生物羊膜联合带自体角膜缘干细胞的结膜瓣移植治疗伴睑球粘连的复发性翼状胬肉

目的:观察生物羊膜联合带自体角膜缘干细胞的结膜瓣移植治疗伴睑球粘连的复发性翼状胬肉的临床效果。方法:将68例76眼伴睑球粘连的复发性翼状胬肉患者按年龄、性别、翼状胬肉大小、睑球粘连程度分为A,B两组,A组30例34眼为翼状胬肉切除加生物羊膜移植组,B组38例42眼为翼状胬肉切除加生物羊膜联合带自体角膜缘干细胞的结膜瓣移植组。术后随访6～24mo。观察角膜透明程度,新生血管的有无,胬肉复发及睑球粘连复发情况。结果:A组有不同程度角膜云翳21眼(62%),其中9眼(26%)伴新生血管,4眼(12%)胬肉复发,1例睑球粘连复发。B组有不同程度角膜云翳9眼(21%),其中3眼(7%)伴新生血管,2眼(5%)胬肉复发,无睑球粘连复发患者。两组比较有角膜云翳及新生血管的发生率有显著性差异,复发率无显著性差异。结论:生物羊膜联合带自体角膜缘干细胞的结膜瓣移植治疗伴睑球粘连的复发性翼状胬肉是一种较理想的治疗方法。     

自体角膜缘干细胞移植联合羊膜移植治疗复发性翼状胬肉

目的 观察自体角膜缘干细胞移植联合羊膜移植治疗复发性翼状胬肉及合并睑球粘连等并发症的疗效。方法 对25例(27只眼)复发性翼状胬肉,其中,5例(6只眼)并发睑球粘连,1例(1只眼)合并上皮囊肿,施行复发性翼状胬肉切除、睑球粘连分离、囊肿切除联合自体角膜缘干细胞移植及羊膜移植术,术后随访(18.76±8.05)月,观察眼表上皮修复、炎症反应、新生血管、视力等。结果 角膜上皮愈合时间为(3.03±0.46)天,无睑球粘连及上皮囊肿再发,翼状胬肉复发7.41％(2／27),视力提高74.07％(20／27),症状改善88.89％(24／27)。结论自体角膜缘干细胞移植联合羊膜移植能够有效重建眼表,修复角膜缘缺损,改善角膜缘基质微环境,促进上皮修复,是治疗角膜缘干细胞功能衰竭、减少复发性翼状胬肉再发的良好方法。     

自体带结膜瓣角膜缘干细胞移植联合羊膜移植治疗复发性翼状胬肉

目的:降低翼状胬肉术后复发率,减少术后并发症。方法:采用自体带结膜瓣的角膜缘干细胞移植联合羊膜移植治疗26例(26眼)复发性翼状胬肉患者。结果:在26眼中显效25眼,复发1眼,有效率为96%。结论:采用自体带结膜瓣角膜缘干细胞移植联合羊膜移植,可有效维持角膜上皮与结膜上皮之间的屏障途径,阻止结膜上皮长入和新生血管形成,并使结膜下成纤维增殖抑制,睑球粘连松解,从而降低翼状胬肉术后复发率,减少术后并发症。     

角膜缘干细胞移植联合羊膜移植治疗复发性翼状胬肉睑球粘连

目的:回顾性分析2002-01/2005-01在我院接受治疗复发性翼状胬肉合并睑球粘连的32例患者,探讨角膜缘干细胞移植联合羊膜移植治疗复发性翼状胬肉合并睑球粘连的效果.方法:复发性翼状胬肉合并睑球粘连的32例患者中12例接受了翼状胬肉切除 丝裂霉素 睑球粘连分离术,20例接受了翼状胬肉切除 睑球粘连分离 角膜缘干细胞移植 羊膜移植术.结果:接受翼状胬肉切除 丝裂霉素 睑球粘连分离术的12例患者中,术后6例翼状胬肉、睑球粘连复发;接受翼状胬肉切除 睑球粘连分离 角膜缘干细胞移植 羊膜移植术的20例患者中,术后2例患者翼状胬肉、睑球粘连复发.结论:接受翼状胬肉切除 睑球粘连分离 角膜缘干细胞移植 羊膜移植术术后复发率低,术后刺激症状较轻,翼状胬肉切除 睑球粘连分离 角膜缘干细胞移植 羊膜移植术是治疗复发性翼状胬肉合并睑球粘连的理想方法.     

