结膜松弛症的临床及病理研究

目的探讨结膜松弛症的临床特征及组织病理学改变。方法收集结膜松弛症患者26例（39只眼）的相关临床资料,并进行回顾性分析;对患病组26例（39只眼）结膜松弛症患者松弛结膜组织和对照组15例（15只眼）单纯白内障患者球结膜组织进行病理组织学检查,对照观察两组样本组织病理改变。结果结膜松弛症患者多为中老年人,性别比较差异无显著性,均为双眼发病,均有溢泪与干眼症状,不同程度的多余球结膜堆积于下眼睑与眼球之间,泪膜破裂时间（BUT）〈3S,角膜荧光素染色阳性。组织病理学改变：对照组有14只眼为正常的结膜改变,患病组39只眼中有16只眼为慢性非肉芽肿性结膜炎,17只眼为弹性组织变性。结论结膜松弛症患者多为中老年人,主要表现为溢泪与干眼症状,选择合适的手术可以有效的改善患者的病情;其主要病理改变为弹性组织变性,慢性非肉芽肿性结膜炎及炎性细胞浸润等。     

New surgical treatment for superior limbic keratoconjunctivitis and its association with conjunctivochalasis

PURPOSE: To introduce a new surgical procedure for treating superior limbic keratoconjunctivitis (SLK) and to suggest the association of SLK with conjunctivochalasis. DESIGN: Interventional case series. METHODS: Six eyes of five patients with long-standing severe ocular irritation unresponsive to treatment with topical steroid and artificial tears were operated on using our new procedure. This technique consists of four steps as follows: (1) Rose bengal (RB) staining is used to localize the abnormal conjunctival area; (2) an arc-like conjunctival incision is placed from the 2 to the 10 o'clock position adjacent and distal to the RB-stained area; (3) the conjunctiva is resected to form a crescent using the arc-like incision as the base; the size of the resection is determined by conjunctival redundancy after removal of the subconjunctival connective tissue; and (4) the crescent conjunctival opening is closed with interrupted sutures. In two eyes, the new surgical procedure was performed together with surgery for inferior bulbar conjunctivochalasis. RESULTS: In all operated eyes, RB staining had disappeared by the end of the second postoperative week; recovery from symptoms and loss of inflammation were recorded by 1 month after treatment. In the case with the longest follow-up (14 months), there was cytologic evidence of goblet cell recovery at 3 months after the operation. In another, there was normalization of the nucleo/cytoplasmic ratio of conjunctival cells without the appearance of goblet cells. CONCLUSIONS: Our treatment very effectively resolved symptoms associated with SLK, even in eyes unresponsive to conventional therapy with eye drops. Considering that we did not address the diseased part of the conjunctiva but rather the adjacent conjunctival redundancy, we propose that superior bulbar conjunctivochalasis is involved in the pathogenesis of SLK.     

角膜缘干细胞移植术治疗双侧翼状胬肉的疗效

目的：观察自体角膜缘干细胞移植术(LCAT)治疗双侧翼状胬肉的临床效果。

方法：前瞻性病例研究。收集2014-01/2015-07在解放军第四七四医院诊断为双侧翼状胬肉患者46例54眼,其中双眼双侧胬肉8例16眼,一眼双侧胬肉一眼鼻侧胬肉11例11眼(仅纳入双侧胬肉眼作为研究对象),单眼双侧胬肉27例27眼,均采用鼻侧翼状胬肉切除联合同眼上方LCAT,而颞侧翼状胬肉切除联合对侧眼下方LCAT。术后1、7d,1mo,1a复查,复查时完成视力、裂隙灯等检查,观察术后并发症及翼状胬肉复发情况。

