不同透明角膜切口对白内障超声乳化术后角膜散光影响

目的 研究不同部位、不同方式的透明角膜切口白内障超声乳化联合后房型折叠式人工晶状体植入术对角膜散光的影响.方法 回顾性临床自身对照研究.将2009年3月至12月在广州医学院第二附属医院眼科就诊的96例(112只眼)白内障患者随机分为3组:A组颞侧透明角膜切口34例(39只眼);B组11:00钟方位透明角膜切口26例(31只眼);C组角膜曲率引导下透明角膜切口(切口位于角膜最大屈光轴方向)36例(42只眼).比较3组病人术前、术后1周、1个月、3个月的视力及角膜散光度变化.结果 术前、术后1周、3组间裸眼视力的差异无统计学意义(P值均>0.05);而术后1个月和3个月C组裸眼视力显著优于A、B组(P值均<0.05),而A组与B组间的差异无统计学意义(P值均>0.05).C组在术后1个月和3个月的角膜散光度显著小于A、B组(P值<0.05).结论 角膜曲率引导下位于角膜最大屈光轴方向的切口对白内障手术术后角膜散光影响最小,并有利于术后视力较快恢复.     

选择性透明角膜切口对白内障超声乳化术后角膜散光的影响

目的:探讨根据患者术前角膜散光差异,在不同部位选择性预设散光轴透明角膜切口行白内障超声乳化联合后房型折叠式人工晶状体植入术,对术后患者角膜散光的影响。方法:收集老年性白内障患者96例112眼,随机分为三组:A组颞侧透明角膜切口,34例39眼;B组11:00位透明角膜切口,26例31眼;C组角膜曲率引导下于角膜屈光力最大轴向上行个体化高选择性透明角膜切口,36例42眼。结果:术前、术后1wk,3组裸眼视力的差异无统计学意义(P>0.05);而术后1,3mo,C组裸眼视力显著优于A,B组(均P<0.05),而A组与B组间差异无统计学意义(P>0.05)。C组在术后1,3mo的角膜散光度显著小于A,B组(P<0.05)。结论:角膜曲率引导下行位于角膜屈光力最大轴方向切口,对白内障超声乳化术后角膜散光影响最小,并有利于患者术后视力较快恢复,有效控制术后术源性角膜散光,进一步提高患者术后视力。     

角膜地形图引导下不同部位角膜切口白内障超声乳化术后角膜散光分析

目的比较角膜地形图引导下不同部位透明角膜切口白内障超声乳化术后散光情况。方法选择行透明角膜切口超声乳化白内障吸除联合人工晶状体植入术的年龄相关性白内障患者198例（231例）为研究对象,分成A、B、C 3组,A组选择在上方11点位透明角膜切口,B组选择在颞侧透明角膜切口,C组选择在角膜最大曲率子午线上透明角膜切口,分别于术前,术后1周、1个月及3个月随访,行视力及角膜地形图检查,记录并比较3组术后视力及角膜散光的变化情况。结果术后3个月时C组裸眼视力≥1.0者多于A组和B组（P〈0.05）;C组患者术后3个月与术前相比,散光度明显减小（P〈0.05）;C组分别与A组、B组相比,术后1周、1个月及3个月时的散光度均明显减小（P〈0.05）;术后3个月平均手术源性角膜散光度（SIA）,C组最小。结论角膜地形图引导下位于角膜最大曲率子午线上透明角膜切口有助于减小术前及术后散光,术后获得较好的裸眼视力。     

不同透明角膜切口对白内障超声乳化术后角膜散光影响

目的 研究不同部位、不同方式的透明角膜切口白内障超声乳化联合后房型折叠式人工晶状体植入术对角膜散光的影响.方法 回顾性临床自身对照研究.将2009年3月至12月在广州医学院第二附属医院眼科就诊的96例(112只眼)白内障患者随机分为3组:A组颞侧透明角膜切口34例(39只眼);B组11:00钟方位透明角膜切口26例(31只眼);C组角膜曲率引导下透明角膜切口(切口位于角膜最大屈光轴方向)36例(42只眼).比较3组病人术前、术后1周、1个月、3个月的视力及角膜散光度变化.结果 术前、术后1周、3组间裸眼视力的差异无统计学意义(P值均>0.05);而术后1个月和3个月C组裸眼视力显著优于A、B组(P值均<0.05),而A组与B组间的差异无统计学意义(P值均>0.05).C组在术后1个月和3个月的角膜散光度显著小于A、B组(P值<0.05).结论 角膜曲率引导下位于角膜最大屈光轴方向的切口对白内障手术术后角膜散光影响最小,并有利于术后视力较快恢复.

