深板层角膜移植治疗角膜病的效果分析

目的探究角膜病患者采用深板层角膜移植的治疗方法和效果。方法选取2014年3月至2015年5月收治的41例角膜病患者进行治疗研究,随机分组,实验组28例患者采用深板层角膜移植治疗,对照组13例患者选择穿透性角膜移植治疗,对比两组患者的治疗效果,视力和并发症等。结果两组患者的视力术后都比术前得到明显提高,有统计学意义(P<0.05)。实验组患者的视力比对照组更好,但没有显著差异,无统计学意义(P>0.05)。实验组2例出现并发症,发生率为7.1%,对照组有4例出现并发症,发生率为30.8%,对照组患者的并发症发生率明显高于实验组,差异显著,有统计学意义(P<0.05)。结论角膜病患者好接受深板层角膜移植的治疗,视力可得到良好的恢复,减少并发症,内皮功能正常,很少有排斥反应,效果显著,值得推荐。     

准分子激光治疗仪和角膜板层刀的维护体会

准分子激光治疗近视、远视、散光,因其良好的稳定性、有效性、可预测性和安全性被广大的近视患者所接受。其中准分子激光仪和角膜板层刀性能的稳定性直接影响手术进程和手术后的效果,因此,对准分子激光仪和角膜板层刀的维护就很重要。     

深板层角膜移植术临床疗效观察

为观察角膜内皮功能正常的角膜盲患者行深板层角膜移植术的增视效果及脱盲比例,探讨深板层角膜移植术的临床应用适应证及手术技巧,采用角膜基质层间注入生理盐水或2%甲基纤维素等多种分离方法对内皮功能正常的角膜基质病变患者行深板层角膜移植术28例(28只眼),术后短期应用激素3个月,随访1年。结果表明,28例中24例植片透明,4例角膜半透明。最佳矫正视力0.5以上的20例,0.3以上的5例,0.1以上的3例。28只眼全部脱盲。结论:深板层角膜移植术具有安全、并发症少的优点,由于植片和植床间对合良好,光学效果好,可达到治疗和增视的双重目的。     

角膜板层刀制瓣联合自体血浆注射治疗大泡性角膜病变的疗效观察

目的观察角膜板层刀制瓣联合自体血浆注射治疗大泡性角膜病变的疗效。方法对8例大泡性角膜病变的患者采用Moria角膜板层刀制瓣联合自体血浆注射治疗,观察术后角膜瓣愈合、上皮及基质修复情况及视力变化。结果 8例患者术后眼部疼痛等刺激症状均消失,上皮修复,角膜基质水肿消失,3例术后视力不同程度改善,随访2m～12m均未发现复发。结论角膜板层刀制瓣联合自体血浆治疗治疗大泡性角膜病变手术操作简单、术后愈合快,可有效地控制症状、防止复发,是一种相对简单有效的手术方式。     

板层角膜移植的手术配合

随着显微手术技术和角膜材料保存方法的不断提高,板层角膜移植治疗角膜病变越来越多,我院自2000年以来,采用8～9个月胎儿供体全眼球甘油脱水保存角膜行板层角膜移植术共2例2眼均获成功,术后随访观察1年,角膜植片保持透明和半透明,视力较前明显提高,获得了较好的治疗效果.现报告如下.     

板层角膜移植联合羊膜移植治疗角膜溃疡22例

对于药物难以控制的感染性角膜溃疡,以及重症眼部烧伤导致角膜基质坏死,角膜移植是治疗及复明的有效手段,但由于不稳定的眼表环境,常常会因排斥反应、新生血管的形成等并发症,导致治疗效果并不理想。我们自2003年10月至2004年5月利用甘油保存的板层角膜及羊膜组织进行板层角膜联合羊膜移植手术治疗22例（22眼）角膜溃疡患者,随访3～6个月,获得较好的临床效果。现报道如下。     

大泡性角膜病变行板层角膜移植术治疗的护理

大泡性角膜病变(bullous keratopathy)是角膜失代偿的晚期表现。系指角膜上皮及实质层长期持续水肿,致使角膜上皮和上皮下形成水泡,它并非是单独的疾病,而是由多种眼病引起[1]。临床     

