A new surgical technique for anterior segment ectasia: tectonic lamellar sclerokeratoplasty.

A 41-year-old patient with severe anterior segment ectasia and a previous history of failed corneal graft was treated by placing a 14-mm tectonic corneoscleral allograft in the eye to support both the corneal and the scleral thinning. Nylon 10-0 interrupted sutures were used at the sclero-scleral junction. The host conjunctiva, including the limbal area, was carefully sutured to the donor limbal area. Three months postoperatively, the graft was stable with no progression of the ectasia. The suturing of a corneoscleral graft over a severely ectatic cornea may be an acceptable technique for providing tectonic tissue support and stabilizing eyes with severe anterior segment ectasia.     

不规则移植片板层角膜移植治疗蚕蚀性角膜溃疡

目的：探讨不规则移植片板层角膜移植联合术后1％环孢霉素A滴眼治疗蚕蚀性角膜溃疡的效果及对视力的影响。方法：应用不规则移植片板层角膜移植治疗蚕蚀性角膜溃疡9例10只眼,术中根据溃疡侵犯角膜的形态切除病变角膜组织及邻近的球结膜和筋膜组织,按照植床的形态制作之相吻合的板层移植片行板层角膜移植术术,术后应用1％环孢霉素A滴眼6－8个月,结果术后随访1－5年,未见复发病例,术后6个月,与术前视力比较,大部分病例视力不变或提高。结论：不规则移植片板层角膜移植术联合术后应用1％环孢霉素A滴眼治疗蚕蚀性角膜溃疡效果肯定,只要植片与植床吻合,疑线松紧适宜,不会导致明显和光而影响视力。     

自体眼表移植术治疗翼状胬肉

目的 观察自体角膜缘(干细胞)及球结膜的眼表移植术治疗翼状胬肉的疗效。方法 对38例42眼进行期翼状胬肉采用自体角膜缘及球结膜移植术治疗。术后随随访5～18个月。结果 41眼移植片Ⅰ期愈合,角膜上皮稳定,无胬肉复发。1眼由于取结膜植片过小,植片皱缩,出现胬肉组织潜在复发可能,占2.38％。结论 自体角膜缘及球结膜移植术治疗翼状胬肉是一种安全而有效地阻止胬肉复发的手术。     

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）     

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。     

A case of lamellar keratoplasty and autoscleroplasty combined with keratoepithelioplasty for Wegener's sclerocorneal ulcer]

A 62-year-old man with Wegener's granulomatosis developed sclerocorneal ulcer. The general condition of the patient became well with steroid and presented cyclophosphamide therapy, he developed sclerocorneal ulcer. The sclerocorneal ulcer was present at the nasal limbus of the right eye. The ulcer was marked and presented descemetocele. Although lamellar keratoplasty was performed, the scleral ulcer recurred after two weeks. Excision of the affected sclera and autoscleroplasty was performed. The ulcer disappeared after 6 months, and the corneal graft was covered with corneal epithelium and conjunctiva. Ten months after autoscleroplasty was performed, a sclerocorneal ulcer was again recurred. We performed lamellar excision of the affected corneal area, resected the adjacent conjunctiva and performed keratoepithelioplasty. These surgical procedures were effective in preventing perforation of the cornea. Specular microscopic study of the corneal epithelium revealed nucleated epithelium and large epithelial cells. The endothelium appeared normal.     

翼状胬肉显微切除联合丝裂霉素C加自体带角膜缘上皮结膜移植术观察

目的 探讨翼状胬肉显微手术方法,观察翼状胬肉切除联合应用丝裂霉素C(MMC)加自体带角膜缘上皮的结膜移植术治疗翼状胬肉的疗效。方法 对1251例1326只眼,在手术显微镜下剖切分离球结膜与病变组织,切除胬肉并做广泛的变性球筋膜切除,在结膜下放置0.2 mg/ml的MMC棉片,彻底冲洗后将同侧眼颞上方带有角膜缘上皮的结膜瓣移植到胬肉处的巩膜上。术后随访12～72月,平均27.5月,观察复发情况。结果 术后反应轻,移植片存活,37只眼复发,复发率为2.79％。结论 翼状胬肉显微手术切除联合应用丝裂霉素C加自体带角膜缘上皮的结膜移植术,术后复发率低,是一种安全、有效的方法。     

