糖尿病性角膜病变

糖尿病性角膜病变 (ＤｉａｂｅｔｉｃＫｅｒａｔｏｐａｔｈｙ ,ＤＫ) ,是由Ｓｃｈｕｌｔｚ〔1〕在 2 0年前提出并命名的。糖尿病性角膜病变可分为两种 :原发性糖尿病性角膜病变和继发性糖尿病性角膜病变。原发性是指糖尿病本身引起的角膜病变 ,继发性是指糖尿病患者行眼部手术后引起的角膜并发症。重新认识糖尿病性角膜病变有重要意义。糖尿病对角膜的每一层结构均有重要影响。目前临床上 ,已发现糖尿病患者会出现许多角膜功能不良 ,如反复发作的角膜溃疡 ,持续性上皮缺损 ,角膜水肿 ,角膜敏感度下降 ,内皮荧光渗透增加等。一、原发性糖尿病…     

Ⅱ型糖尿病患者角膜细胞形态学特征的共焦显微镜观察

目的探讨II型糖尿病患者的角膜在共焦显微镜下各层细胞形态学特征。方法应用Confoscan3.0共焦显微镜对120例(146只眼)II型糖尿病患者和36例(36只眼)同年龄对照组的中央角膜进行检查,依据双目间接眼底镜和眼底荧光血管造影检查的结果,将糖尿病患者分为三组:糖尿病无眼底改变(NDRP)组、非增生性糖尿病视网膜病变(NPDR)组、增生性糖尿病视网膜病变(PDR)组,记录角膜各层细胞的图像,并对其进行分析。结果共焦显微镜下可以观察到糖尿病引起的角膜神经营养性上皮病变;和对照组比较,2型糖尿病患者角膜上皮下神经丛神经分支密度减少,神经纤维的密度在PDR组明显减少,NPDR组、NDRP组的减少不明显。角膜基质中形态异常的神经纤维在糖尿病组中出现的机率也明显高于对照组;角膜前基质细胞密度在PDR组有明显减少,后基质细胞在NPDR组和PDR组均明显降低,NDRP组减少不明显;糖尿病组的后弹力膜层病变表现为特征性的皱折形成;糖尿病各组角膜内皮细胞密度较对照组无显著性差异,但糖尿病各组的细胞面积变异系数高于对照组,六角形细胞所占的百分比在糖尿病各组均较对照组减少,且随着糖尿病视网膜病变的进展,六角形细胞的百分比亦逐渐减少,差异有统计学意义。结论共焦显微镜检查是一种有效、无创的角膜检查方法,糖尿病对角膜每一层结构均有重要影响,角膜上皮层、角膜神经、基质细胞密度、内皮细胞密度和形态均存在改变。     

糖尿病大鼠泪腺、结膜及角膜组织病理学观察

目的 探讨糖尿病造成的泪腺、角膜、结膜组织损伤。方法 雄性SD大鼠40只。随机分为糖尿病组和对照组，各20只。分别于成模后6、8、10、12周断颈处死大鼠，每组各5只。光镜下观察泪腺、角膜、结膜组织病理学改变。结果 糖尿病组随时间依次表现为泪腺细胞水肿、增生，腺泡及导管萎缩，纤维增生及淋巴细胞浸润，角膜上皮、基质层水肿，结膜杯状细胞减少。结论 糖尿病导致的泪腺、角膜、结膜等眼组织破坏是糖尿病性眼表病变的病理基础。     

大泡性角膜病变

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的。大泡性角膜病变患者不仅视力受到严重损害 ,而且在大泡形成的时候疼痛难忍、畏光、流泪 ,且有报道 〔1〕4 .7%的大泡性角膜病变发展为溃疡性角膜炎而延长治疗时间 ,是感染的危险因素。现就其病因及治疗方法综述如下。　　一、病因大泡性角膜病变的形成原因有以下特点 :角膜内皮功能损伤 ,角膜板层结构相对正常。按角膜内皮的损伤因素分析病因 :(一 )物理因素 :1.…     

全厚植片深板层角膜移植术的临床应用研究

角膜病是最常见的致盲性眼病之一,角膜移植术是角膜盲最重要的复明手术。角膜移植术是用健康的角膜替代病变混浊的角膜,目的在于恢复患眼视力或治疗某些难治性角膜病变,有时也为了先改善患眼的角膜基地条件或改变患眼的屈光和美容而行此手术,主要包括穿透性角膜移植术和板层角膜移植术两种。其中板层角膜移植术是指用相应厚度的健康板层角膜取代病变板层角膜,用于治疗未累及角膜厚弹力层和内皮细胞层的角膜混浊、角膜变性和角膜营养不良,又可分为     

糖尿病对眼表结构的影响

糖尿病是全身系统性疾病,可发生多种并发症,严重威胁人类健康.糖尿病性眼表病变包括结膜微血管瘤、干眼、角膜上皮损伤和角膜知觉减退等,这些疾病均可严重影响患者生活质量.糖尿病对眼表的破坏作用包括角膜神经损伤、角膜上皮结构和功能异常、泪液质和量改变、降血糖药物影响等四方面.     

