原发性青光眼对角膜内皮细胞的影响

目的比较不同类型青光眼和正常人的角膜内皮细胞平均密度和六角型细胞百分比变化,探讨不同类型青光眼对角膜内皮细胞的影响。方法选取60~75岁原发性青光眼患者,其中急性闭角型青光眼慢性期50眼,慢性闭角型青光眼96眼,开角型青光眼30眼,对照组为同年龄段的正常人378眼,测量记录角膜内皮细胞平均密度及六角型细胞百分比。测量数据用SPSS11.0进行统计学分析。结果同年龄段急性闭角型青光眼慢性期较对照组统计学有极显著性差异(P<0.01),慢性闭角型青光眼角膜内皮细胞平均密度较对照组统计学有显著性差异(P<0·05),开角型青光眼患者角膜内皮细胞平均密度较对照组无显著性差异(P>0·05),所有青光眼患者六角型细胞百分比较对照组均无显著性差异(P>0·05)。结论60~75岁急性闭角型青光眼慢性期、慢性闭角型青光眼患者的角膜内皮细胞平均密度较同年龄段的正常人下降,开角型青光眼患者角膜内皮细胞平均密度较正常人无明显变化,不同类型原发性青光眼对角膜内皮六角型细胞百分比无明显影响。     

原发性青光眼患者角膜内皮形态研究

目的研究原发性青光眼角膜内皮形态改变。方法住院原发性青光眼56例(89只眼),按诊断标准分为急性原发性闭角型青光眼(aPACG)、慢性原发性闭角型青光眼(cPACG)、原发性开角型青光眼(POAG)3组,同期住院白内障和正常人40例(40只眼)作为对照组。4组均用角膜内皮细胞计检查并用配套的计算机辅助测量分析系统对图象处理分析,指标有单位面积细胞密度、最小细胞面积、最大细胞面积、平均细胞面积、平均细胞面积的标准差、细胞面积的变异系数和六角形细胞所占比例。全部资料用社会科学统计软件包(SPSS)进行统计学分析。结果单位面积细胞密度对照组为(2876.32±257.85)cells.mm-2,显著高于原发性青光眼组。aPACG:(2607.36±431.97)cells.mm-2,P=0.041;cPACG:(2582.42±379.89)cells.mm-2,P=0.001;POAG:(2637.69±342.60)cells.mm-2,P=0.028。慢性原发性闭角型青光眼组的最大细胞面积、平均细胞面积、细胞面积的标准差均高于对照组(MAXP=0.005,AVEP=0.025,SDP=0.031)。结论原发性青光眼患者角膜内皮单位面积细胞密度明显低于正常人,差异有统计学意义;慢性原发性闭角型青光眼组的最大细胞面积、平均细胞面积、细胞面积的标准差均高于正常人组,差异有统计学意义。     

原发性青光眼对角膜内皮细胞影响的临床观察

目的探讨不同类型原发性青光眼对角膜内皮细胞的影响。方法采用Canon-2000非接触式角膜内皮显微镜,对69例(97只眼)年龄56～76岁原发性青光眼患者的角膜内皮细胞变化进行观察。测量记录角膜内皮细胞平均密度(ECD)及细胞面积(CA)。结果同年龄组急性闭角型青光眼角膜内皮细胞平均密度及细胞面积较对照组统计学有极显著性差异(P<0.01);慢性闭角型青光眼角膜内皮细胞平均密度较对照组统计学有显著性差异(P<0.05),细胞面积较对照组无显著性差异(P>0.05);开角型青光眼角膜内皮细胞平均密度及细胞面积较对照组统计学均无显著性差异(P>0.05)。结论原发性闭角型青光眼患者的角膜内皮细胞平均密度较同年龄段的正常人下降,急性闭角型青光眼患者的角膜内皮细胞面积较正常人增大。开角型青光眼患者的角膜内皮细胞平均密度及角膜内皮细胞面积较较正常人无明显变化。因此,术前减少青光眼发作次数及缩短高眼压持续时间,可能减少角膜内皮细胞的损伤和所带来的危害。     

