羊膜移植治療翼狀胬肉

目的評估廣泛切除聯合羊膜移植治療翼狀胬肉的效果.方法對29例(30祗眼)作翼狀胬肉廣泛切除聯合羊膜移植手術,其中復發性胬肉8例8眼(26.7%),原發巨大胬肉7例7眼(23.3%),29例中雙眼胬肉者20例(69.0%).另有10例10眼作單純廣泛胬肉切除.廣泛胬肉切除方法作胬肉體部與球結膜潜行分離,并將胬肉與鞏膜面和肌止部的粘連分離後,在半月襞處甚至連少許半月襞連同胬肉剪除,暴露鞏膜面及肌止部,用深低温保存的羊膜行移植手術.縫合方法作J適當改進,即作間斷固定縫合羊膜瓣,但角膜緣側上下兩角之間免除縫合.術後觀察3～12個月.結果(1)全部病例術後無復發,僅見一例鞏膜面有薄層胬肉樣的結膜增生.術後早期炎癥反應或刺激,羊膜移植與單純胬肉切除相似,拆綫後羊膜移植病例眼部炎癥反應消退快,1周内角膜上皮基本愈合,羊膜無F1染色,術後3～6個月羊膜移植區鞏膜面清澈可見,無胬肉復發傾向.而單純胬肉切除者刮面多有結膜血管與疤痕組織增生現象,并有2例胬肉復發.(2)視力改善程度36.7%患者視力提高2～7行,63.3%患者視力同術前.(3)羊膜移植合并癥僅有一例羊膜下出血.結論廣泛胬肉切除聯合羊膜移植治療復發性胬肉、巨大胬肉等可有效防止復發.手術安全,并達到改善視力的目的.     

自體结膜角膜缘上皮和异體羊膜移植术治疗翼状胬肉的临床研究

目的 觀察自體结膜角膜緣上皮移植術和异體羊膜移植術治療翼狀胬肉的臨床效果。方法 對55例(73只眼)行自體結膜角膜緣上皮移植術,隨訪1-17月,平均8.9月;對35例(46只眼)行异體羊膜移植術,隨訪1-14月,平均7.7月。结果兩組病例中初發性翼狀胬肉均無復發,而復發性翼狀胬肉的復發率分别為10.53％和6.67％,兩者無顯著性差异(P>0.05),但后者術后反應輕、上皮恢復快。结論 自體結膜角膜緣上皮移植術和异體羊膜移植術均是治療翼狀胬肉的良好方法,以后者為佳,治療翼狀胬肉的關鍵在于初發性手術方式的選擇。     

人羊膜移植治療翼狀胬肉的臨床分析

目的探討人羊膜移植治療翼狀胬肉的可行性及其療效評估.方法選擇18例(18衹眼)翼狀胬肉患者,其中初發性12例.復發性6例,行胬肉切除并行人羊膜移植,術後隨訪3～6個月.結果無一例出現排斥反應及嚴重并發癥,瞼球粘連得到解除,僅一例復發.結論羊膜具有抗原性低,促進眼表上皮化,减輕炎性反應,抑制纖維組織增生和新生血管形成等作用.胬肉切除術後,用羊膜修復眼結膜缺損區的創面,可提供一個理想基底膜,使其迅速上皮化及創口愈合,從而防止胬肉復發.     

復合性眼内异物傷的聯合手術

目的探討復合性眼内异物傷的各種聯合手術方法,統計其結果.方法對眼内异物傷伴有角膜瘢痕、外傷性白内障、玻璃體渾濁、PVR、牽引性視網膜裂孔、視網膜脱離或和眼内炎等,分别進行异物摘出與晶狀體切除、玻璃體切除、視綱膜復位、人工晶狀體植入、角膜移植等三聯、四聯或五聯手術.術後隨訪觀察,統計效果.結果復合性磁性及非磁性眼内异物傷45例(45眼)其中36例(80%)術後視力達0.5～1.0.術後視力達0.05者42例(93.33%).結論合并晶狀體、玻璃體、視綱膜或/及角膜外傷的復合性眼内异物傷,進行聯合手術是安全的,效果良好,視力恢復尚滿意.關鍵詞眼内异物傷聯合手術     

自體眼表移植術治瘵翼狀胬肉

目的觀察自體角膜緣(幹細胞)及球結膜的眼表移植衍治瘵翼狀胬肉的瘵效.方法對38例42眼進行期翼狀胬肉采用自體角膜緣及球結膜移植術治瘵.術後隨隨訪5～18個月.結果 41眼移植片Ⅰ期愈合,角膜上皮穩定,無胬肉復發.1眼由于取結膜植片過小,植片皺縮,出現胬肉組織潜在復發可能,占2.38%.結論自體角膜緣及球結膜移植衍治瘵翼狀胬肉是一種安全而有效地阻止胬肉復發的手衍.     