结果：完成1a随访患者共44例52眼,失访2例2眼。术后1a复发3例3眼(6%),鼻侧翼状胬肉复发2眼,颞侧翼状胬肉复发1眼。未见其它术后并发症。

结论：鼻侧翼状胬肉切除联合同眼上方LCAT,同时颞侧翼状胬肉切除联合对侧眼下方LCAT治疗双侧翼状胬肉安全有效,复发率低。     

Superficial conjunctiva cauterization to reduce moderate conjunctivochalasis

AIM: We report here a simple surgical approach to reduce moderate conjunctivochalasis. PATIENTS AND METHODS: A non-comparative prospective interventional case series study of fifteen consecutive patients with moderate conjunctivochalasis was carried out. On the inferior bulbar conjunctiva 10 to 20 superficial burns were performed with an electrical bipolar cauter to reduce moderate conjunctivochalasis. Before and around a mean time of six months after surgery digital photographs of the conjunctivochalasis were taken at the slit lamp. The maximal height of the conjunctivochalasis above the lower eyelid margin measured before surgery was compared with the height of the conjunctivochalasis measured after surgery around the same location (one eye per patient). RESULTS: In each patient, gentle and superficial cauterization induced contraction of the bulbar conjunctiva and reduction of the conjunctivochalasis. No complications were noted during or after the procedure. Mean (+/- SD) maximal conjunctivochalasis height above the lower eyelid margin was higher before (2.3 +/- 0.9 mm) than after surgery (0.8 +/- 0.6 mm). Preoperative values of conjunctivochalasis height were significantly (p < 0.001) different from the postoperative ones (Wilcoxon rank signed test). CONCLUSIONS: Gentle superficial cauterization of the inferior bulbar conjunctiva can induced significant reduction of a moderate conjunctivochalasis.     

The punctal apposition syndrome: a new surgical approach

AIMS: To assess the punctal apposition syndrome (PAS) and its response to lateral canthal tendon (LCT) repair. METHODS: In this retrospective, interventional case series, five patients (seven symptomatic eyes) with PAS were managed. Lateral canthal tendon repair was performed in all seven eyes. The main outcome measure was correction of watery eye symptomatology. RESULTS: All five patients achieved symptomatic resolution. Conjunctivochalasis and functional nasolacrimal duct obstruction were associated with the PAS. CONCLUSION: This new surgical approach to the PAS, using a LCT repair, was successful in all patients. Two patients (three eyes) required conjunctivochalasis excision.     

结膜乳头状瘤和尖锐湿疣18例分析

目的：分析和探讨结膜乳头状瘤、结膜尖锐湿疣的发病特点、临床与病理特征、治疗方法及预后。方法：回顾性总结、分析18例21眼眼结膜乳头状瘤、尖锐湿疣感染者的临床和病理资料。结果：经病理证实，系鳞状细胞乳头状瘤者15例18眼，结膜尖锐湿疣者3例3眼；除1个瘤体位于外眦部球结膜，6个位于上、下方睑结膜，1个位于下泪小管外，其余18个瘤体均位于内眦部球结膜、睑结膜、泪阜等处；患者行瘤体切除联合热灼术后随访时间为6个月～3年，平均2．1年，无复发者20眼，复发1眼。结论：结膜乳头状瘤、结膜尖锐湿疣好发于眼内眦部，表现为结膜尖锐湿疣者不容忽视，瘤体切除联合热灼术是有效的治疗方法。     

A new surgical technique for management of conjunctivochalasis

PURPOSE: To present a new surgical technique for severe, symptomatic conjunctivochalasis and our hypothesis of the pathogenesis of this condition. METHODS: Six eyes of three patients with conjunctivochalasis (average age +/-SD, 70.0 +/- 9.6 years; range, 56-78 years) were treated with a conjunctival fixation to sclera with three 6-0 Vicryl (Johnson & Johnson, New Brunswick, New Jersey) stitches. RESULTS: With a mean follow-up period of 209.5 days (range, 181-219 days), we achieved successful treatment in all eyes, with no recurrence of conjunctival folds. CONCLUSION: We successfully treated conjunctivochalasis with conjunctival fixation to sclera, which strongly suggests that conjuctival folds are caused by the folding and the elevating of loosely adherent bulbar conjunctiva of the lower eyelid.     