Abstract：

Objective To investigate the effect of phacoemulsification with different transparent corneal incisions and foldable posterior chamber intraocular lens implantation on corneal astigmatism. Methods All 112 eyes of 96 patients with cataract were divided into three groups randomly, group A, received superior temporal clear corneal incision(39 eyes of 34 cases); group B, received superior clear corneal incision at 11 O'clock(31 eyes of 26 cases); group C, received steepest corneal meridian as guided by corneal(42 eyes of 36 cases). The changes of corneal astigmatism and visual acuity were determined before and 1 week, 1 month and 3 months after operation. Results There was no statistically significant(P >0.05)in visual acuity in three groups before and after operation 1 week; 1 and 3 months after operation the visual acuities in group C were much better than those of the group A and B(P <0.05), though there was no statistically significant(P >0.05)between group A and B; 1 and 3 months after operation the corneal astigmatism of group C was much lower than in group B and group C(P <0.05). Conclusions The incision at the steepest corneal meridian guided by corneal has the least effect on corneal astigmatism and can improve visual acuity rapidly.     

两种不同切口超声乳化术对合并低度角膜散光白内障患者的角膜散光和视力的影响

目的　观察在合并低度角膜散光的白内障患者中行陡峭轴角膜切口和颞侧角膜切口超声乳化术后角膜散光和视力的变化。方法　将我院收治的合并角膜散光≤0.50 D的年龄相关性白内障患者共60例(60眼)根据术中切口不同分成A、B两组。A组30例行陡峭轴切口,B组30例行颞侧角膜切口。观察术前及术后1周、1个月、3个月裸眼视力（uncorrected visual acuity,UCVA)、最佳矫正视力（best corrected visual acuity,BCVA)、角膜散光、术源性散光(surgically induced astigmatism,SIA),并进行统计学分析。结果　术后1个月、3个月,A组UCVA均优于B组（均为P＜0.05）;两组术后各时间点BCVA比较差异均无统计学意义（均为P＞0.05）,但均较术前明显提高（均为P<0.05）。A组UCVA术后3个月优于术后1个月、术后1个月优于术后1周,差异均有统计学意义 (均为P＜0.05)。A组BCVA于术后1个月基本稳定。术后1周、1个月、3个月,A组角膜散光均低于B组（均为P＜0.05）。A组角膜散光术后3个月为（0.26±0.20）D,略低于术前的（0.32±0.13）D,但差异无统计学意义（P=0.42）。B组术后3个月角膜散光为（0.62±0.45）D,高于术前的（0.23±0.17）D,差异有统计学意义（P<0.05）。术后1周A组 SIA为（1.28±0.63）D,高于B组的（0.77±0.39）D,差异有统计学意义（P=0.01）。术后1个月、3个月两组SIA比较差异均无统计学意义（均为P＞0.05）。结论　术前角膜散光≤0.50 D的白内障患者行白内障超声乳化手术时,选择陡峭轴切口并不能矫正术前角膜散光,但能减小术后总角膜散光,且可以有效提高术后UCVA,术后效果优于颞侧角膜切口。     