自体板层角膜转位联合层间烧灼及羊膜移植术治疗大泡性角膜病变

目的 探讨自体板层角膜转位联合层间烧灼及羊膜移植术在大泡性角膜病变治疗中的临床效果.方法 选取大泡性角膜病变患者6例(6眼),均有明显刺痛、流泪症状.其中白内障术后3例;白内障术后继发青光眼1例:青光眼术后并发白内障1例:角膜异物取出术后1例.6例患者均行自体板层角膜转位联合层间烧灼及羊膜移植术治疗.结果 6例患者术后眼病等刺激症状基本消失,角膜上皮完整,随访3～12个月均未发现大泡性角膜病变复发及并发症出现,视力有轻度提高.结论 自体板层角膜转位联合层间烧灼及羊膜移植术可有效缓解大泡性角膜病变的症状,是解除视功能不佳的大泡性角膜病变患者临床症状的有效方法.     

高危人群眼病筛查:探索防治"可避免盲"新模式

国际防盲组织将眼科致盲性眼病分两大类,即可治愈盲与可避免盲.可治愈盲主要为眼前节疾病,如角膜混浊、白内障等,这些眼病通过手术可以治愈,这类致盲眼病随着医疗技术的提高,所占的比例愈来愈低.可避免盲主要为眼后节疾病,最常见的致盲眼病如青光眼、糖尿病性视网膜病变.这类眼病的特点是:早期无症状,视功能损失不可逆,目前没有治愈的方法,其防治的关键在于早期发现、早期诊断和早期治疗,预后取决于眼病发现的早晚.这类眼病是防盲的重点,深入社区在"健康人"中筛查是早期发现可避免盲眼病的关键.     

糖尿病眼部病变的近代认识

糖尿病是一种常见的内分泌-代谢障碍性疾病。近年来由糖尿病所致眼部病变的发生率不断增高,在美国糖尿病人的眼病发生率比正常人高5倍,糖尿病视网膜病变已成为第二位致盲原因。近年,国外学者对糖尿病的眼部病变进行了广泛深入的研究,特别是在荧光光度测定、角膜知觉改变、糖尿病视网膜病变的病因、分类及预后方面有明显的进展。     

2型糖尿病患者角膜知觉改变及其影响因素

目的 探讨2型糖尿病患者角膜知觉改变及其影响因素.方法 采用病例对照研究.采用Cochet-Bonnet角膜知觉测量仪分别测定并比较59例(59眼)2型糖尿病患者(糖尿病组)和43例(43眼)非糖尿病患者(对照组)右眼中央角膜知觉.分析糖尿病病程、糖化血红蛋白水平、周围神经病变与否及糖尿病性视网膜病变程度对糖尿病患者角膜知觉的影响.结果 糖尿病组角膜知觉(38.02±14.22)mm明显低于对照组(52.93±4.01)mm,(P＜0.01).糖尿病病程、血糖控制状况、周围神经病变及糖尿病性视网膜病变与角膜知觉减退相关(均P＜0.05).结论 糖尿病患者角膜知觉明显减退,病程长、血糖控制不佳、有周围神经病变及糖尿病性视网膜病变严重患者的角膜知觉减退更加明显.     

Neurotrophic keratopathy and diabetes mellitus

Diabetes mellitus is frequently associated with microvascular complications such as retinopathy, nephropathy, and peripheral neuropathy. Neurotrophic keratopathy occurs in response to a neuropathy of the ophthalmic division of the trigeminal nerve. Rarely has diabetic neurotrophic keratopathy been described. This paper discusses the ophthalmic histories of three patients who presented with diabetic neurotrophic keratopathy. In one patient the corneal ulceration was the sole presenting feature of his diabetes. We discuss the need for increased vigilance in the ophthalmic community for suspecting diabetes in patients with unexplained corneal epithelial disease.     