Methicillin-Resistant Staphylococcus aureus and Methicillin-Resistant Coagulase-Negative Staphylococci From Conjunctivas of Preoperative Patients

To evaluate the incidence and characteristics of carriers of conjunctival methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococci (MRCNS) among preoperative patients at an eye clinic, bacterial growth was studied in 978 conjunctival specimens of 628 preoperative patients without signs of ocular infection. Specimens were evaluated for growth of bacteria on nutrient agar plate, blood agar plate, or chocolate agar plate for 2 days at 37°C. Methicillin resistance was confirmed by disk diffusion and agar screening methods. Susceptibilities of the bacterial strain to ampicillin (ABPC), cefazolin (CEZ), minocycline (MINO), gentamicin (GM), erythromycin (EM), vancomycin (VCM), and ofloxacin (OFLX) were determined by the disk diffusion method. Of the 628 patients (978 eyes), 352 patients (580 eyes) had positive bacterial growth. Among them, 8 (13 eyes) had MRSA growth and 2 (4 eyes) had MRCNS growth. The rate of nasolacrimal duct obstruction was significantly higher in eyes with positive bacterial growth than in eyes with negative growth. Of the 10 patients (17 eyes) with MRSA or MRCNS growth, 8 were older than 80 years, 5 had the same bacterial strains in the anterior nares and throat, 6 had nasolacrimal duct obstruction, 3 had dry eye, and 9 had been recently hospitalized. All 10 bacterial strains were resistant to ABPC, CEZ, and EM, but were sensitive to MINO and OFLX. Five strains were resistant and 5 were sensitive to GM. Two strains examined were sensitive to VCM. After topical antibiotic use for 0.5 to 6 months, the bacterial strains were eliminated. Two of the 17 eyes with MRSA or MRCNS growth did not undergo surgery. No postoperative endophthalmitis developed in 976 of the 978 eyes. Ophthalmologists should be aware that about 50% of preoperative patients without signs of ocular infection may have bacterial growth on the conjunctiva, and that elderly patients with nasolacrimal duct obstruction, dry eye, and recent hospital stays may be carriers of MRSA or MRCNS.     

上海市曹杨新村街道60岁及以上人群结膜松弛症流行病学调查

目的 探讨上海市曹杨新村街道≥60岁人群结膜松弛症的患病情况及其相关因素.方法 采用以社区为基础的横断面调查方法.于2008年9月至10月间采用整群随机抽样方法在上海市曹杨新村街道抽取调查点5个,对其中≥60岁2225名老年人进行调查,询问病史,采用裂隙灯显微镜进行眼部检查,并确立结膜松弛症的诊断.正式调查前先进行预试验,并进行保证调查质量的重复性检验.应用SPSS 10.0软件建立数据库,采用卡方检验完成调查数据统计分析.结果 应调查2225人,实际调查2110人,受检率为94.85%,其中确诊为结膜松弛症930例(1762只眼),人群患病率占44.08%.随着年龄增大,结膜松弛症患病率逐渐增高(χ2=10.44,P<0.01).结膜松弛症Ⅰ级556例943只眼占患眼53.52%,Ⅱ级246例647只眼占患眼36.72%,Ⅲ级120例162只眼占患眼9.19%,Ⅳ级8例10只眼占患眼0.57%.患眼组视物模糊、视疲劳、疼痛症状发生比例分别为43.02%、10.73%、9.02%,明显高于非患病组37.02%、6.79%、5.49%,差异有统计学意义(χ2值分别为15.44、20.54和19.74,P值均<0.01).松弛结膜堆积于下眼睑部位最多见于鼻侧和颞侧(944只眼,占患眼53.58%).患病眼的下睑缘位置最多见为角膜缘上型(2589只眼,占61.35%),下睑缘张力分类多为内翻型、内倾型(分别占7.04%和6.63%).患病眼泪河异常的比例(87.23%)明显高于非患病眼(24.49%)(χ2=1615.81,P<0.01).结论 结膜松弛症是年龄相关性眼病,伴有明显的眼表损伤症状、体征和泪液异常.在社区人群中,结膜松弛症多为轻度的Ⅰ级和Ⅱ级,下睑缘的位置和张力是影响结膜松弛症患病的重要因素.     

