穿透性角膜移植的内皮细胞变异分析

目的 :探讨穿透性角膜移植的供眼角膜内皮细胞变异情况及影响其变异的因素。方法 :用角膜内皮显微镜对穿透性角膜移植 44只眼的供眼及术后移植片行内皮细胞摄相分析。并用超声角膜测厚仪测量供眼角膜及术后移植片厚度。结果 :术后 2～ 6周、 3～ 6月、 7～ 12月及 1 5～ 2年的内皮细胞丧失率分别为 12 98%、 2 2 2 3 %、 2 7 2 6%及 2 9 78%。平均细胞面积由术前的 44 5 13 μm2 增加到术后 1 5～ 2年的 65 4 42 μm2 ,细胞大小变异系数 (CV值 )由 43 2 4%增加到 64 76% ,六角形细胞比例由 45 2 6%下降到 2 7 18%。单纯穿透性移植组与穿透性移植联合手术组术后 1 5年～ 2年的细胞丧失率、平均细胞面积、CV值和六角形细胞比例均有显著性差异 (P <0 0 5 ) ,但移植片厚度无显著性差异 (P >0 0 5 )。结论 :穿透性角膜移植后供眼角膜内皮细胞密度逐渐减少 ,平均细胞面积和CV值均渐增大 ,六角形细胞比例渐变小。穿透性角膜移植联合手术比单纯穿透性移植的术后内皮细胞丧失率较高 ,平均细胞面积和CV值增大较显著 ,六角形细胞比例下降较大但移植片厚度无显著性差异。     

复杂性角膜穿孔伤角膜移植手术对植片内皮细胞的观察研究

目的探讨复杂性角膜外伤后穿透性角膜移植手术角膜植片内皮细胞的变化。方法用角膜内皮显微镜对穿透性角膜移植联合手术12例（12眼）的术后移植片行内皮细胞摄像分析,并用超声角膜测厚仪测量术前供体角膜及术后移植片厚度。结果穿透角膜移植术后远期角膜内皮丧失率为34．98％,平均细胞面积明显增大,变异系数也明显增大,六角形细胞比例下降,但植片的厚度在正常范围内。其中11例移植片保持透明,表明多数未发生内皮细胞功能失代偿。结论穿透性角膜移植在严格掌握适应证的情况下是一种安全的方法,虽然移植片内皮细胞各种指标变化较大,但其厚度正常,透明成功率较高,所以穿透角膜移植联合手术仍不失为治疗复杂性角膜穿孔伤的良好办法。     

Transfer of bacterial infections by donor cornea in penetrating keratoplasty.

A 45-year-old man died of Hogdkin's disease complicated by peritonitis and possible septicemia. His corneas were used for transplant in a 26-year-old man with advanced keratoconus and a 42-year-old man with vascularized central leukoma of old herpetic keratitis. Both recipients developed a fulminating endophthalmitis with Pseudomonas aeruginosa. We believe that the donor corneas, although clinically normal, were heavily infected, with signs of inflammation possibly suppressed by the Hodgkin's disease.     

角膜不同保存方法与术后免疫排斥反应相关性的比较研究

目的：探讨角膜不同保存方法与术后免疫排斥反应的关系。方法：随机用Wistar大鼠30只作为供体,SD大鼠60只作为受体。建立角膜移植排斥反应动物模型。将SD大鼠随机分3组,各组分别使用不同保存方法的Wistar鼠眼为供体角膜。观察3组角膜移植术后排斥反应指数（RI）、植片存活时间（MST）和植片的病理变化。结果： MST湿房保存组（Ⅰ组）为10.4±1.70d,中期保存液保存组（Ⅱ组）为12.9±1.81d,深低温保存组（Ⅲ组）为16.1±2.57d。Ⅲ组MST明显延长,与其他两组比较均有显著性（P〈0.01）。角膜移植术后10d时HE 染色显示Ⅲ组炎性反应较Ⅰ组、Ⅱ组明显减轻。结论：深低温保存的大鼠角膜移植术后排斥反应发生率降低,发生时间延迟。     