羊膜移植联合带结膜瓣自体角膜缘移植及丝裂霉素C治疗多次复发性翼状胬肉

目的：探讨羊膜移植(AMT)联合带结膜瓣的自体角膜缘移植及术中应用丝裂霉素c(MMc)治疗多次复发性翼状胬肉的疗效。方法：选择多次复发性翼状胬肉20例，进行复发翼状胬肉局部切除，放置丝裂霉素c后取患眼或对侧健眼带结膜瓣的自体角膜缘进行移植，其余缺损部分应用羊膜进行修补。结果：其中19例翼状胬肉未见复发，20例羊膜无排斥反应发生，睑球粘连患者恢复眼球运动功能，复视消失，部分患者视力提高。结论：羊膜移植联合带结膜瓣的自体角膜缘移植及术中应用丝裂霉素c治疗多次复发性翼状胬肉效果良好。     

两种手术方式治疗复发性翼状胬肉伴睑球粘连的疗效对比

目的:角膜缘干细胞移植与羊膜移植治疗复发性翼状胬肉伴睑球粘连的疗效分析。方法:复发性翼状胬肉伴睑球粘连患者80例。按照随机方式分为翼状胬肉切除术联合角膜缘干细胞移植、翼状胬肉切除联合羊膜移植组,每组40例。术后随访6mo,观察翼状胬肉及睑球粘连的复发率。结果:角膜缘干细胞移植组有2例复发(5%),羊膜移植组有8例复发(20%),两组比较有统计学意义(P<0.05)。结论:两种术式均能显著降低复发性翼状胬肉术后复发率,但角膜缘干细胞移植术后复发率更低。     

人羊膜联合自体角膜缘移植治疗复发性翼状胬肉

目的 探讨人羊膜联合自体角膜缘移植治疗复发性翼状胬肉的临床效果。方法 采用甘油保存或新鲜的人羊膜移植联合自体角膜移植对36例39眼复发性翼状胬肉患者进行治疗,术后随访6个月至4年。结果 角膜上皮均于2周内完全愈合。2例2眼胬肉复发,复发率5．6％。3例3眼发生小柱状睑球粘连,其中1眼下穹隆结膜囊轻度变浅。结论 人羊膜联合自体角膜缘移植术抑制了结膜下纤维组织增生。重建角膜缘部屏障功能,能有效治疗复发性翼状胬肉。     

羊膜和角膜干细胞移植治疗眼表疾病临床观察

目的探讨羊膜移植、自体角膜干细胞移植及自体体外培养角膜干细胞移植重建眼表治疗眼表疾病的疗效。方法眼表疾病43例46眼（瘢痕性结膜囊狭窄、睑球粘连6例6眼，角结膜化学、热烧伤10例13眼，原发和复发性翼状胬肉切除术后结膜缺损27例27眼）进行羊膜移植、自体角膜干细胞移植及自体体外培养角膜干细胞移植，观察植片及角结膜上皮愈合、组织浸润和新生血管情况。结果羊膜移植术重建结膜囊效果满意，睑球粘连松解。羊膜、自体体外培养角膜干细胞移植术治疗角结膜烧伤均可使眼表上皮化，基质炎性浸润减轻，新生血管明显减少；自体体外培养角膜干细胞移植对角膜缘干细胞损伤严重的患者效果显著。自体和自体体外培养角膜干细胞移植治疗翼状胬肉均有良好效果，术后不适症状轻时间短，角膜创面愈合快，随访（1～2）y两种术式各复发1眼。自体体外培养角膜干细胞移植对复发性翼状胬肉切除术后较大的结膜缺损更为适合。结论羊膜移植、自体角膜干细胞移植和自体体外培养角膜干细胞移植对重建眼表都有重要的功效，手术方式的选择必须根据角膜干细胞损伤的程度、范围进行选择。     

聚四氟乙烯联合角膜缘干细胞移植治疗复发性翼状胬肉并睑球粘连

目的:探讨聚四氟乙烯联合角膜缘干细胞移植治疗复发性翼状胬肉合并睑球粘连的临床效果。方法:回顾分析2005-01/2008-08在我院接受治疗复发性翼状胬肉合并睑球粘连的62例患者中,20例接受了翼状胬肉切除+睑球粘连分离+结膜瓣移植术,42例接受了翼状胬肉切除+睑球粘连分离+聚四氟乙烯联合角膜缘干细胞移植术。结果:接受翼状胬肉切除+睑球粘连分离+结膜瓣移植术的20例患者中,术后6例翼状胬肉复发,其中4例再次睑球粘连;接受翼状胬肉切除+睑球粘连分离+聚四氟乙烯联合角膜缘干细胞移植术的42例患者翼状胬肉中2例翼状胬肉复发,无1例睑球粘连。结论:翼状胬肉切除+睑球粘连分离+聚四氟乙烯联合角膜缘干细胞移植术是治疗复发性翼状胬肉合并睑球粘连的理想方法。     