原发性青光眼及高眼压症患者中央角膜厚度的比较研究

目的 探讨用超声角膜测厚仪测量的急性原发性闭角型青光眼、慢性原发性闭角型青光眼、原发性开角型青光眼、高眼压症及正常人中央角膜厚度(central corneal thickness,CCT)的差异.方法 临床病例对照研究.对2010年2月至2011年11月在承德医学院附属医院眼科应用超声角膜测厚仪测量62例(107只眼)的CCT值.急性原发性闭角型青光眼16例(18只眼)、慢性原发性闭角型青光眼14例(26只眼)、原发性开角型青光眼10例(19只眼)、高眼压症6例(12只眼)及正常人16例(32只眼).采用单因素方差分析及SNK-q检验行统计分析.结果 各组CCT值:急性原发性闭角型青光眼(548.44±30.46)μm、慢性原发性闭角型青光眼(522.70±50.39)μm、原发性开角型青光眼(546.32±22.85) μm、高眼压症(585.67±21.22) μm、正常人(536.38±26.53)μm.组间比较差异有统计学意义(F=7.661,P＜0.01).两两比较显示:高眼压症与原发性青光眼组及正常人比较,差异有统计学意义;原发性青光眼各组及正常人两两比较,差异无统计学意义.结论 与正常人及原发性青光眼相比,高眼压症CCT较厚;原发性青光眼CCT与正常人相比差异无统计学意义;CCT与原发性青光眼类型无相关性.     

角膜中央厚度对高眼压症和开角型青光眼眼内压测量值的影响

目的研究角膜中央厚度对高眼压症和原发性开角型青光眼病人的眼内压测量值的影响.方法对44例(88眼)临床诊断为高眼压症的患者,31例(61眼)原发性开角型青光眼患者及52例(104眼)与高眼压症患者屈光状态相近的正常人的角膜中央厚度及眼内压进行检测,用统计学方法比较3组的角膜中央厚度的差异及高眼压症患者的眼内压值与角膜中央厚度的相关关系.结果①高眼压症组的角膜中央厚度的平均值585.6±35.7μm明显高于原发性开角型青光眼(54.1±38.7μm)(P＜0.01)及正常对照组(535.5±29.4μm)(P＜0.01),而原发性开角型青光眼的角膜中央厚度与正常对照组相比无显著性差异(P＜0.05).②将高眼压症患者的角膜中央厚度与眼内压测量值进行简单线性相关分析,可见角膜中央厚度与眼内压测量值呈明显正相关,相关系数为0.636(P＜0.01).角膜中央厚度每增加50μm可使眼内压测量值升高约2mmHg.结论①高眼压症患者的角膜中央厚度明显大于原发性开角型青光眼和正常眼,高眼压症患者的角膜中央厚度与眼内压呈明显的正相关,提示高眼压症患者是由于角膜中央厚度高于正常范围而造成眼内压测量值的升高.②角膜中央厚度值可作为高眼压症及原发性开角型青光眼的诊断与鉴别诊断的重要依据.提示临床工作中,可将角膜中央厚度检测作为排除青光眼的常规检查手段.③当角膜中央厚度在520±50μm的范围内,眼压读数相对准确,如果角膜中央厚度超过570μm,眼压读数相应增高,这可能是高眼压症患者眼压测量值高于正常范围的重要原因之一.     

