中西医结合治疗角膜内皮炎

中西医结合治疗角膜内皮炎上海市第四人民医院（２０００８１）庄小平角膜内皮炎在临床较少见，原因不明，其主要特征为急性周边部的角膜基质水肿与角膜后壁散在或缘状沉着物，国外Ｋｈｏｄａｄｏｕｓｔ与Ｓｕｔｃｌｉｅｆｆ等（２）先后作了报导，孙秉基也报导了２例，笔...     

角膜内皮炎

角膜内皮炎是原发于角膜内皮的炎症导致角膜功能障碍。临床上常以角膜水肿、角膜后沉着物(KP)和轻度前房反应为特点。近20余年来,国内外报道了各种形式的角膜内皮炎,也赋予它多种名称,如自身免疫性角膜内皮病、急性特发性角膜内皮炎、进展性疱疹病毒性角膜内皮炎、疱疹     

带状疱疹性角膜内皮炎

带状疱疹性角膜内皮炎与自身免疫现象或疱疹病毒感染有关,临床上以深基质层水肿及角膜后沉着物为其特征,皮质类固醇治疗获较好效果。     

角膜内皮炎误诊的临床探讨

目的:分析角膜内皮炎的病因,探讨其临床误诊的原因及治疗要点。方法:回顾分析7例临床上被误诊的角膜内皮炎,包括发病诱因、临床表现及治疗。结果:误诊为结角膜炎2例,误诊为急性闭角型青光眼、青光眼睫状体炎综合症、白内障囊外摘除人工晶体植入术后炎症反应、盘状角膜基质炎、虹膜睫状体炎各1例。经治疗7例痊愈,其中1例复发。结论:角膜内皮炎病因尚不明确,正确掌握本病特征及鉴别诊断要点和认真详细地检查病人,可及时地做出正确诊断。临床治愈后,继续维持治疗4wk以上,可降低复发率。     

病毒性角膜内皮炎的诊治探讨

病毒性角膜内皮炎并不少见,但因对其临床表现认识不足,误诊、漏诊病例屡见不鲜.角膜内皮炎常由单纯疱疹病毒、带状疱疹病毒感染所致.临床分为三种类型：盘状角膜内皮炎、弥漫性角膜内皮炎和线状角膜内皮炎.临床表现为病变部位角膜水肿,水肿部位羊脂状KP,当合并小梁网炎时伴有眼压升高,临床上常与青光眼-睫状体炎综合征相混淆.治疗关键点是抗病毒和抗炎,正确合理地使用抗病毒药和皮质类固醇激素类药物非常重要.用药的方法分为全身用药和局部用药.大部分患者眼局部用药是主要的给药途径,对于部分反复发作和病情严重的患者可考虑全身给药.皮质类固醇激素应用的浓度和频度要根据患者的病情而定,但基本原则是在足量应用全身和局部抗病毒药的基础上选择生物利用率高的皮质类固醇激素,将炎症迅速控制后逐渐减量,缓慢停药.     

角膜内皮炎

自1982年Khodadoust和Attarzadch[1]首次报道角膜内皮炎以来,人们发现临床上角膜内皮炎并非少见,其特征为:睫状充血;角膜内皮局限性或弥漫性水肿、混浊;角膜基质、上皮水肿,有时出现大泡;后弹力层粗大皱褶;角膜后沉积物(keratic precipitates,KP);可伴虹睫炎,瞳孔可有后粘连;部分患者眼压高;可复发,也可发生于术后.     