用婴儿供体角膜行穿透性角膜移植治疗真菌性角膜溃疡

目的 观察用婴幼儿供体角膜行穿透性角膜治疗真菌性角膜溃疡的效果。方法 采用３岁以下（平均１．６岁）婴幼儿供体角膜行穿透性角膜移植治疗真菌性角膜溃疡２６例２６眼。结果 手术治愈率达９２．３％,植片透明率达８３．３％,视力获不同程度提高者７９．２％。结论 婴幼儿供体角膜具有材料易得及内皮愈合储备能力高的优点,穿透性角膜移植治疗真菌性角膜泪疡可以控制感染、缩短病程、提高视力及保全眼球。     

Corneal endothelium in penetrating keratoplasty

Specular microscopy of endothelium after corneal transplantation has often shown a sharp reduction in its number density immediately after surgery and long-term cell loss during the next three to four years in addition to continuous morphologic changes. We examined flat preparations of the endothelium of three corneal buttons removed three weeks, eight weeks, and 11 months after penetrating keratoplasty and compared them to similar preparations from the corneal rims of the respective donors. We did not find significant morphologic changes, and direct endothelial cell counts disclosed an endothelial cell loss of 3.8% at three weeks, 2.6% at eight weeks, and 5.6% at 11 months after keratoplasty. We believe the lack of endothelial cell loss and absence of morphologic changes in these specimens are direct results of our surgical technique.     

Decentration of donor cornea in mechanical and excimer laser trephination for penetrating keratoplasty

BACKGROUND AND PURPOSE: Decentration of the trephination is supposed to be one of the major reasons for high and/or irregular astigmatism after penetrating keratoplasty (PK). The purpose of this study was to assess the amount and direction of donor decentration with conventional mechanical and nonmechanical laser trephination. PATIENTS AND METHODS: In this retrospective analysis 106 consecutive mechanical donor trephinations from the endothelial side (mean diameter 7.30 +/- 0.79 mm), 80 mechanical donor trephinations from the epithelial side (mean diameter 7.30 +/- 0.77 mm), and 89 nonmechanical donor trephinations from the epithelial side (Aesculap-Meditec; spot profile 1.5 x 1.5 mm, pulse energy 18-20 mJ, repetition rate 25/s) along metal aperture masks (mean diameter 7.72 +/- 0.40 mm) were included. Remaining corneoscleral rims were fixed in formalin after trephination and photographed from the endothelial side. On colour prints (13 x 18 cm; total magnification x7.33) the amount and direction of decentration were assessed morphometrically using the SummaSketch (Summagraphics, Seymour, USA) and correlated with the total area of the cornea and the trephination. RESULTS: Mean donor decentration was significantly smaller with laser trephination (0.20 +/- 0.12 mm) than with mechanical trephination from the endothelial side (0.26 +/- 0.14 mm; p = 0.001) and from the epithelial side (0.27 +/- 0.16 mm; p = 0.024). In addition, donor decentration correlated significantly inversely with the trephination area (p < 0.001), but not with the total area of the cornea (p = 0.63). A preferred direction of decentration relative to the microsurgeon could not be detected (p = 0.87). CONCLUSIONS: Centration of donor trephination can be improved by using nonmechanical instead of mechanical trephination of the cornea. Further studies are required to investigate the clinical relevance of the statistically better donor centration on astigmatism and visual acuity after PK.     

Selective positioning of the donor cornea in penetrating keratoplasty for keratoconus: postoperative astigmatism

The final "sutures-out" astigmatism in patients who had undergone penetrating keratoplasty for keratoconus was evaluated for two groups of patients. Group 1 consisted of patients operated upon using the Troutman surgical keratometer but without giving attention to the orientation of the donor button in the recipient bed. Patients in Group 2 were also operated upon utilizing the surgical keratometer, but the donor button was rotated in the recipient bed until a position of apparent sphericity was indicated by the keratometer before suturing the graft. The mean final astigmatism was 4.42 +/- 1.85 D for Group 1 and 5.13 +/- 3.17 D for Group 2. The difference was not statistically significant. The results indicate that selective positioning of the donor button in an attempt to minimize astigmatism, as determined with a qualitative surgical keratometer, does not lead to a reduction in the final astigmatic error in patients undergoing penetrating keratoplasty for keratoconus.     