角膜切口对白内障手术后散光的影响

目的:观察沿角膜散光陡峭轴方向做透明角膜切口行白内障超声乳化联合人工晶状体植入术后散光和视力的变化。方法:根据IOL-Master检测结果选择角膜最大屈光力轴行3.0mm透明角膜切口做白内障超声乳化术42眼作为观察组(A组),常规颞上(右眼)、鼻上(左眼)3.0mm透明角膜切口白内障超声乳化术68眼作为对照组(B组)。检测术前、术后1d;1wk;1,3mo角膜散光和视力变化。结果:A组术前、术后1d;1wk;1,3mo视力分别为0.2±0.24,0.73±0.37,0.78±0.38,0.94±0.36,0.76±0.13;B组为0.17±0.2,0.82±0.3,0.84±0.2,0.77±0.26,0.8±0.36;差异无统计学意义(P>0.05)。A组术前、术后1d;1wk;1,3mo角膜散光度分别为1.01±0.10D,1.33±0.13D,1.15±0.14D,0.90±0.13D,0.89±0.12D;B组为0.95±0.13D,1.25±0.15D,1.07±0.13D,0.87±0.12D,0.82±0.11D。术后1d;1wk;1mo与术前相比散光度均无统计学意义(P>0.05)。两组术后3mo散光度与术前相比差异有统计学意义(P<0.05)。两组术后3mo裸眼视力≥0.8者分别为21眼(50%)和32眼(47%),两者相比有统计学意义(P<0.05)。结论:沿陡轴透明角膜切口白内障超声乳化联合人工晶状体植入术有助于患者视力提高及减少术后角膜散光。     

白内障术中采用不同位置切口对角膜散光的影响研究

目的探讨不同部位巩膜隧道切口超声乳化联合后房型人工晶状体植入术对角膜散光的影响。方法住院老年性白内障100例（120眼）随机分为A，B两组。A组行颞侧巩膜隧道切口，B组行上方巩膜隧道切口。术后观察3天、1月、3月的角膜平均散光度数及视力情况。结果2组术后裸眼视力较术前均有明显提高，但术后不同时间内角膜散光度之间有显著性差异。术后各时间点A组散光度均小于B组。结论颞侧巩膜隧道切口较上方巩膜隧道切口术后对角膜散光影响小，术后3月时角膜散光与术前相比无统计学意义（P〉0．05），视力恢复好，是较理想的切口位置。     

不同位置角膜切口对白内障术后角膜散光和视力的影响

目的：探讨不同位置角膜切口对白内障术后角膜散光和视力的影响,提高白内障患者术后视觉质量。方法：选取行超声乳化白内障吸除联合人工晶状体植入术的患者96例96眼,随机分为两组,各48例48眼,使其有可比性。 A组患者角膜切口选择右眼在颞上、左眼在鼻上。 B组角膜切口根据曲率检查选择在角膜最大子午线轴向。结果：两组患者术后1wk,1、3mo视力比较差异无统计学意义(P>0.05)。术后1wk,1mo时A组患者角膜散光度分别为4.03±0.41、3.72±0.35D,B组分别为2.96±0.38、1.29±0.15D,均较治疗前明显增高,且A组明显高于B组,差异有统计学意义(P<0.05)。术后3mo时两组患者散光度均与术前差别不大,且两组比较无统计学意义(P>0.05)。术前两组患者散光轴向均以逆规最为常见,术后1 wk顺规性散光增多,明显多于术前,术前术后比较差异有统计学意义(P<0.05),至术后1、3mo顺规性散光逐渐减少,逆规性散光逐渐增加,接近术前。两组患者不同时间角膜散光轴向比较无统计学意义(P>0.05)。结论：白内障超声乳化术透明角膜切口选择在角膜最大散光子午线方向可以有效减少术后早期散光度数,但是对于远期角膜散光影响不大,而且对患者视力影响不大。在条件允许的情况下,可以通过该方式制作角膜切口,但是考虑到手术复杂性提高,意义不大。     

