深低温保存羊膜在结膜重建中的临床应用

目的：评价深低温保存羊膜移植进行结膜重建的手术疗效，并分析羊膜移植结膜重建手术成功的基本条件和具体手术方法与操作要点。方法：用深低温保存的羊膜治疗43例结膜整形患者。无眼球结膜囊狭窄10例，大面积结膜肿瘤13例，睑球粘连9例，复发性胬肉7例，并尝试对少数病例（4例）义眼座暴露，进行羊膜修补。结果：随诊6－18个月，总治愈率达88．64％，无眼球结膜囊狭窄的治愈率为80％，睑球粘连的治愈率达88．89％，大面积结膜肿瘤和复发性胬肉的治愈率皆为100％，而应用深低温保存羊膜修补义眼座暴露，治愈率只有50％，结论：深低温保存的羊膜是一种有良好发展前景的生物材料，羊膜移植结膜重建术后整形外观良好，在具体实践中，结膜重建的手术效果不仅与羊膜的制备和保存有关，而且受手术方法的选择，手术操作技巧以及术后处理的强烈影响。     

深低温保存羊膜治疗严重睑球粘连的临床观察

目的:探讨深低温保存羊膜移植治疗严重睑球粘连的临床价值。方法:对43例46眼有严重睑球粘连及假性胬肉的患者,进行睑球粘连松解后,应用羊膜移植重建球结膜和角膜表面,观察其临床效果。结果:在随访期内(平均13±3.5mo),24例患者疗效为优,眼睑球粘连均得到明显改善,眼表基本恢复正常;15例疗效为良,睑球粘连部分复发,但较术前有所改善;7例因上下睑球全粘连、结膜囊闭锁愈后效果较差。结论:对于严重的睑球粘连,深低温保存羊膜移植重建眼表是较理想的治疗方法。     

甘油保存羊膜在结膜重建中的临床应用

目的：分析甘油保存羊膜移植重建结膜的基本条件和手术方法，并评价手术疗效。 方法：对11例不同眼部疾病患者采用甘油保存人羊膜进行移植手术以重建结膜。其中4例为无眼球结膜囊狭窄，2例为眼球萎缩结膜囊狭窄，1例为大面积结膜肿瘤，2例为眼球粘连，2例为下眼睑基底细胞痛。 结果：在11例中无1例感染，10d后移植的羊膜透明，缝合处结膜向羊膜上爬行，lmo后新牛的结膜上皮完全覆盖移植区，3mo后2例眼球粘连患者重新出现不同程度的睑球粘连，治疗率为91％。 结论：甘油保存人羊膜移植手术可有效重建结膜，但其基本条件为受体眼有一定量的健康球结膜及有血液供应的植床与羊膜植片紧密贴附。     

羊膜移植治疗严重眼烧伤后的睑球粘连

目的:探讨羊膜移植在治疗严重眼烧伤后的睑球粘连眼表成型中的方法及效果。方法:化学烧伤或热烧伤后结膜囊狭窄、睑球粘连、结角膜假性胬肉等引起眼表变形、泪液动力学改变、眼球运动障碍等患者应用羊膜移植行结膜囊重建及眼表成型。结果:患者23例随访4～27mo,2例结角膜假性胬肉再次复发,但结膜囊缩短好转;4例轻度、2例中度结膜囊缩短;其余患者均能较好的重建眼表。结论:羊膜移植治疗严重眼烧伤后的睑球粘连眼表成型的效果良好。     