Leflunomide抑制大鼠角膜移植免疫排斥反应的研究

目的研究Leflunomide对大鼠角膜移植排斥反应的防治作用。方法建立大鼠穿透性角膜移植排斥反应的动物模型,观察Leflunomide对大鼠角膜植片存活和排斥反应指数（RI）的影响,并与阴性对照组和CsA治疗组相比较。结果阴性对照组角膜植片存活时间为12.375d±1.768d,而CsA组为17.375d±1.408d,Leflunomide组为18.250d±1.356d,均比阴性对照组显著延长（P<0.01）。结论Leflunomide能抑制大鼠穿透性角膜移植免疫排斥反应,显著延长角膜植片的存活时间。     

穿透性角膜移植排斥反应的免疫学机制

尽管角膜具有众多特殊的免疫赦免机制,但CD4+T细胞为主介导的角膜移植排斥反应仍是术后最常见的并发症.本文从高危角膜移植对免疫赦免状态的影响、角膜免疫机制的应答以及排斥反应的预防及治疗几个方面阐述角膜移植排斥反应的最新进展.     

前节OCT对角膜内皮移植术后植床和植片位置关系的评价

目的应用前节OCT（AS—OCT）对角膜内皮移植术（EK）术后植床和植片的位置关系进行观察。方法回顾性分析2007年9月-2009年4月北京大学眼科中心行角膜后弹力层剥除自动角膜刀取材内皮移植术（DSAEK）的患者42例（44眼）,其中男30例,女12例;年龄15～83岁。术前术后分别行裂隙灯显微镜和AS-OCT检查,对比观察DSAEK术后植片与植床间的位置关系。结果28例患者在裂隙灯显微镜和AS—OCT检查均可清晰地显示植片贴附于角膜后表面、植片位置居中;术后不同时间植片、植床的厚度处于动态变化,随着时间的推移,植床水肿逐渐消退,植片和植床越来越稳定,贴附得更紧密,厚度变得更薄,角膜透明度增加;早期植片完全脱位者5例,占11．36％;植片部分脱位者2例,占4．55％;植片巾央贴附良好,周围卷边者1例,占2．27％;植片偏位者8例,占18．18％。结论AS-OCT是评价EK术后植床和植片位置关系的有效工具。     

Pyogenic granuloma of the cornea after penetrating keratoplasty.

An 81-year-old man with metastatic prostate carcinoma underwent a penetrating keratoplasty for phlyctenular keratitis. Two years later he developed a fleshy, vascular mass in the superotemporal corneal graft wound, at the site of prior graft sutures. An excisional biopsy of the mass was performed to rule out metastatic carcinoma. Histopathological findings were consistent with pyogenic granuloma. To our knowledge there have been no prior case reports illustrating pyogenic granuloma as a late complication of penetrating keratoplasty.     

Melting of the recipient part of the cornea after keratoplasty

Four cases of melting of the recipient part of the cornea after cornea transplantation are described. Melting of the cornea has been reported in auto-immune diseases as for example: rheumatism and Sjögren's disease. As far as we know it has never been described after keratoplasty. The 4 patients had a history of many years of recurrent herpetic stromal disease. We describe the case histories of the patients and the possible causes of the phenomenon.     

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。     

穿透性角膜移植术中减少角膜内皮损伤的技术

探讨穿透性角膜移植术中减少角膜内皮损伤的方法。方法在２４例穿透性角膜移植手术中,采用多种保护角膜内皮的方法包括：剪取供体植片时前房注入１％透明质酸钠;内皮侧冲切植片;６针预置缝合后前房注入１％ＳＨ及ＢＳＳ以完全形成前房。