不同位置角膜切口白内障超声乳化对角膜表面形态的影响

目的 探讨颞侧和上方3.2mm透明角膜切口白内障超声乳化联合折叠式人工晶状体植入术对角膜表面形态的不同影响.方法 收集老年性白内障患者44例54眼,将患者随机分为颞侧透明角膜切口组(A组)和上方透明角膜切口组(B组).检查术前、术后1 d、1周、1个月和3个月视力、手术源性散光(surgically induced astigmatism,SIA)和角膜地形图.结果 术后1d、1周、1个月、3个月,A组SIA分别为(0.70±0.34)D、(0.64±0.29)D、(0.60±0.27)D、(0.55±0.26)D,B组分别为(1.18±0.48)D、(1.05±0.42)D、(0.88±0.38)D、(0.77±0.35)D.术后1 d,A组SIA较B组小,差异有统计学意义(P<0.05);随着时间的推移,2组SIA逐渐有减小趋势,但A组SIA仍小于B组,术后3个月差异仍有统计学意义(P<0.05).术后1 d,2组角膜表面非对称性指数(surface asymmetry index,SAI)、角膜表面规则指数(surface regularity index,SRI)均较术前增大,差异有统计学意义(P<0.05),其中A组的SAI、SRI较B组小,差异有统计学意义(P<0.05).术后1周,A组SAI、SRI同术前相比差异无统计学意义(P>0.05);B组SAI、SRI仍比术前高,差异有统计学意义(P<0.05).术后1个月、3个月2组SAI、SRI同术前相比差异均无统计学意义(P>0.05),2组之间各相应时间点SAI、SRI的差异也均无统计学意义(P>0.05).结论 颞侧透明角膜切口操作方便,术后SIA、SAI、SRI均小于上方透明角膜切口,对角膜表面形态的影响小,术后早期视力恢复好.是较理想的手术切口方位.     

角膜地形图引导下的角膜切口白内障手术矫正角膜散光的研究

目的 观察角膜地形图引导下的透明角膜切口白内障手术对术前及术后散光度的影响.方法 透明角膜切口晶状体超声乳化术240只眼,随机分成三组,每组80只眼.A组:切口位于角膜最大屈光轴方向;B组:切口位于90°方向;C组:切口位于180°方向.观察术前、术后1周、1月、3月角膜散光度和视力变化.结果 (1)A组术后1周、1月和3月裸眼视力＞ 0. 7者多于B组和C组(P ＜ 0. 05);三组患者术后最佳矫正视力＞ 0. 6者基本相同.(2)A组患者术后1周、1月及3月与术前相比,散光度明显减小(P＜0.01);术后1周与术后1月、3月相比,散光度也减小(P＜0.05);而术后1月与3月相比,散光度基本相似(P＞0.05).(3)A组与B组相比,术后1周、1月及3月时的散光度均明显减小(P＜0.05);A组与C组相比,术后1周、1月及3月时的散光度也明显减小(P＜0.05).结论 角膜地形图引导下位于角膜最大屈光轴方向的切口有助于减小术前及术后散光,术后获得较好的裸眼视力.     

美容性角膜覆盖术疗效观察

目的:评价美容性角膜覆盖术治疗角膜(角巩膜)葡萄肿的临床效果。方法:对22例角膜(角巩膜)葡萄肿患者进行了美容性角膜覆盖术治疗。术后对所有病例的临床效果进行了随访观察。结果:22例均治愈,残留部分视力的2例的视力术后有所改善(2例2眼从术前手动/眼前到术后指数/眼前)。22例无1例发生排斥,角膜覆盖片的颜色除第1例因缺乏经验术眼的颜色明显深于对侧正常或正常人群眼的颜色外,其它无1例褪色。结论:应用角膜覆盖术治疗角膜(角巩膜)葡萄肿22例(22眼)临床证明疗效确实、安全可靠。     

Anterior amorphous corneal opacity and corneal thinning

PurposeTo present the clinical features of four cases with bilateral anterior amorphous corneal opacity.MethodsA retrospective study in four patients with bilateral anterior amorphous corneal opacity was conducted. Examinations included visual acuity, keratometry, slit-lamp biomicroscopy, confocal microscopy, anterior segment optical coherence topography, and histology.ResultsThree female and one male patients (mean age, 52.3 ± 8.9 years) showed bilaterally oval, amorphous sheetlike corneal opacities with central depression and thinning. Superior limbal opacities were observed in two of these patients. The best-corrected visual acuity ranged from 20/50 to 20/400, and the mean of the keratometry was 39.81 ± 3.97 D (diopters). They had mild dry eyes. The anterior segment optical coherence topography demonstrated hyporeflective abnormalities in the anterior depressed stroma in these four patients. Confocal microscopy revealed large round cells at the epithelial layer in one patient, and amorphous opacities with some strand-shaped opacities in the anterior stroma in all four patients. The mean of the corneal endothelial cells density in the eight eyes was 1521 ± 402 cells/mm². Central corneal stromalysis occurred in three patients, and descemetocele developed in two eyes. One patient received penetrating keratoplasty and two underwent lamellar keratoplasty. The histology of the corneal specimen revealed edematous basal epithelial cells, focal collagen disorganization in the thin stroma, and wartlike excrescences in a thickened Descemet's membrane.ConclusionAnterior amorphous corneal opacity is a rare keratopathy and may be one kind of rare corneal degeneration or dystrophy. Corneal stromalysis may occur in hyporefrective amorphous opacities and progress to descemetocele.     