病毒性角膜内皮炎的临床辨析与治疗

病毒性角膜内皮炎是导致角膜内皮功能失代偿的常见病因, 其临床表现具有多样性、复杂性, 易导致误诊和漏诊。本文以《中国病毒性角膜内皮炎诊疗专家共识(2023年)》为基础, 对病毒性角膜内皮炎的分类、临床特征、影像学诊断、分子生物学及免疫学诊断要点、鉴别诊断以及治疗方案进行详细阐述, 以期为临床工作提供参考。     

角膜内皮炎60例疗效分析

目的 探讨局部抗病毒及激素药物治疗对不同类型角膜内皮炎的疗效.设计前瞻性病例系列.研究对象江苏大学附属人民医院眼科2008年1月到2010年6月间收治的角膜内皮炎患者60例.方法 60例角膜内皮炎患者包括盘状型、弥漫型和线状型,随机分为局部药物治疗组和局部联合全身药物治疗组,局部药物治疗组应用更昔洛韦眼用凝胶和妥布霉素...     

线状角膜内皮炎

线状角膜内皮炎重庆第三军医大学西南医院眼科许立军，戴一华线状角膜内皮炎是一种具有特征性的角膜内皮炎，目前对其病因尚无定论。主要临床特点是角膜内皮炎症局限于某一象限、角膜后沉着呈线状、周围角膜水肿。目前，国内外眼科文献共报道了１７例（２２眼），治疗结果...     

避免角膜内皮炎的误诊

角膜内皮炎在临床并非少见。由于对本病的认识不足及缺乏特异性的临床检测手段，临床误诊的病例时有发生。目前，对角膜内皮炎临床特征的认识及详细询问病史可能是避免角膜内皮炎误诊的最重要手段。     

Relationship Between Corneal Hysteresis and Corneal Resistance Factor with Other Ocular Parameters

Abstract

Purpose: To evaluate the relationship between corneal hysteresis (CH) and corneal resistance factor (CRF) with age, central corneal thickness (CCT), corneal curvature (KM), corneal volume (CV), and refractive error in naïve eyes. Methods: 105 healthy subjects (58 male and 47 female) were included in this study. The ages ranged from 19 to 82 years (mean 43.1?±?15.4 years) and refraction between ?11?D and +6?D (mean ?0.79?±?2.95?D). CH and CRF obtained with the Ocular Response Analyzer (ORA) were correlated with age, refractive error, Goldmann Applanation Tonometry (GAT), and with CCT, KM, CV obtained with the Pentacam, and with Corneal-Compensated Intraocular Pressure (IOPcc) and Goldmann-correlated intraocular pressure measurement (IOPg) obtained with ORA. A multivariable mixed effect model was used to evaluate associations among these parameters. Results: CH ranged from 6.9 to 14.6?mmHg (mean 10.26?±?1.49?mmHg); CRF ranged from 5.8 to 17?mmHg (mean 10.38?±?1.64?mmHg). Multivariate analysis showed a statistically significant correlation between CH with CCT (p?<?0.001), and KM (p?<?0.001), and between CRF with CCT (p?<?0.001) and GAT (p?<?0.001). Conclusions: Our findings support the hypothesis that CH and CRF are related to the corneal shape and thickness, and show a decrease of CH with age.     

A case of congenital corneal anesthesia with hypopyon in china

 PURPOSE: To report a case of congenital corneal anesthesia (CCA) associated with hypopyon and tactile hypoesthesia. METHODS: Case report. RESULTS: A 3-year-old girl presented with redness and mild photophobia in the left eye accompanied by corneal ulcer, hypopyon, and corneal neovascularization. Corneal sensation was reduced bilaterally. She exhibited an absence of normal response to painful stimuli. She also had extensive ulceration of the lateral borders and tip of the tongue. The left corneal biopsy revealed negative cultures for bacteria and fungi. She was treated with human amniotic membrane transplantation in the left eye. The response to treatment was good. CONCLUSION: This is the first case of CCA reported in China. CCA is often misdiagnosed as infectious keratitis. Amniotic membrane transplantation is effective in repairing the severe corneal ulcer which may be associated with CCA.     

Biomechanics and structure of the cornea: implications and association with corneal disorders

Recent studies have shown that alterations in corneal biomechanical properties are associated with corneal pathologies, particularly corneal ectasia. Moreover, these alterations may have implications with regard to the outcomes of therapeutic modalities and corneal refractive surgeries. We address corneal anatomy and its relevance to corneal biomechanical characteristics, as well as ocular and systemic conditions associated with changes in corneal biomechanics.     