板层角膜移植加层间墨染手术的护理配合

目的 探讨24例板层角膜移植加层间墨染手术的护理配合.方法 通过术前充分的心里护理,使患者消除恐惧和焦虑心理.术中手术器械、手术仪器及物品按要求准备,正确保管角膜植片,协助医生熏烤黑烟时注意预防感染,术中配合需要医、护、患共同完成,术后立即对手术眼加绷带包扎.结果 24例患者手术顺利,无1例发生术后并发症.结论 充分的术前准备,严格的术中、术后管理是该手术配合的重点,也是防止术后并发症的关键.     

深板层角膜移植术与穿透性角膜移植术治疗圆锥角膜临床疗效的meta分析

目的:探讨临床研究中深板层角膜移植术(DLKP)和穿透性角膜移植术(PKP)治疗圆锥角膜的有效性与安全性。方法:应用循证医学的研究方法检索美国国立医学图书馆(PubMed数据库)、循证医学数据库(Cochrane library)、荷兰医学与文摘(EMbase.com)和中国知网(CNKI),对有关比较DLKP和PKP在治疗圆锥角膜方面临床疗效的随机对照与非随机对照试验进行方法学质量评价,并根据评价结果对临床随机对照研究进行Meta分析。统计分析采用RevMan5.0。结果:共纳入DLKP和PKP治疗圆锥角膜的临床对照研究14项(3137只眼),其中随机对照试验3项,非随机对照试验8项。在这11项研究中,结果显示,在术后视力方面,DLKP组最佳矫正视力(BCVA)达0.5及1.0以上的眼数较PKP组少,且DLKP组术后残余屈光不正的等效球镜度数较PKP组更偏向于近视,而术后散光情况两组无显著差异;在保护角膜内皮方面,DLKP组术后平均角膜内皮细胞计数显著多于PKP组;在移植排斥反应方面,DLKP组术后总移植排斥反应发生率较PKP低,尤其是内皮型移植排斥反应,DLKP组基本不发生。结论:根据目前现有的研究资料表明,尽管PKP在术后最佳矫正视力和屈光力方面有一定优势,但DLKP术后发生内皮型排斥反应和内皮衰竭的几率低,安全性更高。因此,DLKP为治疗轻、中度圆锥角膜提供了一个安全有效的手术选择方式。     

植床带周边后板层的大植片穿透性角膜移植术临床观察

目的评价植床带周边后板层的大植片穿透性角膜移植术的临床疗效。方法24例24眼用植床带周边后板层的大植片穿透性角膜移植术为改良组,57例64眼用常规大植片穿透性角膜移植术为对照组,两组对照观察。结果1、视力：两组无差别。2、并发症：改良组术后浅前房1眼（4.2%）、虹膜前粘连2例（8.3%）、继发青光眼2例（8.3%）;对照组术后浅前房22眼（34.4%）、虹膜前粘连21例（32.8%）、继发青光眼22例（34.4%）。改良组并发症比对照组低（P〈0.05）。结论植床带周边后板层是大植片穿透性角膜移植术有效的改良方法。     

冷冻干燥羊膜移植联合板层角膜移植治疗蚕蚀性角膜溃疡

目的观察冷冻干燥羊膜移植联合板层角膜移植在蚕蚀性角膜溃疡中的临床应用及效果。方法对12例12眼蚕蚀性角膜溃疡进行板层角膜移植术及病灶临近球结膜、球筋膜切除后进行羊膜移植术。结果术后12例患者临床症状全部消失．随访一年以上，无一例复发。结论冷冻干燥羊膜移植联合板层角膜移植治疗蚕蚀性角膜溃疡，可显著降低术后病变复发率，有较好的临床效果。     