Influence of corneal astigmatism, corneal curvature and meridional differences on corneal hysteresis and corneal resistance factor

Background: This study investigated the influence of corneal astigmatism, corneal curvature and meridional differences on corneal hysteresis (CH) and the corneal resistance factor (CRF) in a group of normal Chinese persons. Methods: Ninety‐five participants were recruited and data from the eye with higher corneal astigmatism were analysed. The anterior corneal curvature was measured by corneal topography. The Goldmann‐correlated intraocular pressure (IOPg), corneal‐compensated intraocular pressure (IOPcc), CH and CRF at different meridians (default horizontal position, 10°, 20° and 30° along the superotemporal and inferonasal meridians) were obtained from an ocular response analyser. The corneal powers at these specific meridians also were calculated. Results: At the default position, the IOPg and CRF had weak correlations with corneal astigmatism, while the IOPcc and CH were not significantly correlated with corneal astigmatism. Both the IOPg and IOPcc were measured significantly higher at the default position. The CH and CRF were lower at the default position but the difference in the CRF from obliquity could not reach statistical significance. The CH was not significantly correlated with the corneal power at all meridians. The CRF correlated with the corneal power only at 30° superotemporal. Conclusion: Corneal astigmatism and head tilt did not have much effect on the measurement of CH and the CRF, both of which were lowest along the horizontal meridian. Clinically, the difference was small. The influence of corneal power on CH and the CRF was minimal.     

角膜生物力学与光密度相关性研究

目的:探究角膜生物力学与角膜光密度的相关性。方法:前瞻性研究。选取2019-03/06在云南省第二人民医院拟行角膜屈光手术术前检查的患者为研究对象。采用Pentacam HR眼前节分析系统进行角膜光密度测量,以角膜顶点为中心,分为0~2mm、> 2~6mm、> 6~10mm直径范围3个区域,以角膜厚度分为前、中、后3层。选取Pentacam HR中角膜最薄点厚度值纳入研究。采用Corvis ST角膜生物力学分析仪测量,相关参数包括第一次压平的长度(AP1L)和速率(AP1V)、第2次压平的长度(AP2L)和速率(AP2V)、最大凹陷时顶点距离(PD)、曲率半径(HCR)和形变幅度(DA)。运用Pentacam&Corvis ST生物力学联合诊断平台软件综合分析检查结果,得出综合角膜生物力学参数(CBI)以及其它独立参数包括硬度参数(SP)、综合半径(IR)、Ambrosio相关厚度-水平方向(ARTh)、形变幅度比(DAR)。各区域光密度间差异采用方差分析,角膜生物力学各项参数与各区域光密度的相关性采用Pearson或Spearman分析。结果:不同直径范围、不同层面间光密度有差异(F=35.101,P<0.01;F=1002.897,P<0.01),CBI与独立生物力学参数中AP2L、AP2V、PD、DA、SP、IR、ARTh、DAR具有相关性(rs=-0.502,P<0.01;rs=-0.457,P=0.001;rs=0.428,P=0.002;rs=0.539,P<0.01;rs=-0.687,P<0.01;rs=0.716,P<0.01;rs=-0.728,P<0.01;rs=0.750,P<0.01)。CBI与角膜0~2mm范围内光密度呈正相关(r=0.343,P=0.015)。0~2mm范围内光密度与独立生物力学参数中AP2L、IR、ARTh、DAR有相关性(rs=-0.298,P=0.035;rs=0.368,P=0.009;rs=-0.419,P=0.002;rs=0.493,P<0.01)。结论:角膜中央区域光密度与角膜生物力学具有显著的关联,临床中可以通过光密度和生物力学对角膜健康状况进行综合评价。     