共焦显微镜观察青光眼患者角膜内皮细胞的变化

目的：利用共焦显微镜观察青光眼患者角膜内皮细胞密度及形态学变化,探讨角膜内皮细胞损伤原因,采取必要措施进行保护。
　　方法：选取不同类型青光眼患者97例143眼,与患者年龄相匹配的正常人20例40眼。采用共焦显微镜观察、测量角膜内皮细胞密度和细胞面积、细胞变异系数等各项指标,分析比较不同类型青光眼各组角膜内皮细胞各项测量指标的差异。
　　结果：年龄相匹配正常人组角膜内皮细胞密度2893.88±255.026个/mm2,急性闭角型青光眼组1674.11±683.95个/mm2,开角型青光眼组2687.22±391.87个/mm2,慢性闭角型青光眼组2706.97±351.27个/mm2。,在各项指标中,角膜内皮平均密度、平均面积均有统计学意义(F=62.950,8.795;P值均为0.000),其中尤以急性闭角型青光眼组与各组相比差异显著。
　　结论：急性闭角型青光眼发作眼角膜内皮细胞各项指标明显低于正常人。开角型与慢性闭角型青光眼角膜内皮细胞与正常人相比,有差别但不显著。眼压升高时限是损伤角膜内皮细胞主要因素。     

原发性急性闭角型青光眼和慢性闭角型青光眼角膜内皮细胞的形态学观察

目的观察原发性急性闭角型青光眼和慢性闭角型青光眼角膜内皮细胞的形态学特点及差异。方法应用非接触型角膜内皮细胞计测量眼压基本控制的18例原发性急性闭角型青光眼18只急性发作眼及对侧18只临床前期眼和20例（26只限）中晚期慢性闭角型青光眼中央角膜内皮细胞的单位面积细胞密度（CD），最小细胞面积（MIN），最大细胞面积（MAX），平均细胞面积（AVG），平均细胞面积的标准差（SD）和细胞面积的变异系数（CV），并进行对比分析。结果原发性急性闭角型青光眼急性发作眼组和对侧临床前期限组比较、原发性急性闭角型青光眼急性发作眼组和慢性闭角型青光眼组比较，中央角膜内皮细胞的单位面积细胞密度显著性减少（P〈0．01），最小细胞面积、最大细胞面积、平均细胞面积、平均细胞面积的标准差和细胞面积的变异系数均有显著性增加（P〈0．01）。结论急性增高眼压对角膜内皮细胞造成显著损害，细胞密度明显下降，细胞多形性增加，损害程度与急性增高眼压持续时间有关；急性增高眼压较慢性增高眼压对角膜内皮细胞的损害更大。     

急性闭角型青光眼手术后角膜厚度的改变

目的 研究急性闭角型青光眼第1次发作经抗青光眼手术治疗缓解后角膜厚度是否发生改变.方法 选择单眼急性闭角型青光眼第1次发作经手术治疗缓解者40例40眼,对侧未发作眼(40只)做为对照.通过手术眼压控制到正常范围2周后,以超声角膜测厚仪测量中央角膜厚度,采用配对t检验对发作眼和对侧眼的角膜厚度进行统计分析;结果就诊时患者症状持续时间1～3 d者占总例数的75.00%(30/40),眼压>60mmHg者(1 mmHg=0.133 kPa)占总例数的80%(32/40).发作跟测得中央角膜厚度平均为(531.24±33.08)μm,对侧眼为(538.29±30.53)μm.发作眼较对侧眼薄,差异有统计学意义(P<0.001).结论 急性闭角型青光眼的第1次发作经抗青光眼手术治疗后,发作眼中央角膜厚度较对侧眼薄.     