血管膜切除联合羊膜移植治疗复发性免疫性角结膜炎

目的报告局部血管膜切除联合羊膜移植治疗复发性免疫性角结膜炎的初步临床结果。设计回顾性病例系列。研究对象病变反复发作并开始累及角膜、药物控制欠佳的泡性角膜炎患者2例、结节状巩膜炎累及角膜1例、角膜基质炎2例。方法切除局部角巩膜缘部结膜及巩膜表面变性组织,并移植相应大小的羊膜组织。术后局部免疫抑制剂治疗2￣3周,随访6￣12个月。主要指标并发症与复发情况。结果4例患者在停药4￣10个月后无复发,角膜浸润逐渐减轻,血管萎缩。1例结节状巩膜炎患者在术后12个月时病变复发,但仅局限于球结膜部位,角膜病变无复发。结论对于反复发作、病变累及角膜的免疫性角结膜炎,局部球结膜切除联合羊膜移植可以阻止角膜病变的进展。(眼科,2006,15:177-179)     

Diagnosis and management of corneal keloid

A 29-year-old man presented with a slowly growing mass in his left eye for the past 6 months. He had undergone a lens aspiration for traumatic cataract with an anterior chamber intraocular lens implantation several years ago. On examination, a pearly white mass was seen on the cornea. Ultrasound biomicroscopy revealed a hyperdense mass well demarcated from the underlying corneal tissue. The mass was excised by superficial keratectomy and the bare stroma covered with amniotic membrane. Histopathological examination of the excised mass revealed findings consistent with the diagnosis of a corneal keloid. At follow up after 6 months, no recurrence was observed.     

Nonpreserved human amniotic membrane transplantation for conjunctival reconstruction after excision of extensive ocular surface neoplasia

PURPOSE: To report our experience on the use of nonpreserved human amniotic membrane transplantation (AMT) in ocular surface reconstruction after excision of extensive ocular surface neoplasia (OSN). DESIGN: Prospective noncomparative interventional case series. PARTICIPANTS: In all, 10 eyes of 10 consecutive patients with extensive OSN involving various areas of limbus, conjunctiva, and cornea (conjunctival carcinoma in situ, four eyes; squamous cell carcinoma, three eyes; malignant melanoma, two eyes; conjunctival-orbital lymphangioma, one eye) were included in this prospective noncomparative interventional case series. After excision of the neoplasia with 3-4 mm tumour-free margins, double freeze-thaw cryotherapy was applied to the margins of the remaining conjunctiva, and nonpreserved human amniotic membrane graft was sutured to the adjacent conjunctiva using 8/0 vicryl sutures and cornea using 10/0 nylon sutures, with the epithelial side facing up to cover the bare sclera and cornea. Postoperatively, topical corticosteroids were used for 3 months. RESULTS: After tumour excision and AMT, a satisfactory result with a wet, stable conjunctiva, and rapid and complete healing was observed in all eyes. Over a mean follow-up of 10.0 months (range, 6-27 months), all but one eye remained free of tumour recurrence. In one eye with conjunctival melanoma, there was a small recurrence, which was treated with excision and cryotherapy. Treatment complications were partial stem cell deficiency in two eyes and symblepharon formation in one eye. Immune graft rejection was not encountered. CONCLUSION: Nonpreserved human AMT appears to be useful for reconstruction of ocular surface following excision of extensive OSN.     

翼状胬肉切除联合自体球结膜瓣移植术的临床分析

目的：探讨显微镜下施行翼状胬肉切除联合下方游离自体球结膜瓣移植术的疗效。方法：对93例97眼翼状胬肉施行翼状胬肉切除联合下方游离自体球结膜瓣移植术,观察术后恢复情况。结果：术后随访6～18mo,3眼复发（3%）,1眼并发炎性息肉（1%）,无其他并发症。结论：显微镜下翼状胬肉切除联合下方游离自体球结膜瓣移植术是治疗翼状胬肉的有效方法,具有术后复发率低且不影响白内障、青光眼手术切口选择的优点。     

板层角膜移植联合羊膜层间植入治疗重症蚕蚀性角膜溃疡

目的探讨板层角膜移植联合保存人羊膜移植重建角膜基质和眼表结构,治疗重症蚕蚀性角膜溃疡的疗效和安全性。方法重症蚕蚀性角膜溃疡患者5例(5眼),具疼痛性、进行性角膜溶解的临床特征,常规治疗方法疗效差,病变区域累及角膜缘6～12个钟点(平均9个钟点)范围。手术前全身和局部应用皮质类固醇。切除角膜缘处5mm宽的结膜和筋膜组织暴露巩膜。仔细的清除溃疡的基底部和边缘部组织,在坏死组织的表面和新生血管区域行烧灼,单层羊膜覆盖在溃疡区域的表面,10-0尼龙线间断缝合固定。在角膜穿孔的部位,移植多层羊膜以修复角膜基质层。在深层溃疡区域,行板层角膜移植。术后,局部应用人工泪液、抗生素眼液和类固醇眼液。术后观察前房深度、再上皮化速度、炎症状况、角膜基质厚度稳定状况、溃疡复发情况和视力。术后7d每日行常规检查,以后每周复查1次。随访期4～15(平均8.6)月。结果 手术获得了良好的疗效。术后自觉症状消失,眼表炎症明显减退,角膜溃疡的表面上皮稳定愈合,新生血管减少,获得了平滑、湿润的眼表。板层角膜植片平复半透明。未见溃疡复发。术后视力无明显下降。无手术并发症发生。结论 角膜板层移植联合羊膜移植可用于治疗重症蚕蚀性角膜溃疡。     

Spontaneous corneal perforation in a patient with unusual unilateral pellucid marginal degeneration.