角膜基质透镜在角膜溃疡或穿孔修复中的应用

目的：研究由全飞秒激光SMILE手术所得的角膜基质透镜作为角膜移植材料治疗角膜溃疡的临床疗效。

方法：回顾性病例研究。收集本院2017-01/06角膜溃疡患者6例6眼,其中细菌性、真菌性、深层异物伴感染各1例1眼,角膜穿孔3例3眼。采用由全飞秒激光SMILE手术所得的角膜基质透镜作为角膜移植的材料进行修复手术,确保植片与角膜层间无空气间隙。术后随访1～6(平均3.71±1.56)mo,观察手术前后视力、角膜移植物存活情况及术后并发症发生情况等。

结果：所有患者均在控制感染下顺利完成手术,无术中并发症。术后所有角膜植片透明。末次随访时,患者最佳矫正视力(best corrected visual acuity,BCVA)较术前明显改善(0.48±0.12 vs 1.50±0.08),差异具有统计学意义(P<0.01)。

结论：来源于全飞秒激光屈光手术的角膜基质透镜用于角膜溃疡修复是安全有效的,但植片的远期疗效尚需进一步观察。     

Alcohol delamination of the corneal epithelium for recurrent corneal erosion syndrome

AIM: To evaluate the outcomes of alcohol delamination (ALD) of the corneal epithelium for the treatment of recurrent corneal erosion syndrome (RCES) and to implement a standardized treatment protocol for this condition utilizing evidence based practice and the findings of an internal audit. METHODS: A retrospective analysis of 42 eyes of 40 patients diagnosed with RCES who were treated with ALD between January 2006 and March 2016 was conducted. Patients had 20% alcohol applied to the cornea with the use of a well for 40s. Patients were reviewed one week later in the Outpatient Department. Outcome criteria were established based on standards from other studies in the medical literature. These included, a treatment success rate of at least 72% (defined as complete resolution of symptoms one month after treatment), a postoperative complication a rate of <5% (mainly infective keratitis, and subepithelial haze), and the absence of any detrimental effect on visual acuity in ≥95% of patients. RESULTS: The mean age at the time of ALD was 41.17±13.44y. Patients were followed for an average of 12.8±15.65mo. The majority were female (52.5%, n=21) and the majority of eyes treated with ALD were left eyes (62.9%, n=26). Trauma was the primary aetiology in our study population. Treatment was successful in 73.8% (n=31) of eyes and in 75% (n=30) of patients. Recurrence occurred in 26.2% of eyes at a mean of 10.41±12.63mo post treatment. CONCLUSION: ALD is an efficacious and cost-effective primary surgical intervention for RCES.     

Orbscan-II角膜地形图仪与超声角膜测厚仪角膜测厚结果的对比分析

目的:探讨Orbscan-II角膜地形图仪与角膜测厚仪对角膜测厚的结果差异的统计学及临床意义。方法:选115例204眼(右104眼,左100眼)分别行Orb-scan-II及超声测厚法测量角膜厚度,经统计学检验后进行分析。结果:204眼Orbscan-II所得结果为527.20±37.83,超声测厚法所得结果为525.25±34.83,行配对t检验,t=2.407,P=0.017,认为两种测量方法结果的差异有统计学意义。进一步将角膜厚度分4组进行配对t检验,角膜厚度<500μm时,Orbscan-II测厚(478.36±14.47)与超声测厚(478.3±20.15)差异无统计学意义,角膜厚度≥500,<550μm时,Orbscan-II测厚(527.88±17.32)与超声测厚(525.32±12.92)差异有统计学意义(P=0.027),角膜厚度≥550,<600μm时,Orbscan-II测厚(571.24±14.89)与超声测厚(568.04±13.82)差异有统计学意义(P=0.022),角膜厚度≥600μm时,Orbscan-II测厚(615.33±8.50)与超声测厚(615.33±14.29)差异无统计学意义。结论:传统的超声测厚与Orbscan-II对角膜测厚结果有一定差异,并具统计学意义,但在临床意义上二者仍有较好的相符性。     