实验性糖尿病的角膜病理形态学研究

目的 探讨糖尿病造成的角膜组织损伤。方法 选取SD雄性大鼠20只，随机分为糖尿病组和正常对照组，每组各10只，前者以链脲佐菌素诱导成糖尿病模型。于12周取角膜，进行组织病理学、扫描电镜及透射电镜观察。结果 糖尿病大鼠角膜上皮和内皮层细胞水肿，胞浆内线粒体增多和肿胀，基质纤维排列紊乱。结论 糖尿病导致的角膜组织破坏是糖尿病性角膜病变的病理基础。     

The impact of sensory neuropathy and inflammation on epithelial wound healing in diabetic corneas

Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes, with several underlying pathophysiological mechanisms, some of which are still uncertain. The cornea is an avascular tissue and sensitive to hyperglycemia, resulting in several diabetic corneal complications including delayed epithelial wound healing, recurrent erosions, neuropathy, loss of sensitivity, and tear film changes. The manifestation of DPN in the cornea is referred to as diabetic neurotrophic keratopathy (DNK). Recent studies have revealed that disturbed epithelial-neural-immune cell interactions are a major cause of DNK. The epithelium is supplied by a dense network of sensory nerve endings and dendritic cell processes, and it secretes growth/neurotrophic factors and cytokines to nourish these neighboring cells. In turn, sensory nerve endings release neuropeptides to suppress inflammation and promote epithelial wound healing, while resident immune cells provide neurotrophic and growth factors to support neuronal and epithelial cells, respectively. Diabetes greatly perturbs these interdependencies, resulting in suppressed epithelial proliferation, sensory neuropathy, and a decreased density of dendritic cells. Clinically, this results in a markedly delayed wound healing and impaired sensory nerve regeneration in response to insult and injury. Current treatments for DPN and DNK largely focus on managing the severe complications of the disease. Cell-based therapies hold promise for providing more effective treatment for diabetic keratopathy and corneal ulcers.     

药物毒性角膜病变的研究进展

药物毒性角膜病变通常是指眼局部或全身应用药物所导致的角膜组织病理性改变。药物毒性角膜病变的产生是由于药物本身毒性或药物制剂中所含防腐剂的毒性所致。近年来，随着滴眼剂种类的增多、眼局部药物的滥用和滴药过度导致的药物毒性角膜病变在临床上不断增加。本文就近年关于药物毒性角膜病变的研究进展进行综述，以期为临床角膜疾病的诊断和治疗提供帮助。     

Non-enzymatic glycation in corneas from normal and diabetic donors and its effects on epithelial cell attachment in vitro.

BACKGROUND: Diabetic keratopathy manifests as persistent and recurrent erosions and delayed wound healing. To investigate the role of non-enzymatic glycation of proteins in the pathogenesis of diabetic keratopathy, we studied the presence of advanced glycation end products in corneas normal and diabetic donors, and the ability of human comeal epithelial cells to attach to non-enzymatically glycated extracellular matrix proteins. METHODS: Corneas from normal donors and donors with diabetes were sectioned and immunostaining was performed using a primary antibody that detects N(epsilon)-(carboxymethyl) lysine. Collagen I and fibronectin-coated tissue culture plates were non-enzymatically glycated by incubating with 500-mM glucose-6-phosphate for three weeks at 37 degrees C. To determine attachment corneal epithelial cells were allowed to adhere to glycated plates (1 to 4 hours, 37 degrees C). Non-adherent cells were removed by gentle washing and the number of attached cells was quantitated using Calcein-AM. RESULTS: Corneas from donors with diabetes showed more-intense immunostaining for N(epsilon)-(carboxymethyl) lysine than normal donors of similar ages. Non-enzymatic glycation of collagen I and fibronectin significantly reduced the ability of corneal epithelial cells to adhere to these extracellular matrix proteins. CONCLUSION: Our data suggest that non-enzymatically glycated proteins may interfere with attachment and hence migration of epithelial cells across the corneal surface, and therefore may contribute to some of the clinical manifestations of diabetic keratopathy. Diabetes leads to an accelerated aging process resulting in a cornea that may be much older than the chronological age of the patient. From a clinical perspective, particular care should be taken when considering the use of contact lenses and following corneal injury in these patients.     

Trends in the indications for penetrating keratoplasty in Shandong, 2005-2010

AIM: To identify the current indications and the trend shifts for penetrating keratoplasty (PKP) in Shandong. METHODS: The medical charts of all patients who underwent PKP at Shandong Eye Institute from June 1, 2005 to May 31, 2010 were analysed retrospectively. RESULTS: A total of 875 patients (875 eyes) received PKP in this 5-year period, accounting for 61.6% of all corneal transplantation surgeries. The leading indications for PKP were infectious keratitis (37.1%), HSK (19.1%), keratoconus (11.2%), bullous keratopathy (8.5%), regrafting (6.7%) and corneal scarring (4.8%). The percentage of PKP for keratoconus declined year by year, whereas the percentage of bullous keratopathy had a mild annual increase. Fungal infections accounted for 65.2% of the infectious keratitis cases, remaining the leading cause of corneal infection. In addition, 54.1% of bullous keratopathy cases were associated with cataract surgery. The leading initial diagnoses associated with regrafting were infectious keratitis (38.9%), HSK (18.6%) and corneal burn (16.9%). The major causes of regrafting included graft endothelial dysfunction (39.0%), graft ulcer (28.8%) and primary disease recurrence (15.3%). CONCLUSION: Infectious keratitis remained the leading indication for PKP in Shandong, and fungal infections were still the major cause of corneal infections. There was an increasing trend in the percentage of PKP cases indicated for bullous keratopathy but a decline in the same for keratoconus. Even with a decline in the overall proportion among all corneal transplantation surgeries, PKP is still the major corneal transplant choice in Shandong.     