Tear meniscus measurement in nasolacrimal duct obstruction patients with Fourier‐domain optical coherence tomography: novel three‐point capture method

Purpose: Fourier‐domain optical coherence tomography (FD ODT) for the evaluation of marginal tear film has not been performed in patients with watery eye or in a controlled study. We used FD OCT to evaluate the height of the lower lid tear film at three points in normal adults and compared it with two watery eye groups. Methods: We prospectively evaluated with FD OCT 25 normal subjects and 44 patients with a watery eye. Twenty‐three patients with primary acquired nasolacrimal duct obstruction (PANDO) and 21 patients with functional nasolacrimal duct obstruction (FNLDO) were enrolled. Three images were obtained by three vertical FD OCT scans centred on the lower eyelid and inferior cornea, the medial limbus and the lateral limbus. The tear meniscus height (TMH), tear meniscus depth (TMD) and tear meniscus area (TMA) were measured with computer calipers and compared at three points between the two groups. Results: Watery eyes have significantly greater median TMHs at three points (medial: 584 μm, central: 592 μm, lateral: 470 μm) than controls (274, 291, 205 μm, p < 0.001). Medial and central TMHs were higher than lateral TMH in controls and watery eyes. TMD and TMA also increased significantly in watery eyes (p < 0.001). There was a significant increase in central TMH compared to medial TMH in FNLDOs than in PANDOs (p < 0.05). Conclusion: Fourier‐domain OCT is a valuable clinical tool in the evaluation of TMH in normal and watery eyes. TMH at three points can be a useful clinical parameter that investigates changes of lower tear meniscus pattern in both PANDO and FNLDO groups.     

Conjunctival resection combined with tenon layer excision and the involvement of mast cells in superior limbic keratoconjunctivitis

PURPOSE: To evaluate the effectiveness of conjunctival resection combined with Tenon layer excision in treating superior limbic keratoconjunctivitis (SLK) and the involvement of mast cells in SLK. DESIGN: Retrospective, interventional case series. METHODS: Forty eyes of 30 SLK patients who were unresponsive to medical treatment received superior bulbar conjunctival resection, and another 20 patients who underwent cataract and retinal surgery served as a control group. The conjunctiva specimens from study and control patients were examined by hematoxylin and eosin staining and immunohistochemistry using antibodies against mast cell tryptase. RESULTS: In all operated eyes, the clinical symptoms and signs, including irritation and redness and superior bulbar conjunctival hyperemia and superior tarsal conjunctival papillary hypertrophy, subsided significantly three months after the operation. Only three eyes had recurrence from the margin of conjunctival resection, and this was relieved after reoperation. Keratinized conjunctival epithelium, loss of goblet cells, and increased mast cell numbers (P<.05) were found in the SLK group. CONCLUSIONS: Our cases demonstrate that superior bulbar conjunctival resection combined with Tenon layer excision is an effective treatment for SLK. The pathologic findings suggest that mast cells may play a role in the pathogenesis of SLK.     

Gastric adenocarcinoma presenting as an eyelid and conjunctival mass.

A 50-year-old white man complained of "inflammation" of his right eyelid since January 1989. In June 1990, he had undergone a gastrectomy for an adenocarcinoma of the stomach. In August 1990, his right eye showed a painless, firm infiltration of the upper and lower lid, ulceration and loss of eyelashes of the upper lid and a reddish, subepithelial thickening of the medial bulbar conjunctiva. Biopsies of the right upper lid and nasal bulbar conjunctiva disclosed a metastatic, poorly differentiated adenocarcinoma of the stomach (signet ring cell carcinoma) both in the lid and conjunctival biopsies. Carcinoembryonic antigen (CEA) was detected in the tumor cells. Electron microscopic examination revealed tumor cells with signs of secretory activity. Although metastases to the eyelids and conjunctiva are rare, they may precede the clinical manifestation of the primary tumor for months or even years. In patients with chronic, recalcitrant lesions of eyelids or conjunctiva, especially if accompanied by loss of eyelashes, a primary or secondary malignancy should be excluded by early biopsies and histopathological examination.     