配戴软性角膜接触镜对角膜中央厚度影响的临床研究

目的:探讨配戴软性角膜接触镜对中央角膜厚度的影响。方法:应用超声角膜测厚仪检测中央角膜厚度,在我院近视患者中随机抽取配戴软性角膜接触镜者及不戴镜者各100例200眼,做统计分析。再在近视患者中按戴镜时间<1a,1～3a,3～5a,5～7a,≥7a分组,每组随机抽取60例120眼,做统计分析。结果:配戴软性角膜接触镜者与不戴镜者的角膜厚度比较,差异有统计学意义(P<0.05)。戴镜时间<1a,1～3a,3～5a,5～7a者的角膜厚度比较,差异有统计学意义(P<0.05)。结论:配戴软性角膜接触镜者平均中央角膜厚度薄于不戴角膜接触镜者,并且配戴软性角膜接触镜的时间越长中央角膜厚度越薄。     

角膜内皮炎的角膜内皮细胞形态改变

目的探讨角膜内皮炎对患者中央角膜内皮细胞形态的影响。方法用EM-1000型接触式角膜内皮镜对10例单眼角膜内皮炎愈后4-12周的患者的双眼分别摄取中央角膜内皮像并对其图像进行电脑分析。患眼作为实验组。健眼作为对照组。观察其角膜内皮细胞密度。六角形细胞的百分比及异形性的变化。用计量资料配对设计的2样本均数的t检验进行统计分析（双侧检验，P〈0．01为统计学有差异）。结果在10例临床诊断角膜内皮炎愈后的患者中，中央角膜内皮细胞密度实验组平均为（1981±181）／mm^2。对照组平均为（2284±315）／mm^2。六角形细胞比例实验组平均为34％，对照组平均为43％．变异系数实验组平均为53％，对照组平均为45％．以上各项观察指标实验组与对照组之间在统计学上都存在显著性差异（P〈0．01）。结论角膜内皮炎对角膜内皮细胞造成损伤，导致严重的形态改变，在临床工作中应给予充分重视。[眼科新进展2007；27（2）：138-139]     

Construction of a full-thickness human corneal substitute from anterior acellular porcine corneal matrix and human corneal cells

AIM: To construct functional human full-thickness corneal replacements. METHODS: Acellular porcine corneal matrix (APCM) was developed from porcine cornea by decellulariztion. The biomechanical properties of anterior-APCM (AAPCM) and posterior-APCM (PAPCM) were checked using uniaxial tensile testing. Human corneal cells were obtained by cell culture. Suspending ring was designed by deformation of an acupuncture needle. MTT cytotoxicity assay was used to check the cytotoxicity of suspending ring soaking solutions. A new three-dimensional organ culture system was established by combination of suspending ring, 48-well plate and medium together. A human full-thickness corneal substitute was constructed from human corneal cells with AAPCM in an organ coculture system. Biochemical marker expression of the construct was measured by immunofluorescent staining and morphological structures were observed using scanning electron microscopy. Pump function and biophysical properties were examined by penetrating keratoplasty and follow-up clinical observations. RESULTS: There were no cells in the AAPCM or PAPCM, whereas collagen fibers, Bowman’s membrane, and Descemet’s membrane were retained. The biomechanical property of AAPCM was better than PAPCM. Human corneal cells grew better on the AAPCM than on the PAPCM. There was no cytotoxicity for the suspending ring soaking solutions. For the constructed full-depth human corneal replacements keratocytes scattered uniformly throughout the AAPCM and expressed vimentin. The epithelial layer was located on the surface of Bowman’s membrane and composed of three or four layers of epithelial cells expressing cytokeratin 3. One layer of endothelial cells covered the stromal surface of AAPCM, expressed Na+/K+ATPase and formed the endothelial layer. The construct was similar to normal human corneas, with many microvilli on the epithelial cell surface, stromal cells with a long shuttle shape, and zonula occludens on the interface of endothelial cells. The construct withstood surgical procedures during penetrating keratoplasty. The corneal transparency increased gradually and was almost completely restored 7d after surgery. CONCLUSION: AAPCM is an ideal scaffold for constructing full-thickness corneal replacement, and functional human full-thickness corneal replacements are successfully constructed using AAPCM and human corneal cells.