Trends in the indications for penetrating keratoplasty in Shandong,2005-2010

AIM:To identify the current indications and the trend shifts for penetrating keratoplasty(PKP) in Shandong.METHODS:The medical charts of all patients who underwent PKP at Shandong Eye Institute from June 1,2005 to May 31,2010 were analysed retrospectively.RESULTS:A total of 875 patients(875 eyes) received PKP in this 5-year period,accounting for 61.6% of all corneal transplantation surgeries.The leading indications for PKP were infectious keratitis(37.1%),HSK(19.1%),keratoconus(11.2%),bullous keratopathy(8.5%),regrafting(6.7%) and corneal scarring(4.8%).The percentage of PKP for keratoconus declined year by year,whereas the percentage of bullous keratopathy had a mild annual increase.Fungal infections accounted for 65.2% of the infectious keratitis cases,remaining the leading cause of corneal infection.In addition,54.1% of bullous keratopathy cases were associated with cataract surgery.The leading initial diagnoses associated with regrafting were infectious keratitis(38.9%),HSK(18.6%) and corneal burn(16.9%).The major causes of regrafting included graft endothelial dysfunction(39.0%),graft ulcer(28.8%) and primary disease recurrence(15.3%).CONCLUSION:Infectious keratitis remained the leading indication for PKP in Shandong,and fungal infections were still the major cause of corneal infections.There was an increasing trend in the percentage of PKP cases indicated for bullous keratopathy but a decline in the same for keratoconus.Even with a decline in the overall proportion among all corneal transplantation surgeries,PKP is still the major corneal transplant choice in Shandong.     

Dr. P. Siva Reddy Oration. Diabetic keratopathy

Diabetes mellitus, which affects millions of people all over the world, produces significant ocular morbidity. Corneal complications such as tear film dysfunction, elevated glucose in tears, different forms of epitheliopathy, neurotrophic ulcers, corneal edema, wrinkles in Descemet's membrane and decrease in corneal sensitivity have been reported. While a few reports described altered epithelial morphology as the possible basis for epithelial disease, all other clinical phenomena have been unexplained thus far. In this first-ever multifaceted approach to study the pathogenesis of diabetic keratopathy, striking abnormalities were observed in corneal nerves, corneal epithelium and corneal endothelium of diabetics. We have clearly demonstrated the existence of neuropathy in diabetic cornea, both in an animal model and in the humans, -- the first demonstration of such an abnormality. Our in vivo specular microscopic observations on epithelium confirmed in vitro observations in our study as well as of others while the analysis of endothelium provided the basis for the problems noticed in the diabetic cornea following intraocular surgical procedures. Our observations should help the clinician in the understanding of diabetic keratopathy and in developing better prophylactic and therapeutic strategy against some recalcitrant forms of corneal disease in this group of individuals.     

角膜基质细胞生物学活性与角膜病变

角膜基质细胞是位于角膜基质层中平行排列的胶原纤维板潜在空隙内的扁平细胞。在正常的角膜组织中,角膜基质细胞处于相当稳定的状态。然而,在角膜病变中,角膜基质细胞在发病机制、病理过程及疾病转归中扮演了重要的角色。     

Collagen staining in corneal tissues

We adapted a previously described procedure to quantitate collagen in corneal tissue sections prepared from paraffin-embedded samples. The method entailed staining the deparaffinized tissue sections with Sirius red, eluting the bound dye with NaOH-methanol, and estimating the color in a spectrophotometer as an indication of the collagen content. This simple, rapid and reproducible method is comparable to biochemical assays and can be applied to study various corneal specimens readily available from eye pathology laboratories. We examined corneal sections from patients with aphakic bullous keratopathy, pseudophakic bullous keratopathy, Fuchs' dystrophy and lattice corneal dystrophy with this method. No significant difference in collagen staining was found between these pathologic specimens and normal control tissues. Biochemical assays also confirmed these findings. Sections from patients with macular and granular corneal dystrophies showed reduced staining suggesting a possible alteration in collagen content. This possibility, however, was not supported by data from biochemical analysis.