A new multiple noncontinuous puncture (pointage) technique for corneal tattooing

AIM:To assess the safety and cosmetic efficacy of a new multiple noncontinuous transepithelial puncture technique for tattooing a decompensated cornea.METHODS:It was anon-comparative clinical case series study.The study examines 33 eyes in 33 patients with total corneal opacity due to corneal decompensation, which developed following intraocular surgery.Corneal tattooing was performed using the multiple noncontinuous transepithelial puncture technique (i.e. pointage). The safety of this new surgical strategy was assessed by occurrence of adverse events for the follow-up period. The cosmetic efficacy was determined by the patient’s cosmetic satisfaction and independent observer’s opinion about patient appearance.RESULTS:Seven women and 26 men were included in the study. The mean age was 46.4±17.5y (range:7-67). In total, 30 of 33 patients (91%) reported cosmetic satisfaction within the follow-up period. Only 3 patients (9%) required additional tattooing due to cosmetic unsatisfaction. Cosmetic outcomes were analyzed and classified as excellent or good in 13 (39%) and 17 (52%) patients, respectively. No serious adverse events developed, except delayed epithelial healing in 3 cases.CONCLUSION:The cosmetic outcomes of the multiple noncontinuous transepithelial puncture technique for corneal tattooing were good. The safety of this method is higher than conventional procedures. This new procedure also provides improved cost-effectiveness and safety over current corneal tattooing techniques.     

Anterior amorphous corneal opacity and corneal thinning

PurposeTo present the clinical features of four cases with bilateral anterior amorphous corneal opacity.MethodsA retrospective study in four patients with bilateral anterior amorphous corneal opacity was conducted. Examinations included visual acuity, keratometry, slit-lamp biomicroscopy, confocal microscopy, anterior segment optical coherence topography, and histology.ResultsThree female and one male patients (mean age, 52.3 ± 8.9 years) showed bilaterally oval, amorphous sheetlike corneal opacities with central depression and thinning. Superior limbal opacities were observed in two of these patients. The best-corrected visual acuity ranged from 20/50 to 20/400, and the mean of the keratometry was 39.81 ± 3.97 D (diopters). They had mild dry eyes. The anterior segment optical coherence topography demonstrated hyporeflective abnormalities in the anterior depressed stroma in these four patients. Confocal microscopy revealed large round cells at the epithelial layer in one patient, and amorphous opacities with some strand-shaped opacities in the anterior stroma in all four patients. The mean of the corneal endothelial cells density in the eight eyes was 1521 ± 402 cells/mm². Central corneal stromalysis occurred in three patients, and descemetocele developed in two eyes. One patient received penetrating keratoplasty and two underwent lamellar keratoplasty. The histology of the corneal specimen revealed edematous basal epithelial cells, focal collagen disorganization in the thin stroma, and wartlike excrescences in a thickened Descemet's membrane.ConclusionAnterior amorphous corneal opacity is a rare keratopathy and may be one kind of rare corneal degeneration or dystrophy. Corneal stromalysis may occur in hyporefrective amorphous opacities and progress to descemetocele.     

过夜配戴角膜矫形镜(OK镜)后角膜曲率及厚度变化

目的了解过夜配戴角膜矫形镜(OK镜)后早期角膜曲率、角膜厚度及屈光度的变化.方法14个中低度近视患者(平均屈光度-3.89±1.26D)25眼,随机分成2组分别配戴Dk值不同的角膜矫形镜BE角膜矫形镜组(7人12眼,Dk≈140);E&E角膜矫形镜组(7人13眼,Dk＝58).采用夜戴方式,平均配戴时间10.76±1.27小时.用Orbscan角膜地形图系统检查配戴1晚后角膜曲率、角膜厚度的改变.同时记录裸眼视力及屈光度的改变.结果配戴1晚后所有患者的中央及周边的角膜均增厚(P＜0.05).Orbscan角膜地形图SimK值在垂直轴及水平轴均变平(垂直轴△SimK0.94±0.56D,P＜0.001;水平轴△SimK0.996=0.68D,P＜0.001).裸眼视力平均提高0.4±0.24(P＜0.001).屈光度平均减少-1.85±0.82D(P＜0.001).Dk值不同的2组之间中央及颞上方位点角膜增厚程度的差别有统计学意义.结论过夜配戴角膜矫形镜后减低近视屈光度的效果明显.初次过夜配戴角膜矫形镜可导致角膜厚度轻度增加.     

