大鼠角膜移植术后植片内颗粒酶B和穿孔素的表达

目的观察大鼠角膜移植术后植片内穿孔素(PFP)和颗粒酶B(GrB)的表达情况。方法以Wister大鼠为供体,SD大鼠为受体,常规行穿透角膜移植术,裂隙灯观察移植排斥情况。分别于移植术后第3、7、14、21d取角膜植片,HE染色及免疫组织化学方法检测植片内PFP和GrB的表达。结果角膜移植术后(7.63±0.74)d出现排斥反应。免疫组织化学结果可见,PFP、GrB阳性染色为棕色,表达于淋巴细胞、中性粒细胞及单核吞噬细胞的胞浆。当被分泌出后多分布于角膜上皮细胞间隙和细胞膜,正常角膜无表达。角膜移植术后第3d,大部分植片未见PFP和GrB的表达,少数植片见植片植床交界处上皮少量表达,第7d起表达明显,第14d达高峰,第21d稍有下降。PFP与GrB的表达具有相关性。结论PFP与GrB在大鼠角膜排斥反应中起着重要的作用。     

神经生长因子对兔角膜板层移植术后神经再生的作用

目的 探讨负载神经生长因子（NGF）的重组人Ⅲ型胶原（RHC-Ⅲ）移植入兔眼角膜后,对角膜神经再生的影响.方法 实验研究.16只中国大耳白兔随机分为A组和B组,每组8只,右眼为手术眼.A组兔角膜前板层植入负载5 ng/mg NGF的RHC-Ⅲ,B组植入不含NGF的RHC-Ⅲ.术后2周、1个月、3个月和6个月,每组随机取1只兔眼做角膜神经氯化金染色,光镜下观察角膜神经的修复情况,并对各时间点角膜上皮及浅基质层的神经纤维进行计数.采用独立样本t检验对A、B两组间各时间点的神经纤维数量进行比较.结果 术后2周,两组即可观察到上皮及浅基质层有新生的神经纤维;术后1个月,A组浅基质层已可见到少量新生的神经纤维相互连成网状;术后3个月,两组新生神经纤维数量明显增多,均可见到网络结构以及较多侧枝形成;术后6个月,A组新生神经纤维数量明显多于B组,且结构更为完善,但两组部分神经断端没有神经再生.A组术后2周、1个月、3个月和6个月的新生神经纤维数量分别为（6.80±0.84）、（11.80±1.10）、（25.20±1.30）、（42.40±1.82）根/100倍光镜视野;B组分别为（3.00±0.71）、（5.80±0.84）、（13.20±0.84）、（26.60±1.14）根/100倍光镜视野;A组各时间点新生神经纤维数量明显高于B组,两组差异均有统计学意义（t=7.76、9.73、17.32、16.47,P均＜0.01）.结论 NGF可以明显促进兔角膜板层移植术后的神经修复.     

Corneal wedge resection to treat progressive keratoconus in the host cornea after penetrating keratoplasty

We present 3 cases of progressive keratoconus in the host after penetrating keratoplasty PKP that were treated with a wide crescentic excision of the diseased tissue in the host cornea guided by Orbscan II topography (Bausch & Lomb). In all cases, the procedure resulted in a more regular corneal shape with a marked reduction in astigmatism, preventing the need for repeat PKP     

穿透性角膜移植术后角膜屈光力改变与三联手术

目的研究穿透性角膜移植术后角膜屈光力的改变,探讨对侧健眼角膜屈光参数在穿透性角膜移植联合白内障摘除、人工晶体植入术(三联手术)中的意义.方法穿透性角膜移植术(PKP)患者41例,其中单纯PKP25例,三联手术10例,PKP联合白内障摘除6例,其中5例术后1～1.5年行二期人工晶体植入.对术眼手术前后角膜曲率及眼轴的改变进行对比观察,并与健眼进行比较.结果术前角膜屈率为36.685～48.935D,平均40.935±3.569D;术后角膜屈率为39.190～50.31D,平均43.955±3.414D,配对T检验示两者有显著性差异(P=0.021);手术前后的眼轴分别为20.92～29.29mm(平均24.179±0.511mm)和22.76-30.86mm(平均24.85±2.35mm),配对T检验示两者无显著性差异(P=0.081);健眼的角膜屈率为42.125～44.810D,平均43.963二1.224D,经配对T检验与患眼术后角膜屈率无显著性差异(P=0.36).1例三联手术患者术后因高度近视而行人工晶体取出,另有两例因高度复性近视散光行LASIK;5例PKP联合自内障,人工晶体二期植入的患者,4例裸眼视力在0.5以上.结论PKP术后角膜屈率发生显著性变化,健眼角膜屈光参数是三联手术中人工晶体计算的重要参数,但患眼术后角膜屈率的改变有很大的不可预测性,PKP联合白内障摘除,二期再植入人工晶体可使患者获得更好的裸眼视力.     