中央角膜厚度对压平眼压计测量值的影响

目的采用非接触式角膜内皮镜测量高眼压症与临床常见类型青光眼患者的中央角膜厚度central corneal thickness(CCT),并与正常人CCT平均值比较,探讨CCT对青光眼诊断、分类与治疗的指导意义.方法采用KONAN非接触式角膜内皮镜测量中央角膜厚度,Goldmann压平眼压计测量眼内压(IOP).将39例52眼原发性开角型青光眼(POAG),32例45眼慢性闭角型青光眼(CACG),18例29眼高眼压症眼(OHT),15例24眼正常眼压性青光眼(NTG),34例66眼可疑开角型青光眼(GS)的CCT和IOP值与173例322眼正常眼进行比较研究.所有资料输入计算机后在Windows操作环境下使用SPSS10.0统计软件进行统计分析.结果平均CCT值比较高眼压症(OHT)眼(600.21±24.20μm)＞POAG眼(574.37±31.92μm)＞正常对照眼(554.78±32.61μm)＞NTG眼(528.43±36.40μm).OHT、NTG、POAG眼与正常眼的CCT值有差异(F=9.629,P=0.000),CACG眼与POAG及正常眼CCT值均无差异(P=0.119).GS眼CCT值(564.72±31.96μm)较正常眼厚.CCT与IOP成直线正相关,眼压测量值的校正公式为眼压校正值(mmHg)=-(测得的角膜厚度μm-555μm)×(1/24).IOP经CCT校正后,OHT眼平均高估1.89mHg,NTG眼平均低估1.1mmHg,POAG眼平均高估0.80mmHg.根据经CCT校正后的IOP值,13.5%POAG眼重新诊断为NTG眼,34.5%OHT眼重新诊断为正常眼,16.7%NTG眼重新诊断为POAG眼.结论非接触式角膜内皮镜能准确地测量中央角膜厚度.OHT眼CCT较厚,而NTG眼CCT较薄.CCT测量对青光眼的分类与治疗有重要的指导意义,应作为OHT、NTG及GS的常规检查项目.     

急性闭角型青光眼对角膜内皮细胞的影响分析

目的观察角膜内皮细胞在急性闭角型青光眼中的形态变化。方法采用TOPCON-2000非接触式角膜内皮显微镜(含分析仪),对45例单眼发病的急性闭角型青光眼的住院患者,以健眼作对照眼,测量角膜内皮细胞变化情况。结果急性闭角型青光眼患者平均眼压54mmHg,平均持续时间73小时(范围3~528小时),受累眼角膜内皮细胞密度为(2390.01±435.56)个/mm2,显著低于对照眼(2769.07±343.35)个/mm2,发作眼角膜内皮细胞丢失率13.68%。患眼平均最大细胞面积(MA)、最小细胞面积(M IW)、平均细胞面积(AVE)、细胞面积标准差(SD)、细胞面积变异系数(CV)均较对照眼显著增加,六角形细胞百分率(6A)下降(P<0.05)。结论急性闭角型青光眼发作会显著引起角膜内皮细胞密度降低和角膜内皮形态学的改变,这种变化与高眼压持续的时间有关。     

Relationship Between Corneal Hysteresis and Corneal Resistance Factor with Other Ocular Parameters

Abstract

Purpose: To evaluate the relationship between corneal hysteresis (CH) and corneal resistance factor (CRF) with age, central corneal thickness (CCT), corneal curvature (KM), corneal volume (CV), and refractive error in naïve eyes. Methods: 105 healthy subjects (58 male and 47 female) were included in this study. The ages ranged from 19 to 82 years (mean 43.1?±?15.4 years) and refraction between ?11?D and +6?D (mean ?0.79?±?2.95?D). CH and CRF obtained with the Ocular Response Analyzer (ORA) were correlated with age, refractive error, Goldmann Applanation Tonometry (GAT), and with CCT, KM, CV obtained with the Pentacam, and with Corneal-Compensated Intraocular Pressure (IOPcc) and Goldmann-correlated intraocular pressure measurement (IOPg) obtained with ORA. A multivariable mixed effect model was used to evaluate associations among these parameters. Results: CH ranged from 6.9 to 14.6?mmHg (mean 10.26?±?1.49?mmHg); CRF ranged from 5.8 to 17?mmHg (mean 10.38?±?1.64?mmHg). Multivariate analysis showed a statistically significant correlation between CH with CCT (p?<?0.001), and KM (p?<?0.001), and between CRF with CCT (p?<?0.001) and GAT (p?<?0.001). Conclusions: Our findings support the hypothesis that CH and CRF are related to the corneal shape and thickness, and show a decrease of CH with age.     

