近屈光性缝合在角膜穿孔伤中的应用

目的 探讨应用显微手术及黏弹剂行角膜穿孔伤的近屈光性缝合的临床意义和价值。方法 68例不同程度的角膜穿孔伤,均通过显微技术及黏弹剂的近屈光性缝合,观察临床疗效。结果 手术均无严重并发症,视力与术前比较绝大多数有明显提高。结论 近屈光性缝合使角膜形成良好的解剖对位,减少了术后散光,提高了手术质量,对角膜穿孔伤的预后和功能恢复具有实用价值。     

角膜穿孔伤的屈光性缝合手术

目的　探讨角膜穿孔伤手术缝合中运用辅助手段减轻术后角膜散光 (屈光性缝合 )的方法。方法　术中采用黏弹剂、缩瞳剂、辅助切口及相应的缝合技巧 ;术后合理应用治疗性角膜软性接触镜。结果　 10 8例 10 9眼术后角膜创口愈合良好 ,瘢痕小 ,不规则散光减轻 ,其中 49眼术后健眼与患眼角膜地形图参数值显示差异无显著性意义 (P >0 .0 5 )。结论　角膜穿孔伤创口修复时采用相应的辅助手段能有效减轻术后角膜散光状态 ,重建原有的角膜外形     

黏弹剂在角膜穿孔伤术中的应用

目的:探讨黏弹剂在角膜穿孔伤手术中的重要作用.方法:回顾性分析32例32眼角膜穿孔伤修补术,其中单纯性角膜修补14眼,角膜修补+虹膜复位术18眼.结果:全部病例伤口均甲级愈合.术后视力0.05～0.25者7眼,0.3～0.5者18眼,0.6～0.8者7眼.结论:角膜穿孔伤修补术中应用黏弹剂,可有效建立前房操作空间,减少或避免手术时眼球进一步损害.     

黏弹剂在角膜穿孔伤修补术中的应用

目的 探讨黏弹剂在角膜穿孔伤手术中的重要作用.方法 回顾性分析52例(52眼)角膜穿孔伤修补术,其中单纯性角膜修补14眼,角膜修补 虹膜复位术18眼,角膜修补 白内障晶状体超声乳化摘出 人工晶状体植入术20眼.结果 全部病例伤口均甲级愈合.术后视力0.05～0.25者17眼,0.3～0.5者28眼,0.6～0.8者7眼.结论 角膜穿孔伤修补术中应用黏弹剂,可有效建立前房操作空间,减少或避免手术时眼球进一步损害.     

角膜穿孔伤虹膜复位48例体会

目的探讨角膜穿孔伤虹膜复位的方法。方法对48例角膜穿孔伤并虹膜脱出应用黏弹剂的充填、推压作用,散瞳剂及缩瞳剂的牵拉虹膜作用进行虹膜复位。结果48例均Ⅰ期愈合,无感染。瞳孔圆形或近圆形42例(87.50%),无虹膜缺损,3例轻度后粘连,1例轻度前粘连。均保存了较好视力。结论黏弹剂在角膜穿孔伤并虹膜脱出术中有助于形成前房,保护眼内组织,分离虹膜嵌顿及复位,利于缝合。散瞳剂及缩瞳剂有助于牵拉虹膜回纳前房进行复位,并减少虹膜前粘连。     

玻璃酸钠在角膜穿孔伤缝合术中的应用

目的探讨角膜穿孔伤缝合术中使用玻璃酸钠的效果。方法在32例32眼角膜穿孔伤缝合术中使用国产黏弹剂玻璃酸钠（正大福瑞达生产）形成前房，保护眼内组织，分离虹膜前粘连。结果术中前房深度稳定，脱出的虹膜易复位，角膜创口较易缝合，无医源性晶状体损伤，术后角膜创口关闭良好，前房形成，无虹膜前粘连。23例术后瞳孔圆，9例瞳孔变形部分虹膜缺损。结论玻璃酸钠在角膜穿孔伤缝合术中有助于形成前房，保护眼内组织，利于角膜创口缝合，能减轻眼科并发症，促进伤口愈合。     