异体角膜缘移植术后免疫排斥反应的临床研究

目的：了解不同术式的异体角膜缘移植术后免疫排斥的特点及其对预后的影响。方法：对1999年12月—2001年8月因酸、碱化学伤或热烫伤致角膜缘干细胞缺乏在我院行异体带新鲜角膜缘干细胞移植的患者33人(35眼)进行随访，术式包括：环状角膜缘移植(CLAT)7眼，CLAT联合板层角膜移植(LKP)14眼，CLAT联合穿透性角膜移植(PKP)14眼。术后全身和局部应用环孢素A(CsA)和糖皮质激素，定期观察记录异体角膜缘和中央角膜植片及LKP的层间情况。有选择性地行角膜印迹细胞学检查了解眼表情况。应用统计学分析角膜缘排斥的发生率和因排斥导致角膜缘再次失代偿在不同术式之间的差别。随访6—24个月，平均11．29个月。结果：CLAT联合PKP组排斥发生率为57．14％(8／14)；CLAT联合LKP组排斥发生率为50％(7／14)，均发生在术后4个月内；CLAT组4眼排斥发生率为57．14％。CLAT联合LKP 5眼层间新生血管长入，术后1．5个月后开始萎缩。印迹细胞学检查结果：查见到杯状细胞，CLAT合PKP组5眼；CLAT组3眼；CLAT联合LKP组0眼。统计结果：CLAT Ⅰ期联合PKP组与单纯CLAT组或CLAT Ⅰ期联合LKP组的角膜缘排斥反应发生率的差别无统计学意义(P＞0．05)。CLAT Ⅰ期联合PKP组与Ⅰ期联合LKP组的角膜缘失代偿率差别有统计学意义(P＝O．02)；CLAT Ⅰ期联合PKP组与CLAT组的角膜缘失代偿率差别有统计学意义(P＝0.03)。结论：CLAT Ⅰ期联合手术并不增加角膜缘排斥反应的发生率。CLAT Ⅰ期联合LKP的角膜缘失代偿率明显低于CLAT Ⅰ期联合LKP或CLAT，而又排斥均发生在术后4．5个月内，但是层间常有新生血管长入。术后6个月后仅有CLAT Ⅰ期联合PKP的角膜缘可能发生排斥。     

Contact lenses and special back surface design after penetrating keratoplasty to improve contact lens fit and visual outcome

AIMS: To describe the fitting of patients with high or irregular astigmatism following penetrating keratoplasty with contact lenses and to answer the question whether or not contact lenses with special back surface design can improve visual acuity in complex cases after penetrating keratoplasty. METHODS: 28 eyes were included. They were fitted with contact lenses with a special back surface that was designed for optical rehabilitation after penetrating keratoplasty. Four different types of these lenses (tricurve, keratoconus, reverse, oblong) were used selectively depending on abnormal eccentricity determined by videokeratoscope. The patients were followed up for an average period of 15.5 months. Lens tolerance and corrected visual acuity were evaluated and compared with that corrected with spectacles. RESULTS: The visual acuity was significantly improved in nearly all eyes with an average increase of 3.6 lines (maximal nine lines) accompanied by good contact lens tolerance and satisfactory contact lens fit. No noticeable complications were observed. CONCLUSION: Contact lenses with special back surface design can improve visual results and lens tolerance, and minimise problems in contact lens fitting. This is in favour of contact lenses as an alternative to surgical procedures for correction of high or irregular astigmatism after penetrating keratoplasty. This procedure is recommended especially in cases of patients who decline further operative interventions.     

癌钙调蛋白在炎症反应促视神经再生作用中的研究进展

癌钙调蛋白(oncomodulin,OM)作为钙结合蛋白的一种,逐渐为我们熟知.近年来有研究证实,OM源于活化的炎症细胞(中性粒细胞),是体内先天免疫系统和神经元之间一种有效的生长促进信号,通过炎症反应诱导的OM是受损视神经轴突再生的关键.OM的促视神经轴突再生作用逐渐成为研究的热点之一.本文就近年来OM作用机制和炎症诱导下OM与视神经再生关系方面的研究和进展做一综述.     

