoV-2 RNA fragments were found in ocular discharges by SARS-CoV-2 RT-PCR in only one patient. Our findings suspect the incidence of SARS-CoV-2 infection through the ocular surface is extremely low, while the nosocomial infection of SARS-CoV-2 through the eyes after occupational exposure is a potential route. To lower the SARS-CoV-2 nosocomial infection, all health care professionals should wear protective goggles. The inefficient diagnostic method and the sampling time lag may contribute to the lower positive rate of conjunctival swab samples of SARS-CoV-2.