板层植片与全厚植片在板层角膜移植术后屈光状态对比观察

目的 研究板层植片与全厚植片术后的屈光状态及探讨提高矫正视力及视觉质量的方法.方法 板层角膜移植术患者55例(55眼),随机分为2组,试验组(28例28只眼),采用全厚植片,术中仅去除内皮层及后弹力层;对照组(27例27只眼),采用普通板层植片.分别于术后3、6、9个月检查患者矫正视力、屈光状态、角膜地形图等资料.结果 2组术后3、6、9个月矫正视力、散光值比较,差异有统计学意义(P＜0.05).试验组角膜地形图发现角膜植片中央区曲率规整、角膜植床与植片层间愈合较好,完全透明,且角膜厚度各点均一.结论 在板层角膜移植术中,采用全厚角膜植片,能够最大程度的保持植片生理光滑面,有效的减少了瞳孔区的不规则散光,及浅层瘢痕形成,同时更加符合角膜中间薄周边厚的生理特点.     

3. 0 mm 透明角膜切口白内障超声乳化术后角膜散光的临床观察

目的 观察3.0 mm透明角膜切口白内障超声乳化术后角膜散光及角膜形态变化特点.方法 收集年龄相关性白内障患者53例（77眼）,实施3.0 mm透明角膜切口白内障超声乳化联合折叠人工晶体植入术.检查术前,术后3 d、1周、1个月、3个月的裸眼视力及行角膜地形图检查观察散光变化.结果 平均角膜散光度术后1个月较1周明显减少,两者比较有显著性差异,3个月与1个月比较无显著性差异,即1个月时视力明显提高且趋于稳定.结论 角膜地形图可准确全面反映白内障术后角膜形态变化.3.0 mm透明角膜切口白内障超声乳化联合折叠人工晶体植入术具有术后角膜散光小,视力恢复快等优点,是较理想的白内障手术切口方法.     

Ocular lamellar crystalline gels for sustained release and enhanced permeation of resveratrol against corneal neovascularization

Corneal neovascularization (CNV) is the major cause of blindness after eye injury; however, only several drugs can be applied and the invasive administration ways (i.e., intravitreal injection and subconjunctival injection) are used. Resveratrol is a highly effective anti-VEGF agent against CNV. However, its applications are limited due to its strong hydrophobicity and instability. Here, we developed a resveratrol-loaded ocular lamellar crystalline gel (ROLG) for high inhibition of CNV. ROLGs were composed of resveratrol, glyceryl monooleate (GMO), ethanol, and water, and their lamellar crystalline structures were identified by polarizing light microscopy and small-angle X-ray scattering. High drug loading (4.4 mg/g) of ROLGs was achieved due to the hydrogen bonding between GMO and resveratrol. Resveratrol showed sustained release with 67% accumulative release in 7 h, which was attributed to the slow erosion of gels. Resveratrol in ROLGs had a high corneal permeation 3 times higher than resveratrol in hyaluronic acid suspensions (RHSs). ROLGs were administered to rats only once a day because of their strong retention on the cornea surface. ROLGs were safe due to the very little contact of ethanol in ROLGs to the cornea. CNV post-rat corneal alkaline injury was highly inhibited by ROLGs, resulting from the attenuation of corneal VEGF expression and then corneal healing was improved. The ROLG was a promising ocular medicine for the prevention of CNV.     

Intraoperative corneal thickness measurements during corneal collagen cross-linking with isotonic riboflavin solution without dextran in corneal ectasia

Objective: To monitor the changes in corneal thickness during the corneal collagen cross-linking procedure by using isotonic riboflavin solution without dextran in ectatic corneal diseases.

Materials and Methods: The corneal thickness measurements were obtained before epithelial removal, after epithelial removal, following the instillation of isotonic riboflavin solution without dextran for 30?min, and after 10?min of ultraviolet A irradiation.

Results: Eleven eyes of eleven patients with progressive keratoconus (n?=?10) and iatrogenic corneal ectasia (n?=?1) were included in this study. The mean thinnest pachymetric measurements were 391.82?±?30.34?µm (320–434?µm) after de-epithelialization of the cornea, 435?±?21.17?µm (402–472?µm) following 30?min instillation of isotonic riboflavin solution without dextran and 431.73?±?20.64?µm (387–461?µm) following 10?min of ultraviolet A irradiation to the cornea.