大鼠角膜移植术后植片内γ干扰素mRNA的表达及血清白介素2的变化

目的观察大鼠角膜移植术后植片内干扰素(IFNγ)mRNA的表达及血清白细胞介素2(IL2)的变化。方法以Wistar大鼠为供体,SD大鼠为受体,按常规行穿透性角膜移植,用裂隙灯观察移植排斥情况。角膜移植术后第7天取角膜植片,用RTPCR方法检测IFNγ的表达。分别于移植术后第3天、第7天、第14天、第21天取角膜植片,行HE染色,同时采血清,检测IL2的变化。结果角膜移植术后(7.63±0.74)d出现排斥反应。移植术后第7天角膜植片内可见IFNγmRNA的表达,正常角膜无表达。正常SD大鼠血清IL2浓度为(35.18±2.59)pg/ml,移植术后第3天见IL2浓度略有升高,第7天时明显升高,第14天时血清IL2的水平达高峰(105.52±20.66)pg/ml,第21天时IL2水平有所下降。结论IFNγ、IL2在角膜移植排斥中起着重要作用。     

Correction of myopia and astigmatism after penetrating keratoplasty with laser in situ keratomileusis

PURPOSE: We evaluated whether laser in situ keratomileusis (LASIK) was a safe and effective treatment for myopia and astigmatism after penetrating keratoplasty (PK). METHODS: We performed a retrospective review of medical records of all the patients who underwent LASIK following PK at the University of Minnesota between January 1999 and March 2000. RESULTS: Seventeen patients (20 eyes) underwent LASIK following PK between January 1999 and March 2000. Mean age of the patients at the time of LASIK was 37 years (range, 20-62). Keratoconus was the indication for PK in the majority of the eyes (73.7%). Anisometropia and/or contact lens intolerance was the indication for LASIK following PK. No intraoperative complications occurred. Following LASIK, the best spectacle-corrected visual acuity remained within 1 line of preoperative visual acuity in 94.7% of the eyes. The mean sphere was reduced by 3.93 diopters (80.0%) and the mean cylinder was reduced by 2.83 diopters (69.9%) from the preoperative values at the last follow-up visit. Uncorrected visual acuity became 20/40 or better in 73.7% of the eyes after LASIK. CONCLUSIONS: LASIK is a safe procedure in eyes in which PK has previously been performed. LASIK is effective in the treatment of myopia and astigmatism following PK.     

血管内皮生长因子与大鼠角膜移植术后新生血管增生关系的实验研究

目的：观察血管内皮生长因子（ｖａｓｃｕｌａｒ ｅｎｄｏｔｈｅｌｉａｌ ｇｒｏｗｔｈ ｆａｃｔｏｒ,ＶＥＧＦ）在大鼠角膜移植术后不同时间点的表达及与角膜新生血管（ＣＮＶ）生长之间的关系。方法：利用免疫组化方法观察同种异体大鼠角膜移植术后不同时间点ＶＥＧＦ的表达。结果：角膜移植术后,ＶＥＧＦ组ＣＮＶ生长面积与其它各组差异有高度显著性（Ｐ〈０．０１）,生长时间提前,高峰期持续时间长,ＶＥＧＦ表达明显强,     

Comparison of contrast sensitivity and visual acuity between deep anterior lamellar keratoplasty and penetrating keratoplasty in patients with keratoconus

AIM: To evaluate postoperative visual acuity and contrast sensitivity results following deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) in patients with keratoconus (KC). METHODS: All the patients’ records with KC who had PK or DALK surgery between May 2010 and May 2011 were retrospectively reviewed. Sixty patients who underwent successful corneal transplantation for KC: 30 eyes underwent DALK and 30 eyes underwent PK were included in this study. Preoperative and postoperative mean logarithm of the minimum angle of resolution (logMAR) uncorrected visual acuity (UCVA), logMAR best spectacle-corrected visual acuity (BSCVA) and intraocular pressure (IOP) were evaluated. Contrast sensitivity tests (CS) were done preoperative and 2 months after all sutures had removed. All surgeries were performed under regional anesthesia (retrobulbar anesthesia) by 1 surgeon (B.K.) who was experienced in penetrating and lamellar keratoplasty techniques.RESULTS: The mean age of the DALK group was 29.67±4.95 (range 18-40) years and the PK group was 28.7±3.53 (range 18-39) years. Preoperatively there was no significant difference in the logMAR UCVA, logMAR BSCVA and IOP between the DALK (1.281±0.56; 0.97±0.85; 12.07±2.12mmHg) and PK (1.34±0.21; 0.98±0.21; 13±2.12mmHg) groups. One-year after surgery there was no significant difference in the mean logMAR UCVA and IOP between the DALK (0.46±0.37; 11.73±2.1mmHg) and PK (0.38±0.21; 12±2.12mmHg) groups. The mean contrast sensitivity was evaluated by CC-100 Topcon LCD at 1.5, 2.52, 4.23, 7.10 and 11.91 cycles per degree (cs/deg) spatial frequencies before and 2 months after the all sutures had removed. CONCLUSION: All patients with keratoconus in both DALK and PK groups performed good visual function postoperatively. The mean contrast sensitivity increased considerably at all spatial frequencies compared with preoperative levels in the DALK and PK groups. The mean post-operative evaluation of contrast sensitivity measurements was not significantly different between the two groups.