角膜穿通伤近屈光性缝合临床报告

我们将1998年1月～2003年1月应用显微技术及粘弹剂行角膜穿通伤清创缝合术，对角膜伤口施行近屈光性缝合，获得满意疗效，现报告如下。     

黏弹剂在角膜穿孔伤修补术中的应用

目的　探讨角膜穿孔伤修补术中使用黏弹剂的效果。方法　对 63例角膜穿孔伤修补术中使用黏弹剂形成前房 ,维持眼压 ,分离虹膜前粘连 ,保护眼内组织。结果　术后 49例无虹膜前粘连 ,瞳孔圆 ;5例轻度虹膜前粘连 ,瞳孔牵引变形 ;9例瞳孔严重变形 ,部分虹膜缺损。结论　黏弹剂在角膜穿孔伤修补术中有助于形成前房 ,保护眼内组织 ,分离虹膜嵌顿 ,利于缝合。     

粘弹剂在角膜穿孔伤缝合术中的应用

角膜穿孔伤中最常见的并发症是虹膜脱出 ,而穿孔伤缝合术后 ,虹膜前后粘连影响虹膜正常复位。近年来 ,我们在角膜穿孔伤缝合术中应用粘弹剂 ,效果良好 ,现报告如下。1　临床资料1.1　一般资料　 1998年以来 ,我们共收治角膜穿孔伤 46例。男 38例 ,女 8例。年龄 5～ 48a,平均 2 4a。伤口 3～ 10 mm,均有不同程度的虹膜组织脱出与嵌顿。1.2　手术方法　常规消毒、麻醉 ,开睑器开睑 ,用庆大霉素盐水充分冲洗角膜伤口及脱出的虹膜组织。在角膜伤口下方缓慢注入玻璃酸钠使前房充盈 ,在保持前房的前提下 ,按一般原则处理脱出的虹膜。修整伤口后间…     

黏弹剂在角膜全层裂伤显微缝合术中的应用

目的:探讨黏弹剂在角膜全层裂伤显微缝合手术中的作用。方法:角膜裂伤患者146例146眼随机均分为试验组和对照组,试验组在进行角膜裂伤缝合术中,将适量黏弹剂注入前房,还纳脱出的眼内容物,精确对位缝合角膜伤口,对照组缝合过程中不应用黏弹剂。对比观察术后两组角膜散光度和虹膜前粘连发生率。结果:试验组2例(2.7%)发生轻微伤口处虹膜前粘连,对照组26例(35.6%)虹膜前粘连且程度较重,两组间差异有统计学意义(P<0.05)。角膜散光度试验组平均为1.29±0.25D,对照组为2.43±0.39D,两组之间术后角膜散光度差异有统计学意义(P<0.05),试验组角膜散光明显小于对照组。结论:黏弹剂在角膜全层裂伤缝合术中具有重要的辅助作用,能有效分离眼内组织与伤口的粘连,使角膜缝合对位更精密,减少术后角膜散光及其它并发症的发生,有利视功能的恢复。     

The management of corneal trauma: advances in the past twenty-five years

Over the past quarter century, advances in our understanding of corneal anatomy, physiology, and wound healing have all played an integral role in the management of corneal trauma. As the etiologies of corneal trauma have changed, so has our understanding of the impact of injury on corneal function as it relates to visual rehabilitation. Numerous new classes of antibiotics, antiinflammatory agents, and tissue adhesives have emerged. Occlusive therapy has advanced from simple pressure patching bandage soft contact lenses and collagen shields. Surgical instrumentation, operating microscopes, viscoelastic substances, and suture materials have all improved the outcomes of corneal trauma repair. Improved understanding of the refractive properties of the cornea through topography and alternative suture techniques has helped us restore the natural corneal curvature and visual outcomes. Consequently, in the last quarter of this century our therapeutic approaches to cornea trauma, both medical and surgical, have improved.     