復雜視網膜脱離硅油填充后的高眼壓與低眼壓

目的探討復雜性視網膜脱離平坦部玻璃體切割硅油填充后高眼壓與低眼壓的發生和危險因素.方法對62例(66眼)平坦部玻切硅油填充的復雜網脱病例進行隨訪檢查.結果隨訪至1年,高眼壓和低眼壓發生率爲31.82%和15.15%,術后第一天高眼壓與其它隨訪期比較無差异,p＞0.05.增殖性糖尿病視網膜病變和增殖性玻璃體視網膜病變及有青光眼史和糖尿病史與無上述病史的高眼壓發生率有顯著差异,分别爲p＜0.01和p＜0.05.80%術后低眼壓患者術前就存在低眼壓和無晶狀體.結論高眼壓和低眼壓是復雜網脱硅油填充術后的常見許發症,其發生率分别爲31.82%(21眼)和15.15%(10眼),前者的危險因素包括青年眼和糖尿病史及術后第一天高眼壓的發生;術前低眼壓和無晶狀體是后者的危險因素.     

非超聲乳化小切口白内障摘出及人工晶狀體植入術171例

探討小切口非超聲乳化白内障摘出及人工晶狀體植入術臨床效果.方法采用上方角膜緣後2mm反眉形1/2層鞏膜隧道小切口進行手法碎核及人工晶狀體植入,鞏膜切口不縫或縫一針.結果術後3個月視力≥0.2占98.7%,≥0.5占83.5%,≥0.8占48.3%;衍後并發角膜水腫42祗眼,前房出血和上瞼下垂各1例.結論小切口無縫綫人工碎核白内障摘出及人工晶狀體植入費用小,操作簡單,省時安全,衍後視力恢復快.     

肝細胞生長因子受體在增生性糖尿病視網膜病變視網膜前膜中的表達

目的肝細胞生長因子(hepatocyte growth factorreceptor,HGF)是具有多種生物活性的細胞因子,通過與受體結合轉導生物學效應,發揮促細胞增生、促運動和促形態發生等作用.本實驗目的在于觀察增生性糖尿病視綱膜病變(proliferative diabetic retinopathy,PDR)不同時期視網膜前膜(epiretinal membranes,ERM)中HGF受體的表達情况.方法13例PDR患者行玻璃體切除術剥離視綱膜前膜.采用免疫組化染色方法觀察HGFR在ERM中的表達情况.結果在7例Ⅳ、Ⅴ期ERM標本中,5例HGF受體陽性表達,陽性表達率為71.4%;6例PDR Ⅵ期增殖前膜標本中,有5例HGF受體陽性表達,陽性表達率為83.3%.HGF受體陽性表達率與PDR分期無顯著性差别(P＞0.05).結論HGF受體在PDR視網膜前增生膜中表達,提示HGF可能參與了PDR增生膜的形成.     

糖尿病患者白内障摘除人工晶體植入術的臨床觀察

目的評價Ⅱ型糖尿病患者白内障摘除人工晶體植入術的療效.方法對17例21眼糖尿病患者行白内障摘囊外除後房型人工晶體植入術,以122例152眼非糖尿病患者同類手術為對照組,進行術後視力及并發癥的比較.結果糖尿病組術後視力較術前明顯提高(P＜0.05),與非糖尿病組無顯著性差异(P＞0.05),術後影響視力的主要原因是糖尿病性視網膜病變,手術前後血糖無顯著性差异(P＞0.05),未發生嚴重的眼部并發癥.結論糖尿病患者血糖控制穩定,實行ECCE+I0L治療白内障可改善視力,無全身及眼部并發癥,手術安全可靠.     

自體角膜緣幹細胞球結膜移植治療翼狀胬肉

目的探討自體角膜緣幹細胞球結膜移植治療翼狀胬肉的療效以及顯微手術技術的有關要點.方法應用自體角膜緣幹細胞球結膜移植治療翼狀胬肉38例52祗眼,其中静止期翼狀胬肉13例22祗眼,活動期25例30祗眼,包括復發性胬肉3例4祗眼,隨訪期最長18個月,最短6個月.結果經過平均11.80個月觀察,祗有1眼胬肉術後復發(占52祗眼的1.92%),其餘病例無復發,角膜上皮穩定、泪膜正常、供區角膜創面正常愈合.結論本術式是目前治療翼狀胬肉最爲安全有效的方法.     