翼状胬肉上结膜反向移植联合羊膜移植治疗复发胬肉

目的：观察胬肉上结膜反向移植联合羊膜移植治疗复发性翼状胬肉的疗效。

方法：回顾性系列病例研究。回顾2009-01/2012-01本院确诊的复发性翼状胬肉26例26眼,均为经历一次手术,手术方法为翼状胬肉切除联合自体角膜缘干细胞移植术,复发1a以上病例。本次研究中,切除胬肉组织时,将其上结膜充分游离后切下保存,羊膜覆盖胬肉切除后裸露巩膜面,再将保留的胬肉上的结膜植片反向覆盖羊膜上缝合。术后1,2wk; 1mo及3mo观察结膜植片愈合情况、羊膜溶解吸收时间、角膜创面修复时间、角膜新生血管及胬肉复发率。术后随访12mo。

结果：结膜植片愈合时间6.03±2.76d,羊膜溶解吸收时间14.26±3.64d,角膜创面修复时间5.42±1.58d。术后3mo,胬肉切除后裸露巩膜面新生结膜及结膜植片愈合良好,无明显胬肉术后并发症。术后1a,再度复发2例,复发率8%,治愈率92%。

结论：对于复发性翼状胬肉,因传统自体角膜缘干细胞移植已经创伤部分角膜缘及眼表结膜瘢痕,单纯结膜移植,或单纯羊膜移植,术后胬肉复发率偏高,本方法取胬肉上结膜反向移植,避免大面积创伤眼表,取材容易,而且良好控制术后翼状胬肉复发问题,不失为一种解决复发性翼状胬肉的良好选择。     

Strabisme Alternant - Etude clinique - traitement

The author defines motor and sensory alternation: the term alternation should not be used in isolation, it should always be accompanied by the name of the parameter concerned. Sensory alternation is always found together with motor alternation but the reverse is not true.The examining criteria for a diagnosis of sensory alternation are given, sensory alternation must not be confused with alternating inhibition. Working from clinical observations of cases of motor alternating strabismus, the author selects 2 types of binocular sensory relations which allow one to differentiate between:- cases of primary alternating strabismus- cases of secondary alternating strabismusThese forms will develop in different ways; in both cases a cure is possible providing that the right treatment is prescribed and once prescribed carefully followed, etc. It is always a case of serious forms of strabismus whose developmental period is spread over several years.According to the authors, the frequency of cases of true primary strabismus is from 1–3%, the frequency of cases of secondary alternating strabismus varies according to the type of therapy practised on cases of monocular strabismus with amblyopia. These latter will become cases of alternating strabismus under the influence of certain types of therapy carried out over several years (penalization, rocking, alternated occlusion, etc...).Experimental data on kittens confirm clinical data; kittens placed in abnormal environments during the sensitive period will show modification in the distribution of cortical cells and the absence of binocular cells (either because the excitation of the two eyes was not simultaneous, or not identical: artificial strabismus, occlusion, opaque glasses). This disturbances become irreversible after a certain period of exposure (a function of age, length of exposure, etc...).It is thus necessary to bear in mind: 1) the iatrogenic risks of certain orthoptic treatments, 2) the necessity for a binocular form of treatment as soon as possible, as once a certain stage is passed, cortical plasticity diminishes and the elaboration of normal binocular relations becomes impossible.

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Effects of Adenosine Agonists on Intraocular Pressure and Aqueous Humor Dynamics in Cynomolgus Monkeys

The effects of single or multiple topical doses of the relatively selective A₁adenosine receptor agonists (R)-phenylisopropyladenosine (R-PIA) and N⁶-cyclohexyladenosine (CHA) on intraocular pressure (IOP), aqueous humor flow (AHF) and outflow facility were investigated in ocular normotensive cynomolgus monkeys. IOP and AHF were determined, under ketamine anesthesia, by Goldmann applanation tonometry and fluorophotometry, respectively. Total outflow facility was determined by anterior chamber perfusion under pentobarbital anesthesia. A single unilateral topical application of R-PIA (20–250 μg) or CHA (20–500 μg) produced ocular hypertension (maximum rise=4.9 or 3.5 mmHg) within 30 min, followed by ocular hypotension (maximum fall=2.1 or 3.6 mmHg) from 2–6 hr. The relatively selective adenosine A₂antagonist 3,7-dimethyl-1-propargylxanthine (DMPX, 320 μg) inhibited the early hypertension, without influencing the hypotension. Neither 100 μg R-PIA nor 500 μg CHA clearly altered AHF. Total outflow facility was increased by 71% 3 hr after 100 μg R-PIA. In conclusion, the early ocular hypertension produced by topical adenosine agonists in cynomolgus monkeys is associated with the activation of adenosine A₂receptors, while the subsequent hypotension appears to be mediated by adenosine A₁receptors and results primarily from increased outflow facility.