眼烧伤后重度睑球粘连眼表重建的临床研究

目的探讨新鲜供体带角膜缘板层角膜移植（LKP）联合带角膜缘干细胞自体球结膜移植和羊膜移植治疗眼烧伤后重度睑球粘连的眼表重建效果。方法选择1998年2月至2003年2月我院收治的眼烧伤后重度睑球粘连患者26例（26只眼）。根据视功能受损程度将睑球粘连分为4度．其中Ⅲ度19只眼、Ⅳ度7只眼。手术方法：（1）分离睑球粘连,保留假性胬肉;（2）利用新鲜供体行带角巩膜缘的部分LKP（19只眼）或全LKP（7只眼）;（3）取带角膜缘组织自体球结膜瓣移植于粘连最重的创面;（4）假性胬肉后徙,部分替代球结膜,联合羊膜移植重建结膜囊。术后随访8～36个月,观察结膜囊情况、眼球活动、角膜植片免疫排斥反应情况以及羊膜和假性胬肉的转归。结果除1只眼因睑裂闭合不全行永久性睑裂缝合术外,其余25只眼的眼表情况均得到不同程度改善。（1）睑球粘连：17只眼（65％）第一次手术后粘连完全分离,复视消失;8只眼（31％）在单纯羊膜覆盖的创面区复发条带状睑球粘连,其中5只眼经再次手术粘连完全解除,3只眼残余Ⅰ度粘连。（2）羊膜在术后1周开始自溶,3个月时完全消失;保留的假性胬肉术后1～3个月充血消退,逐渐变薄,相应区域无睑球粘连复发。（3）角膜情况：6只眼角膜植片发生免疫排斥反应,其中3只眼治疗后植片恢复透明,2只眼因植片混浊行二次LKP。结论新鲜供体带角膜缘LKP联合带角膜缘干细胞自体球结膜移植和羊膜移植是治疗眼烧伤后重度睑球粘连的有效方法,假性胬肉可部分替代球结膜重建结膜囊,羊膜移植在重度睑球粘连的治疗中仅发挥暂时支持创面促进眼表恢复的作用。（中华眼科杂志,2005,41：791-795）     

羊膜移植结膜囊再造治疗睑球粘连的临床观察

目的 观察和评价不同眼表疾病中羊膜移植结膜囊再造治疗睑球粘连的效果。方法 采用新鲜羊膜移植行结膜囊再造11例(11眼)。其中酸、碱、热灼伤及机械损伤所致睑球粘连6例(6眼)，复发性翼状胬肉睑球粘连5例(5眼)，其中2眼眼球活动受限。分别行粘连切除、羊膜移植及结膜囊再造术，术后随访6～11月。结果 11例中手术成功形成满意结膜囊8例。局部瘢痕粘连，但仍有正常深度结膜囊2例，结膜囊变浅l例。结论 新鲜羊膜取材方便，羊膜移植是行结膜囊再造治疗睑球粘连的有效方法。     

球结膜瓣移植联合羊膜移植治疗伴睑球粘连的复发性翼状胬肉

目的对伴睑球粘连的复发性翼状胬肉,行球结膜瓣移植联合羊膜移植治疗作回顾性分析。方法 30例伴睑球粘连的复发性翼状胬肉切除后,分离睑球粘连,创面行球结膜瓣移植联合羊膜移植,术后观察羊膜溶解及上皮修复情况。结果随访3-6月,2眼(6.7%)翼状胬肉复发,1眼(3.3%)睑球粘连复发。结论采用球结膜瓣移植联合羊膜移植治疗伴睑球粘连的复发性翼状胬肉,简单易行,成功率高。     

羊膜移植治疗眼表疾病的疗效观察

人羊膜作为植被和修补材料已在临床上广泛应用。人羊膜能促进结膜上变化,加速表面愈合,防止广泛结膜下纤维瘢痕化形成。些外,羊膜还具有很强的抗粘附效果,可预防睑球粘连等并发症的发生。我科自2003-02以来采用羊膜移植治疗翼状胬肉,睑球粘连及眼化学性烧伤致结膜囊狭窄等眼表疾患40例41眼,现总结如下。     

羊膜移植治疗严重结膜囊狭窄

目的 从临床角度探讨羊膜移植在严重结膜囊狭窄整形中的应用。方法 对11例严重的结膜囊狭窄患者在行结膜囊成形中，根据结膜缺损的范围取相当范围的羊膜铺于植床，形成新的球结膜、穹隆结膜甚至睑结膜。结果 11例中10例经一次手术、1例经二次手术后重建的结膜囊上皮化愈合，结膜囊大小、形态稳定。义眼安放合适。结论 在严重结膜囊狭窄手术修复中，用羊膜移植重建结膜囊，取材方便、手术安全、疗效可靠。     

多层羊膜移植用于眼窝重建术

目的 评价保存后的多层羊膜移植用于眼窝重建或结膜囊成形术的临床效果。方法 19例无眼球结膜囊狭窄患者行眼窝重建或结膜囊成形术，结膜缺损及眼窝重建用羊膜移植，术后4～6个月剪开睑裂，安装义眼，随访8—48个月。结果 19例均无继发感染及排斥反应，16例结膜囊形成良好，表面光滑红润，义眼植入后外观满意；3例重度结膜囊缩窄者，结膜囊虽形成，但羊膜已溶解，结膜囊仅部分上皮化，3—6个月后再次发生结膜囊收缩变浅。结论 保存后多层羊膜移植治疗结膜囊缩窄取材方便，疗效显著，但对严重缩窄者，效果欠佳。     

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.