义眼座植入同期利用羊膜移植结膜囊重建术的临床观察

目的 探讨结膜囊狭窄患者义眼座植入同期利用羊膜移植重建结膜囊的临床效果。方法 对23例结膜囊狭窄患者行义眼座植入同时行结膜囊重建术。术中下穹隆采用埋线法固定在眶下壁骨膜,保存羊膜移植于结膜缺损区,上下睑缘褥式缝合。每周打开眼睑并用荧光素试纸染色,观察结膜上皮生长情况。术后2个月拆除上下眼睑缝线,定制合适的义眼。结果 术后第4周20只术眼羊膜表面全部被结膜上皮覆盖,其余3只术眼发生羊膜融解,结膜上皮未愈。术后2个月4只Ⅰ度结膜囊狭窄患眼全部治愈;10只Ⅱ度结膜囊狭窄患眼中8只治愈,2只好转;9只Ⅲ度结膜囊狭窄患眼中3只术眼痊愈、3只术眼好转,余3只术眼无效,其中1只术眼半年后重新行结膜囊成形术。完成治疗的21例患者无义眼座暴露、感染及睑球粘连等并发症,对术后眼座的活动度和外观比较满意。结论 对于Ⅰ和Ⅱ度的结膜囊狭窄采用保存羊膜移植同期行眼座植入术是安全可行的。对于Ⅲ度结膜囊狭窄采用保存羊膜移植疗效欠佳。（     

羊膜移植在治疗眼表疾病的临床应用

目的:探讨深低温保存羊膜移植治疗眼表疾病的临床效果。方法:采用深低温保存人羊膜移植治疗难治性眼表疾病100例124眼,其中睑球粘连24眼,翼状胬肉及复发性翼状胬肉40眼,热烧伤、化学烧伤10眼,上下睑新生物16眼,角膜溃疡、角膜瘘20眼,植入义眼台裸露14眼。结果:术后患者眼部充血、刺激症状均较轻,约在2wk后移植区水肿消退。79眼(63.7%)视力有提高,115眼(92.7%)一次性达到治疗效果。结论:保存人羊膜移植能够安全有效地重建眼表疾患患者的眼表,可广泛应用。     

人羊膜移植治疗翼状胬肉等眼表疾病的临床观察

目的：观察用人羊膜移植术治疗翼新诗胬肉、角膜热灼伤、化学伤、睑球粘连等眼表疾病的临床疗效。方法：用人羊膜移植术治疗翼状胬肉46例65只眼，其中复发性胬肉16只眼，假性翼状胬肉1只眼，角膜热灼伤、化学伤3例4只眼，睑球粘连2例2只眼，手术均在显微镜下完成。结果：随访3-11个月，羊膜移植手术均一次成功，无免疫排斥反应。翼状胬肉组，角膜透明，无新生血管，巩膜面结膜覆盖良好，充血消失；2只眼复发，复发率为3.1％，成功率96.9％。3例（4只眼）角膜热灼伤、化学伤者，术后均未见继续溶解、穿孔。睑球粘连者，结膜囊形成，睑球粘连者，结膜囊形成，睑球粘连松解，眼球活动基本正常。结论：人羊膜移植是治疗翼状胬肉等眼表疾病较有效方法，它可抑制结膜下及角膜纤维化，促进结膜、角膜的上皮化。     

Amniotic membrane transplantation to reconstruct the conjunctival surface in cases of chemical burn

PURPOSE: To evaluate the efficiency of preserved human amniotic membrane transplantation for conjunctival surface reconstruction in cases of chemical burn. METHODS: Preserved amniotic membrane transplantation was performed in 6 patients (6 eyes) having symblepharon and fornix insufficiency due to chemical burn. Amniotic membrane was sutured to the intact conjunctiva after the fibrotic tissue was excised. The fornix was reconstructed in cases having fornix insufficiency. These cases were followed up for 4-24 months. RESULTS: During the mean follow-up period (10+/-7.37 months) adequate bulbar conjunctiva and fornix depth was achieved in 5 patients without recurrence and with mild fibrosis. In 1 patient who did not have a healthy conjunctiva preoperatively, conjunctival fibrosis and symblepharon recurred. CONCLUSIONS: Preserved human amniotic membrane transplantation is a good alternative treatment method for conjunctival surface reconstruction in those cases with some healthy peripheral conjunctival tissue.     