A case of conjunctival malignant melanoma treated with subconjunctival injection of interferon beta--efficacy and side effects

BACKGROUND: The management of conjunctival malignant melanoma remains controversial. Interferon-beta (IFN-beta) is a well-known antineoplastic agent against cutaneous malignant melanoma. CASE: A 44-year-old man was referred to Kobe University, Hospital for treatment of pigmented lesions in the corneal limbus of his right eye, first recognized in 2000 and growing gradually. FINDINGS: There were two pigmentary neoplastic lesions in the conjunctiva of his right eye, one at 9 o'clock in the limbus and the other at the inferior bulbar conjunctiva close to the fornix. Primary acquired melanosis (PAM) extended widely over the bulbar conjunctiva and the corneal surface. These findings led to the clinical diagnosis of conjunctival malignant melanoma. Systemic work-up did not detect any other neoplastic lesion. COURSE: The melanotic lesions were resected and histopathologically malignant melanoma was diagnosed. Microscopically, the tumor cells were present at the surgical margin. Melanoma recurred a half-year later at 3 o'clock in the limbus of the right eye. IFN-beta (3 million units/) was injected subconjunctivally 22 times. Side effects observed were as follows: corneal epithelial erosion, increase of the corneal thickness, lid swelling, conjunctival congestion, subconjunctival hemorrhage, and liver dysfunction. These findings were transient. Melanotic lesions, including PAM, diminished 6 months after the end of treatment. CONCLUSION: This therapeutic trial of local therapy using the subconjunctival administration of IFN-beta demonstrated excellent efficacy for the treatment of conjunctival malignant melanoma. Local and systemic side effects were seen, though transient, suggesting the necessity of long-term follow-up study.     

Clinicopathologic analysis of conjunctivochalasis and paste-pinch-cut conjunctivoplasty for management

ObjectiveTo correlate the histopathologic results of conjunctival specimens with clinical findings in patients with conjunctivochalasis and report the results of the paste-pinch-cut technique for management.Design: Retrospective chart review.SettingSingle tertiary ophthalmological centre (Ocular Surface Diseases and Dry Eye Clinic, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Md.).MethodsTwenty-five patients (32 eyes) with clinically significant conjunctivochalasis. All patients were referred for clinically significant dry eye without previous diagnosis of chalasis. Sixteen patients had an underlying inflammatory systemic condition. Intervention or Observation Procedure(s): Patients underwent surgery with paste-pinch-cut technique. Subjective dry eye symptoms and ocular surface staining scores (corneal and conjunctival staining using fluorescein and lissamine green respectively) were assessed at every visit.Main Outcome MeasuresChange in patient symptoms and ocular surface staining scores and histopathologic findings in conjunctival specimens.ResultsAfter surgery, significant improvement was achieved in dry-eye symptoms as well as both corneal and conjunctival staining scores in 29 eyes on reduced topical therapy. Only 3 eyes had persisting conjunctival lissamine staining. Light microscopic examination disclosed mild to moderate lymphoplasmocytic inflammation of the conjunctivae with areas of epithelial goblet cell loss, squamous metaplasia, stromal edema, and fibrosis.ConclusionConjunctivochalasis appears to be associated with significant inflammation in the setting of dry eye and underlying inflammatory systemic conditions. Although topical anti-inflammatory treatment could be attempted in the initial management, surgical excision should be considered in the absence of clinical response.     