TGF-β2反义寡核苷酸对兔角膜基质创伤修复的影响

目的:探讨TGF-β2反义寡核苷酸对兔角膜基质成纤维细胞转化、增殖的作用,揭示其对角膜创伤修复的影响。方法:新西兰大白兔28只,双眼均制备角膜基质创伤模型,右眼为实验组,用浸有TGF-β2反义寡核苷酸的8-0薇乔缝线缝合角膜创口;左眼为对照组,用普通8-0薇乔缝线缝合角膜创口,分别于4,7,14,21d处死动物,取角膜后行免疫组化(α-SMA和PCNA)染色和电镜观察。结果:术后各时间段均发现,实验组α-SMA和PCNA阳性的成纤维细胞数明显少于对照组,但成纤维细胞的超微结构实验组和对照组比较无明显区别。结论:TGF-β2反义寡核苷酸可抑制兔角膜基质成纤维细胞转化、增殖,为调控角膜基质伤口修复提供了一个新的途径。     

纤维蛋白胶治疗兔大的不规则角膜穿通伤

背景 缝线缝合是目前标准的角膜穿通伤治疗方法,缝线缝合的缺点促使人们探索非缝合的手术方法,组织黏合剂是一种有前景的非缝合替代手术方法. 目的 探讨用纤维蛋白胶治疗兔大的不规则角膜穿通伤的效果.方法 18只清洁级健康白色獭兔,按照随机数字表法分成缝合组和黏合组,用15°角膜穿刺刀在角膜非瞳孔区形成V字形、总长度为6 mm的角膜全层穿通伤,缝合组和黏合组分别用10-0缝线对位间断缝合3～5针或用纤维蛋白胶联合临时缝线和治疗性绷带角膜接触镜治疗,每只兔均以右眼为实验眼,左眼为自身对照.比较2个组手术时间,并对术后裂隙灯显微镜观察结果进行比较,分别于术后1、3、8周行角膜组织病理切片评估2个组伤口的愈合修复情况.结果 黏合组的平均手术时间为(3.48±0.48) min,显著低于缝合组的(7.77-±1.30) min,差异有统计学意义(t=9.28,P＜O.01).术后裂隙灯显微镜观察发现,黏合组伤口愈合快且平整.角膜组织病理学检查发现,黏合组伤口愈合规则,炎症反应轻,无新生血管形成;而缝合组纤维排列不整齐,缝线周围有大量炎性细胞及巨噬细胞浸润,炎症反应较重,术后3周发现有新生血管形成.结论 与传统缝线相比,采用纤维蛋白胶联合临时缝线和治疗性绷带角膜接触镜的方法治疗兔大的不规则角膜穿通伤具有操作简单、手术时间短、术后刺激小、炎症反应轻、愈合时间短、伤口愈合规则、无新生血管形成的优点.     

超声乳化术角膜内皮细胞损伤的多因素分析

目的 探讨造成超声乳化联合人工晶状体植入术后角膜内皮细胞损伤的相关因素。方法 观察142例手术眼,分别记录：梗硬度、超声总能量、术前角膜内皮细胞密度、粘弹剂类型、撕囊方法、人工晶体状类型、麻醉方式。术后观察角膜内皮细胞变化,计算术后1周内和3个月后细胞损失率。应用SPSS统计软件进行多因素相关回归分析。结果 角膜内皮细胞损失率在术后1周内与核硬度、粘弹剂类型密切相关;在术后3个月与梗硬度和术前角膜内皮细胞密度密切相关。结论 为了减少超乳术对角膜内皮细胞的影响,有必要行角膜内皮细胞检查;提高手术技巧、稳定前房、减少能量和机械损失;选用良好的粘弹剂;有手术适应证的患者应尽早手术。     