Outcome of surgery for recurrent pterygium using intraoperative application of mitomycin C and amniotic membrane transplantation

PURPOSE: Preserved human amniotic membrane has been used in reconstruction of the ocular surface. In this paper, we report our method of amniotic membrane transplantation (AMT) for recurrent pterygium. METHODS: Twenty-six eyes of 26 patients with recurrent pterygium are reported. All subjects were operated on with an extensive excision of the subconjunctival fibrous tissues followed by application of mitomycin C (0.04%, 3-5 min) during the operation. Amniotic membrane transplantation was performed with implantation of conjunctival autograft in cases with a large excision. RESULTS: The mean follow up time was 17.3 +/- 9.3 (mean +/- standard deviation) months. Twelve eyes showed severe symblepharon and 14 patients suffered from double vision before the operation. There were only three mild recurrences (12%), 11 patients recovered from double vision, and no major complications such as sclermalasia were noted during the follow-up period. CONCLUSION: AMT with application of mitomycin C is effective in preventing pterygium recurrence and for improved ocular movement. The cosmetic outcome of our methods has also been satisfactory.     

Transplantation of amniotic membrane and limbal autograft for patients with recurrent pterygium associated with symblepharon

AIM—Treatment of recurrent pterygium associated with symblepharon requires both suppression of fibrosis and reconstruction of limbal barrier. To achieve this, human amniotic membrane was transplanted and limbal autografts performed.
METHODS—Four patients with severe symblepharon resulting from multiple surgeries for pterygium were treated. Human amniotic membrane was obtained at caesarean section and preserved until surgery. After excision of the fibrous tissues, the amniotic membrane was placed on the sclera, and a limbal autograft transplantation was performed using limbal tissues taken from the affected eye.
RESULTS—Recurrence of symblepharon was not observed in any of the patients and significant suppression of the subconjunctival fibrosis was achieved. Ocular movement improved in all cases. Complete remission of pterygium regrowth occurred in three cases, and a slight (about 1 mm) recurrence occurred in one case. The limbal donor site showed the presence of mild depressions without the formation of pseudopterygium.
CONCLUSION—Transplantation of human amniotic membrane with a limbal autograft appears to be a promising surgical treatment for reconstructing the ocular surface in patients with recurrent pterygium associated with symblepharon.

Keywords: pterygium; limbal transplantation; amniotic membrane; symblepharon     

羊膜移植在翼状胬肉术中的应用

目的观察保存人胎盘羊膜移植在翼状胬肉切除术后结膜重建及防止翼状胬肉复发中的疗效。方法对117例（143眼）翼状胬肉行广泛切除后，用保存人羊膜移植修补。结果术后2～3天角膜上皮修复，2～3周结膜血管化完成，与正常结膜不易区分。随访观察2～24月，治愈率91％。结论翼状胬肉切除联合羊膜移植术可有效地降低复发率。     

羊膜移植治疗复发性翼状胬肉临床观察

目的：观察羊膜移植治疗复发性翼状胬肉的疗效。方法：共治疗复发性翼状胬肉60只眼。按常规方法切除胬肉组织,巩膜裸露区采用保存的人着膜移植。结果：随访1年,56只眼角膜透明,无新生血管及结膜样组织增生,巩膜区结膜覆盖良好,充血消失。手术成功率93%,4只眼翼状胬肉复发（7%）。结论：羊膜移植治疗复发性翼状胬肉有独特疗效,治疗愈率高,复发率低,是目前较为理想的手术方法。     

羊膜移植治疗义眼座植入术后结膜裂开伴结膜囊狭窄

目的:探讨羊膜移植治疗羟基磷灰石义眼座植入术后结膜裂开伴结膜囊狭窄的临床效果。方法:羟基磷灰石义眼座植入术后结膜裂开伴结膜囊狭窄患者16例16眼,手术松解结膜张力后,行保存羊膜移植于巩膜暴露区。结果:所有患者中,15例术后结膜愈合完全遮盖巩膜,结膜囊恢复理想深度;1例失败。结论:保存羊膜移植是治疗义眼座植入术后结膜裂开、保持理想结膜囊深度的有效方法。     

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。