A 56-year-old man presented with acute loss of vision and tearing in his left eye. Slitlamp examination demonstrated peripheral corneal edema extending between the 2 and 6 o'clock positions as well as a perforation located inferiorly. The right eye was unremarkable. An emergent crescentic lamellar keratoplasty was performed. The patch graft remained clear during the 30-month follow-up, and visual acuity improved significantly. No changes occurred in the right eye. This case represents an unusual, unilateral corneal ectatic disorder, most likely pellucid marginal degeneration.     

带蒂结膜瓣转移联合丝裂霉素C治疗复发性翼状胬肉的临床研究

目的:探讨带蒂结膜瓣转移联合应用丝裂霉素C治疗复发性翼状胬肉的临床疗效。方法:对26例(26眼)复发性翼状胬肉患者,采用翼状胬肉切除、术中加用丝裂霉素C并行带蒂结膜瓣转移、术后低浓度丝裂霉素C点眼进行治疗并随访观察。结果:所有患者均接受了6~12mo随访,有1例患者复发,复发率为4%。没有并发症发生。结论:对复发性翼状胬肉,翼状胬肉切除术中加用带蒂结膜瓣转移联合应用丝裂霉素C,是一种有效的治疗方法。     

Relapsing Mooren's ulcer after amniotic membrane transplantation combined with conjunctival autografting

PURPOSE: To report a patient with Mooren's ulcer that relapsed 2 months after amniotic membrane (AM) transplantation and conjunctival autografting and its subsequent retreatment. DESIGN: Interventional case report. METHODS: We performed multilayered AM transplantation and conjunctival autografting from the opposite healthy eye to treat a corneoscleral perforation caused by Mooren's ulcer in a 60-year-old woman. MAIN OUTCOME MEASURES: Reformation of the anterior chamber, absence of inflammation, and restoration of visual acuity. RESULTS: The perforated corneoscleral lesion was sealed successfully by the AM and conjunctiva graft and led to a stable condition for 2 months. Relapsing corneal edema, keratic precipitates, and cell infiltration occurred along the margin of the conjunctival graft with severe vessel engorgement. After removing the conjunctival graft and regrafting of additional AM, the lesion subsided for at least 1 year. CONCLUSIONS: Amniotic membrane transplants may be useful in treating corneal perforation of immunologic origin, but conjunctiva and its vessels may play a role in the process of peripheral corneal destruction of Mooren's ulcer.     

眼表重建术治疗翼状胬肉219例分析

目的探讨眼表重建术治疗翼状胬肉的手术方法及其效果。方法4年来手术治疗的翼状胬肉219例（239眼）。原发性215眼,继发性24眼。手术切除翼状胬肉后,同眼健侧取宽1mm角膜缘板层并带有结膜的移植片,对位移植于创区进行眼表重建。结果术后观察3月～4年,原发性翼状胬肉术后复发率3．26％,继发性者复发率4．17％,总复发率3．35％,低于其它手术。未复发病例中,术后眼表基本恢复正常,复发病例未行二次手术,仍在观察中。结论角膜干细胞联合结膜移植,可使翼状胬肉病变区眼表结构修复正常,减少复发,是治疗翼状胬肉的较好方法。     

A comparative evaluation of the efficacy of intraoperative mitomycin C use after the excision of cobblestone-like papillae in severe atopic and vernal keratoconjunctivitis