眼睑重叠综合征的诊断和治疗

目的探讨眼睑重叠综合征的诊断和治疗。方法收集了2001年1月至2004年12月在我院就诊的18例患者,详细询问病史,进行裂隙灯显微镜检查、SchirmerI试验、泪膜破裂时间(BUT)检查、虎红眼表染色,并统计分析患者的临床资料。结果所有患者上睑缘附近的睑结膜均有不同程度的染色,13例患者角膜和球结膜不同程度的虎红染色,SchirmerI试验(7.3±1.5)mm,BUT为(1.3±2.0)s,2例患者发生持续性角膜上皮缺损。所有患者均给予人工泪液和凝胶,分泌物多者加用抗生素眼膏,两例患者进行了上睑水平缩短术。结论EIS是一种少见的上睑重叠于下睑表面的位置异常,虎红着染上睑缘周围的睑结膜有助于其诊断,常伴有干眼,主要给予人工泪液治疗,无效时手术缩短上睑。     

Amniotic membrane transplantation for symptomatic conjunctivochalasis refractory to medical treatments

PURPOSE. To determine whether preserved human amniotic membrane can restore the large conjunctival defect created during surgical removal of conjunctivochalasis. METHODS: Amniotic membrane transplantation was performed at two facilities in 40 consecutive patients (47 eyes) with symptomatic conjunctivochalasis refractory to conventional treatments. RESULTS: The majority of patients were elderly (73.1 +/- 9.7 years) and women (75%). Over a follow-up period of 6.9 +/- 4.3 months, 46 (97.8%) eyes recovered smooth, quiet, and stable conjunctival surfaces. Epithelial defects healed in 16.5 +/- 7.3 days. Episodic epiphora was resolved in 24 of 30 (83.3%) eyes and improved in five other eyes. Notable relief was also noted for such symptoms as fullness or heaviness (19/19, 100%), sharp pain (6/6, 100%), redness (14/17, 88.2%), tiredness (17/20, 80.9%), itching (11/13, 78.6%), blurry or decreased vision (6/8, 75%), burning (8/13, 61.5%), foreign body sensation (8/13, 61.5%), and crust formation (1/2, 50%). Complications included focal inflammation of the host conjunctiva adjacent to the graft (six eyes), scar formation (five eyes), and suture-induced granuloma (one eye). CONCLUSION: Amniotic membrane transplantation can be considered as an effective means for conjunctival surface reconstruction during removal of conjunctivochalasis.     

首发于眼结膜的淋巴瘤MRI特征分析

目的 分析眼结膜淋巴瘤影像学表现,了解其MRI特征。设计 回顾性病例系列。研究对象 首诊于北京同仁医院眼科的21例眼结膜淋巴瘤患者。方法 分析21例患者临床表现、MRI影像学特征和病理诊断。主要指标 眼结膜淋巴瘤原发部位、范围及MRI特征。结果 21例（25眼）患者中,病变位于上睑结膜4眼,下睑结膜7眼,上下睑结膜同时受累14眼;病变局限于结膜或眼睑19眼,侵及眼眶6眼（2眼累及肌锥外间隙、眼外肌和泪腺,3眼累及眼上肌群,1眼累及Tenon囊及视神经）;边界欠清晰15眼,清晰10眼;17眼病变包绕眼球生长,8眼表现为眼球前部结节影。与眼外肌相比,所有病变T1WI均显示等信号,T2WI 18眼显示等信号,7眼显示稍高信号;18眼信号均匀,7眼不均匀或欠均匀。13例（15眼）进行增强扫描的病变均呈轻至中度强化,强化均匀8眼,不均匀7眼。7例（8眼）行动态增强扫描的病变,动态增强曲线表现为平台型6眼,流出型2眼。结论 眼结膜淋巴瘤MRI特征是呈等T1等或稍高T2信号,信号多均匀,增强呈轻中度强化,动态增强曲线呈平台型。（眼科,2013, 22：320-323）     

Conjunctival cytologic features of primary Sj?gren's syndrome.