A case of congenital corneal anesthesia with hypopyon in china

 PURPOSE: To report a case of congenital corneal anesthesia (CCA) associated with hypopyon and tactile hypoesthesia. METHODS: Case report. RESULTS: A 3-year-old girl presented with redness and mild photophobia in the left eye accompanied by corneal ulcer, hypopyon, and corneal neovascularization. Corneal sensation was reduced bilaterally. She exhibited an absence of normal response to painful stimuli. She also had extensive ulceration of the lateral borders and tip of the tongue. The left corneal biopsy revealed negative cultures for bacteria and fungi. She was treated with human amniotic membrane transplantation in the left eye. The response to treatment was good. CONCLUSION: This is the first case of CCA reported in China. CCA is often misdiagnosed as infectious keratitis. Amniotic membrane transplantation is effective in repairing the severe corneal ulcer which may be associated with CCA.     

Biomechanics and structure of the cornea: implications and association with corneal disorders

Recent studies have shown that alterations in corneal biomechanical properties are associated with corneal pathologies, particularly corneal ectasia. Moreover, these alterations may have implications with regard to the outcomes of therapeutic modalities and corneal refractive surgeries. We address corneal anatomy and its relevance to corneal biomechanical characteristics, as well as ocular and systemic conditions associated with changes in corneal biomechanics.     

A new multiple noncontinuous puncture (pointage) technique for corneal tattooing

AIM:To assess the safety and cosmetic efficacy of a new multiple noncontinuous transepithelial puncture technique for tattooing a decompensated cornea.METHODS:It was anon-comparative clinical case series study.The study examines 33 eyes in 33 patients with total corneal opacity due to corneal decompensation, which developed following intraocular surgery.Corneal tattooing was performed using the multiple noncontinuous transepithelial puncture technique (i.e. pointage). The safety of this new surgical strategy was assessed by occurrence of adverse events for the follow-up period. The cosmetic efficacy was determined by the patient’s cosmetic satisfaction and independent observer’s opinion about patient appearance.RESULTS:Seven women and 26 men were included in the study. The mean age was 46.4±17.5y (range:7-67). In total, 30 of 33 patients (91%) reported cosmetic satisfaction within the follow-up period. Only 3 patients (9%) required additional tattooing due to cosmetic unsatisfaction. Cosmetic outcomes were analyzed and classified as excellent or good in 13 (39%) and 17 (52%) patients, respectively. No serious adverse events developed, except delayed epithelial healing in 3 cases.CONCLUSION:The cosmetic outcomes of the multiple noncontinuous transepithelial puncture technique for corneal tattooing were good. The safety of this method is higher than conventional procedures. This new procedure also provides improved cost-effectiveness and safety over current corneal tattooing techniques.     

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。     

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.     

过夜配戴角膜矫形镜(OK镜)后角膜曲率及厚度变化

目的了解过夜配戴角膜矫形镜(OK镜)后早期角膜曲率、角膜厚度及屈光度的变化.方法14个中低度近视患者(平均屈光度-3.89±1.26D)25眼,随机分成2组分别配戴Dk值不同的角膜矫形镜BE角膜矫形镜组(7人12眼,Dk≈140);E&E角膜矫形镜组(7人13眼,Dk＝58).采用夜戴方式,平均配戴时间10.76±1.27小时.用Orbscan角膜地形图系统检查配戴1晚后角膜曲率、角膜厚度的改变.同时记录裸眼视力及屈光度的改变.结果配戴1晚后所有患者的中央及周边的角膜均增厚(P＜0.05).Orbscan角膜地形图SimK值在垂直轴及水平轴均变平(垂直轴△SimK0.94±0.56D,P＜0.001;水平轴△SimK0.996=0.68D,P＜0.001).裸眼视力平均提高0.4±0.24(P＜0.001).屈光度平均减少-1.85±0.82D(P＜0.001).Dk值不同的2组之间中央及颞上方位点角膜增厚程度的差别有统计学意义.结论过夜配戴角膜矫形镜后减低近视屈光度的效果明显.初次过夜配戴角膜矫形镜可导致角膜厚度轻度增加.     

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。     

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.