OBJECTIVE: To evaluate the effect of intraoperative 0.02% mitomycin-C (MMC) use after excision of cobblestone-like papillae on preventing corneal recurrences compared with simple papillary resection. METHODS: Thirteen cases of atopic keratoconjunctivitis (AKC) and 6 cases of vernal keratoconjunctivitis (VKC) with a mean age of 12.0 +/- 3.4 years participated in this study. All patients had cobblestone-like papillae on the upper tarsal conjunctiva and corneal ulcers or erosions that were refractory to conventional treatment. Seventeen eyes received simple papillary excision. Papillary excision with intraoperative application of MMC was performed in 7 eyes: 0.02% MMC was applied for 2 minutes to the upper palpebral conjunctiva immediately after papillary excision. Recurrence of corneal lesions and regrowth of papillae were evaluated and compared retrospectively between the 2 groups. Postoperative follow-up ranged from 12 to 18 months. RESULTS: Papillary regrowth was observed in 14 out of 17 eyes (82.4%) in the simple resection group, whereas regrowth was noted in 4 out of 7 eyes (57.1%) in the MMC group (P > 0.05). The recurrence of corneal lesions was observed in 8 out of 17 eyes (47.1%) in the simple resection group (mean onset 1.5 +/- 1.7 months) compared with 1 eye with corneal recurrence 6 months after surgery in the MMC group (14.3%). The difference was statistically significant (P < 0.05). No complications related to MMC use were observed during the follow-up period. CONCLUSION: MMC-aided papillary resection may be rewarding in well-selected severe AKC and VKC cases in preventing recurrence of corneal complications, but the potential complications of MMC use would suggest caution in its consideration.     

纤维蛋白胶对眼表的作用

目的观察以纤维蛋白胶（FG）为载体构建兔角膜上皮、基质和内皮细胞片,以及FG对兔结膜和角膜的黏合作用。方法在培养板孔底制作薄层和厚层FG,将培养兔角膜3种细胞分别接种于FG表面,观察细胞生长情况。FG对兔结膜的黏合研究：分为A组（结膜原位粘合组）,B组（结膜移位粘合组）,对照组（单纯切除结膜植片）,每组5只眼,观察结膜组织黏合情况。FG对兔角膜的黏合研究：3例兔前板层角膜移植术,先用10—0尼龙线间断缝合4针固定植片,再用FG黏合,将植片固定于植床。结果角膜3种细胞在薄层和厚层FG表面生长良好：角膜上皮细胞可形成单层和复层;角膜基质细胞间网状连接;角膜内皮细胞排列紧密。对兔结膜的黏合研究：A组和B组植片与植床对位良好,紧密黏合。组织切片显示术后第4周A组和B组结膜上皮完整,炎症基本消退。对照组结膜上皮有局部脱落区,纤维层局部显示瘢痕组织结构特征。兔前板层角膜移植术后3个月,植片与受体角膜愈合良好。结论FG可作为角膜3种细胞的生长载体构建细胞片。FG对兔结膜和角膜组织有良好的黏合作用。     

Inferior conjunctival autograft for primary pterygia

OBJECTIVE: Superior conjunctival graft is commonly used in pterygium surgery, which may adversely affect the outcome of future filtration surgery. We retrospectively studied the success rate of inferior conjunctival autografting for primary pterygia in our unit. DESIGN: A noncomparative, retrospective, interventional case series. PARTICIPANTS: Thirty eyes of 27 patients treated between August 1996 and February 2001 with primary pterygia. INTERVENTION: Excision of pterygium followed by conjunctival autograft harvested from the inferior bulbar conjunctiva. Surgeries were performed by an experienced surgeon (CL) in 23 patients and by trainees in the remaining four cases. MAIN OUTCOME MEASURES: Recurrence of the pterygium and complications. RESULTS: Mean follow-up was 27 months (range, 8-53). Recurrence occurred in one eye (3.3%). This was a white female in her early fifties, with recurrence detected 3 months after the surgery. Conjunctival scarring at the donor site was observed in 11 eyes (36.66%). There was no symblepharon formation. There was no restriction of up gaze. Hemorrhage under the conjunctival graft developed in three eyes, corneal dellen near the limbus developed in four eyes, and epithelial inclusion cysts at the recipient site developed in two eyes. CONCLUSIONS: Inferior conjunctival autografting is an effective technique with a low recurrence rate. This is a useful technique in cases in which it is not possible or desirable to use the superior conjunctiva as a donor source.     

Limbic transplantation in the surgical rehabilitation of patients with prior severe ocular burns

The paper provides the results of limbic transplantations in 21 patients with varying postburn leukomas. Autolimbic (n = 6; 28.6%) and limbic (n = 15; 71.4%) transplantation was performed 34.27 +/- 13 months after injury. Limbic transplantation with removal of the fibrovascular pannus resulted in improved visual acuity in all cases with the relatively transparent corneal stroma (Group 1; n = 10). In some cases, limbic transplantation could circumvent the problems associated with corneal graft epithelization after further corneal transplantations in Group 2 patients (n = 8) with turbid corneal stroma. In Group 3, surgery was made to prevent corneal changes occurring when the bulbar conjunctiva was removed during plastic repair of mucosal fornices from the lip. Postoperative recurrent corneal conjunctivization and epithelial erosion were observed only in 4 patients. The findings are of value in defining the site and indications for limbic transplantations in the surgical rehabilitation of patients who have experienced severe eye burns.