To determine whether there are specific cytologic features associated with primary Sj?gren's syndrome (SS), the authors evaluated impression cytology specimens from three conjunctival sites (temporal bulbar [TB], inferior bulbar [IB], and inferior tarsal [IT]) from 38 SS eyes, 34 eyes of aqueous tear-deficient patients without SS, 35 eyes of seborrheic blepharitis patients, and 17 eyes of normal controls in a masked fashion. The following features were observed more frequently in SS eyes than in the eyes of the other groups: squamous metaplasia of the TB and IB (P less than 0.05), extensive (greater than 75%) goblet cell loss of the TB (P less than 0.05), mucous aggregates of the bulbar conjunctiva (P less than 0.05), and inflammatory cells intercalated with epithelial cells on the IT conjunctiva (P less than 0.06). The conjunctival inflammatory cell infiltrate correlated with the presence of extensive squamous metaplasia (P less than 0.01) in SS specimens. The inflammatory cells on the IT conjunctival epithelium were found to consist predominantly of T-lymphocytes by immunofluorescent staining of cytologic specimens from six eyes. Based on these findings, the authors speculated that conjunctival squamous metaplasia, in addition to aqueous tear deficiency, may be due to primary involvement of the dysfunctional immune system of SS.     

Effects of sequential artificial tear and cyclosporine emulsion therapy on conjunctival goblet cell density and transforming growth factor-beta2 production

PURPOSE: To evaluate the effects of sequential treatment with artificial tears and cyclosporine emulsion on conjunctival goblet cell density and production of transforming growth factor (TGF)-beta2 in patients with dry eye disease. METHODS: Patients with dry eye disease (N = 6) defined by an Ocular Surface Disease Index symptom score >or=25, Schirmer test 1 <10 mm, and corneal fluorescein and conjunctival lissamine green staining scores >or=3 were treated with artificial tears (Refresh Plus; Allergan, Irvine, CA) 4 times a day for 4 weeks, followed by 0.05% cyclosporine emulsion (Restasis; Allergan) twice a day for 12 weeks. Impression cytology was performed on the bulbar conjunctiva of both eyes at baseline, after artificial tear therapy, and after 6 and 12 weeks of cyclosporine therapy. Goblet cells were counted in 5 representative microscopic fields per membrane in those taken from the temporal and inferior bulbar conjunctiva of the worse eye, and membranes taken from the fellow eye were immunostained for TGF-beta2. RESULTS: There were no differences in mean goblet cell density between baseline and 4 weeks of artificial tears in the temporal and inferior bulbar specimens. After 6 weeks of cyclosporine emulsion, goblet cell density was significantly greater than baseline and artificial tears in the inferior bulbar conjunctiva (P < 0.01). After 12 weeks of cyclosporine emulsion, goblet cell density was significantly greater than baseline and artificial tears in both temporal and inferior bulbar sites (P < 0.01). The number of TGF-beta2-positive goblet cells was also noted to increase after 6 and 12 weeks of cyclosporine therapy (P < 0.001). CONCLUSIONS: Cyclosporine emulsion, but not artificial tears, increases goblet cell density and production of the immunoregulatory factor TGF-beta2 in the bulbar conjunctiva in patients with dry eye.     

结膜松弛症术后干眼改变

目的探讨结膜松弛症术后的泪液学变化。方法对29例（32眼）结膜松弛症新月形球结膜切除,分别于术前和术后3个月进行症状评估、裂隙灯显微镜检查、泪河观察、SchirmerI试验、泪膜破裂时间（BUT）、眼表荧光素染色、以及泪液清除率（TCR）对比分析。结果症状改善者29眼（90．63％）,泪河高度恢复正常28眼（87．50％）,Schirmer I试验手术前后差异无统计学意义（P〉0．05）,BUT和眼表荧光素染色评分术后较术前差异有统计学意义（P〈0．05）,荧光素清除试验恢复正常31眼（96．88％）。结论手术切除松弛多余结膜组织可以明显改善结膜松弛症的干眼症状以及泪液动力学改变。