Corneal wound healing in tenascin knockout mouse

PURPOSE: Tenascin (TN) is a large hexameric extracellular matrix glycoprotein that is expressed in developing organs and tumors. It has also been reported that TN is expressed in the embryonic cornea and during corneal wound healing. However, the role of TN in the cornea is not fully known. In this study, the role of TN in corneal wound healing was examined using the TN knockout (KO) mouse. METHODS: Two different injuries (a linear perforation wound and two 10-0 nylon suture wounds) were made separately on the corneas of both TNKO and congenic wild-type mice. The corneal wound healing was compared histologically, and the expression of TN and fibronectin (FN) on the injured cornea was examined immunohistochemically and by immunoblot analysis. RESULTS: Based on histologic analysis, there was no significant difference in the wound healing process between wild-type and TNKO mice in the linear incision experiment. However, the corneal stromata of TNKO mice were compressed prominently and devoid of migrating keratocytes in suture injury, which induced a more significant amount of TN than perforation wounds. Although FN expression on the sutured corneas of TNKO mice was upregulated during suture injury, the amount of FN protein was smaller than that of wild-type mice at the same time points after injury. CONCLUSIONS: In suture wounds, TN appears to enhance the amount of FN expression, and a lack of TN may impair stromal cell migration. TN plays a significant role in corneal wound healing, especially for wounds with mechanical stress.     

亲水性软性角膜接触镜在眼外伤治疗中的应用

目的：探讨治疗性亲水性软性角膜接触镜的适应证与效果。方法：对眼部化学烧伤与热烧伤所致的上皮缺损３３例３４眼、手术创伤等原因导致的大泡性角膜病变３０例以及角膜上皮剥脱６例７眼,角膜创口缝线刺激者１５例１５眼,及角膜小裂孔伤２例２眼等患者,用连续配戴治疗性亲水性软角膜接触镜治疗,联用抗生素眼药水、人工泪液和爱丽眼药水治疗。结果：化学与热烧伤后上皮缺损戴镜后治愈率为８２．４％,白内障手术创伤等因素影响,     

Deep lamellar keratoplasty by deep parenchyma detachment from the corneal limbs

AIM: To improve the deep lamellar keratoplasty technique. METHOD: For the easy and reliable perfomance of deep lamellar keratoplasty (DLKP), detachment of Descemet's membrane through the corneal limber flap was improved. To expose Descemet's membrane, the parenchyma was detached by hydrodelamination through a sclerocorneal flap made in the corneal limbs. The parenchyma was removed after the pseudochamber between it and Descemet's membrane was maintained with viscoelastic material. The corneal graft was placed with a running suture. 22 eyes were treated. RESULTS: Complete exposure of Descemet's membrane was obtained in 20 of the 22 eyes (91%). The membrane was perforated in five of the 22 eyes (23%) during surgery, and two of the 22 eyes (9%) were converted to penetrating keratoplasty. These two eyes developed keratoconus after acute corneal hydrops. CONCLUSION: Compared with the conventional procedure, this new method provides easy, reliable exposure of Descemet's membrane.     

Corneal topography for selective suture removal after penetrating keratoplasty

Twenty-nine suture removals from 20 eyes (21 patients) on which penetrating keratoplasty had been performed were analyzed in a nonrandomized consecutive study to evaluate the role of computer-assisted corneal topography in selective suture removal to reduce astigmatism. Topographic guidance for suture removal resulted in a net decrease in refractive and keratometric astigmatism in 21 of the 29 cases. The net reduction in astigmatism averaged 1.4, 0.9, and 1.0 diopters when measured by refraction, keratometry, and topography, respectively. The preliminary choice of sutures to be removed on the basis of refraction, keratometry, and inspection was changed in 20 of the 29 cases when information added by the topographic map was considered. Although many variables of suture removal remain unpredictable, computer-assisted corneal topography is a powerful means of describing corneal power after penetrating keratoplasty and is useful as a guide in selective suture removal for reduction of astigmatism.