角膜基质透镜在角膜溃疡或穿孔修复中的应用

目的：研究由全飞秒激光SMILE手术所得的角膜基质透镜作为角膜移植材料治疗角膜溃疡的临床疗效。

方法：回顾性病例研究。收集本院2017-01/06角膜溃疡患者6例6眼,其中细菌性、真菌性、深层异物伴感染各1例1眼,角膜穿孔3例3眼。采用由全飞秒激光SMILE手术所得的角膜基质透镜作为角膜移植的材料进行修复手术,确保植片与角膜层间无空气间隙。术后随访1～6(平均3.71±1.56)mo,观察手术前后视力、角膜移植物存活情况及术后并发症发生情况等。

结果：所有患者均在控制感染下顺利完成手术,无术中并发症。术后所有角膜植片透明。末次随访时,患者最佳矫正视力(best corrected visual acuity,BCVA)较术前明显改善(0.48±0.12 vs 1.50±0.08),差异具有统计学意义(P<0.01)。

结论：来源于全飞秒激光屈光手术的角膜基质透镜用于角膜溃疡修复是安全有效的,但植片的远期疗效尚需进一步观察。     

美容性角膜覆盖术疗效观察

目的:评价美容性角膜覆盖术治疗角膜(角巩膜)葡萄肿的临床效果。方法:对22例角膜(角巩膜)葡萄肿患者进行了美容性角膜覆盖术治疗。术后对所有病例的临床效果进行了随访观察。结果:22例均治愈,残留部分视力的2例的视力术后有所改善(2例2眼从术前手动/眼前到术后指数/眼前)。22例无1例发生排斥,角膜覆盖片的颜色除第1例因缺乏经验术眼的颜色明显深于对侧正常或正常人群眼的颜色外,其它无1例褪色。结论:应用角膜覆盖术治疗角膜(角巩膜)葡萄肿22例(22眼)临床证明疗效确实、安全可靠。     

使用猪角膜脱细胞基质的人板层角膜移植治疗真菌性角膜炎的临床观察

目的:观察猪角膜脱细胞基质构建的生物角膜支架用于人角膜板层移植术治疗药物难以控制的浅层真菌性角膜炎的效果.方法:对2015-06/2016-03我院收治的16例16眼真菌性角膜炎患者的临床资料进行回顾性分析.16例真菌性角膜炎进行猪角膜脱细胞基质移植,术后随访6mo.对患者术后视力、角膜植片情况、并发症及复发情况进行分析.结果:术后7~10d植片角膜上皮化.16例病例术后1mo角膜水肿,1mo后角膜水肿消失,角膜逐渐透明.术后1mo有2例出现术眼角膜上皮缺损,药物治疗均恢复.术后出现眼压高3例,给予降眼压治疗后眼压控制.随访期间未出现角膜溶解、感染复发、排斥现象.术后1、3、6mo视力分别为1.27±0.22,1.11±0.13,0.79±0.22,术后视力均较术前明显提高,术后1mo视力与术前相比无统计学差异(P=0.06),术后3、6mo视力与术前相比具有明显统计学差异(P=0.01、0.001);其中术后3mo与术后1mo视力相比无明显提高,结果无统计学差异(P=0.11),而术后6mo视力较术后1、3mo均有明显提高,结果具有显著统计学差异(P<0.001).结论:猪角膜脱细胞基质移植治疗真菌性角膜炎是安全、有效的方法.