Conclusion: Performing corneal cross-linking procedure with isotonic riboflavin solution without dextran might not induce corneal thinning but a little swelling throughout the procedure.     

Epidermal growth factor receptor in corneal damage: update and new insights from recent reports

Agonist and antagonist drugs acting on epidermal growth factor receptor (EGFR) signaling are emerging as a new possibility for pharmaceutical study and clinical manipulation of some skin and corneal disorders. EGFR activation appears to be effective in reducing the time of reepithelialization after corneal wound healing, with potential uses in penetrating keratoplasty, refractive surgery, alkali burns, diabetic keratopathy, keratopathy following chemotherapy, cornea transplantation, and dry eye. Most of the studies show therapeutic advantages of human recombinant epidermal growth factor (hrEGF) eye drops without showing adverse effects. In contrast, EGFR inhibition delays epithelial cell proliferation and stratification during corneal regeneration.The aim of this review is to summarize the most seminal discoveries and recent advances so as to clarify the role of the EGFR system in corneal physiology and pharmacology. Epidermal growth factor eye drops could be a first-choice treatment for promoting regeneration in numerous epithelial defects in the medium to long term.     

Conjunctival and corneal ulceration associated with nicorandil

Context/Objective: To report an association between conjunctival and corneal ulceration and nicorandil therapy for angina.

Methods: Review of the literature and spontaneous reports collected at the National Registry of Drug-Induced Ocular Side Effects (Portland, Oregon), the FDA Spontaneous Reporting System (Bethesda, Maryland) and the World Health Organization’s Uppsala Monitoring Center (Uppsala, Sweden).

Results: Thirteen case reports of adverse ocular reactions were collected. Abnormal vision (5 reports), corneal ulcer (4 reports) and conjunctival ulcer (4 reports) were associated with nicorandil. Eight subjects were male and 5 female with an average age of 75.4?±?8.3 years. The average duration of therapy to development of the ADR was 30.4 days ±3 days. Eleven case reports had positive dechallenge and the patients fully recovered. The average dose was 21.6?mg daily.

Conclusion: Using WHO classification for adverse drug reactions, the association between nicorandil and conjunctival and corneal ulceration is “possible”. The case reports indicate that, if recognized, withdrawing nicorandil will lead to resolution of the conjunctival or corneal ulceration. Advanced age and accumulation of nicotinic acid in tissues may be contributory to the risk of developing ocular ulcerations from nicorandil.     

Epithelial healing in experimental corneal alkali wounds with nondiluted autologous serum eye drops

Purpose: To evaluate the effects of the topical application of nondiluted autologous serum on epithelial healing as an adjuvant therapy in rabbit corneal alkali wounds.

Methods: Central corneal alkali wounds were produced on the right eye of 16 rabbits, by a 60-second application of a 6-mm round filter paper soaked in 1 N sodium hydroxide (NaOH). One group of rabbits (n=8) was treated with non-diluted autologous serum, the other control group (n=8) was treated with physiologic saline, topically 4 times a day. The epithelial healing of the wounds was followed on a slit lamp with and without fluorescein staining daily for 1 week. On day 7, both corneas of each rabbit were excised and assessed histopathologically.

Results: A significant increase in the epithelial healing rate was observed in the autologous serum–treated corneas compared with the controls. Epithelial hyperplasia was noticed in specimens with thickened surface cells with multilayers, revealing disorganization in both groups. The autologous serum–treated epithelium showed a relatively well-organized appearance.

Conclusion: Nondiluted autologous serum eye drops could be used as an adjuvant therapy for promoting the epithelial healing process during the repair stage of corneal alkali wounds.     

碘酊烧灼联合药物治疗真菌性角膜溃疡的临床观察

目的观察碘酊烧灼联合药物治疗真菌性角膜溃疡的效果。方法37例真菌性角膜溃疡的患者随机分为治疗组21例和对照组16例,治疗组应用碘酊烧灼联合药物治疗,对照组单纯应用药物治疗,对两组疗效进行统计学分析。结果治疗组效果明显优于单纯药物治疗的对照组。结论碘酊烧灼联合药物治疗真菌性角膜溃疡疗效显著,经济安全,值得推广。