真菌性角膜溃疡两种实验室诊断方法的比较

目的:寻找快速,简便、准确诊断真菌性角膜溃疡的实验室诊断方法。方法:采用角膜刮片取材,涂片后进行KOH湿片直接镜检法及丫啶橙荧光染色法同时检测140例临床疑似真菌性角膜溃疡患者的标本,对结果进行比较。结果:KOH湿片直接镜检法检测阳性率为71%,丫啶橙荧光染色法阳性率为86%,结果比较有统计学意义(P<0.05)。结论:丫啶橙荧光染色法简便,快速、准确,阳性率高,优于KOH湿片直接镜检法。随着目前国产荧光显微镜的日益普及,我们认为该方法为快速检出真菌的好方法,值得推广应用。     

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。     

干燥保存角膜穿透性移植治疗真菌性角膜溃疡

目的：观察以干燥保存角膜片进行穿透性角膜移植术治疗严重的真菌性角膜溃疡的疗效。方法：采用无水甘油保存的角膜片进行穿透性角膜移植68例,术后随访6月－5年。结果：68例中,67例经手术治疗后感染控制,植片存活。其中4例术后复发,经药物和再手术治愈。术后主要并发症有排异反应、继发性青光眼、大泡性角膜病变等。结论：对药物治疗无效的严重的真菌性角膜溃疡,穿透性角膜移植可有效去除病灶,控制感染,重建眼球,为二期光学角膜移植奠定基础。     

穿透性角膜移植治疗重症真菌性角膜溃疡效果观察

目的探讨穿透性角膜移植治疗重症真菌性角膜溃疡的临床效果。方法对重症真菌性角膜溃疡10例(10眼)行穿透性角膜移植术,随访3~6月。结果术后10眼感染全部得到控制,8眼植片透明,1眼行二次穿透性角膜移植,术后角膜透明。术后视力均比术前提高。结论穿透性角膜移植治疗真菌性角膜溃疡可有效地控制感染,改善视功能,效果较好。     

真菌性角膜溃疡的手术治疗

目的：评价板层角膜移植和穿透性角膜移植对真菌性角膜溃疡的治疗效果。方法：以无水甘油保存的角膜片或新鲜角膜材料,根据真菌性角膜溃疡的面积和深度的不同行板层角膜移植术和穿透性角膜移植术,板层移植术中手５％的碘酊烧灼植床表面,穿透性角膜移植术中应同时清除虹膜表面渗出物并以林格氏液冲洗。结果：３１例真菌性角膜溃疡的患者行板层或穿透性角膜移植术,２９例一次手术痊愈并获得良好视功能。２例复发,二次穿透性角膜移     

应用长期干燥保存角膜行板层角膜移植术治疗真菌性角膜溃疡穿孔

目的评价无水氯化钙长期干燥保存的角膜组织行板层角膜移植治疗真菌性角膜溃疡穿孔的临床效果。方法12例（12眼）真菌性角膜溃疡并穿孔者因无法获得有角膜内皮功能的角膜用于角膜移植,采用无水氯化钙干燥保存2年以上的角膜行板层角膜移植术,分析治疗的效果。结果12例（12眼）真菌性角膜溃疡穿孔病情得到控制,并均已脱盲。结论在无法获得新鲜角膜材料的情况下,应用长期十燥保存的角膜,对真菌性角膜溃疡并穿孔的病人行板层角膜移植有一定的临床价值。     

板层角膜移植术治疗真菌性角膜溃疡疗效分析

目的探讨板层角膜移植术治疗中、浅层真菌性角膜溃疡的手术适应证及临床疗效。方法67例（67眼）真菌性角膜溃疡经抗真菌药物治疗效果不满意者行板层角膜移植术,术后观察复发情况、角膜植片透明度及免疫排斥反应。结果术后随访6个月至2年,其中66例（66眼）术后有效控制了感染,植片透明,无排斥反应,术后视力提高至0.3-0.6。1眼真菌感染复发。结论板层角膜移植可有效治疗中、浅层真菌性角膜溃疡。     

角膜移植术治疗真菌性角膜溃疡临床报告

目的：探讨角膜移植术治疗真菌性角膜溃疡的手术适应证及其临床效果。方法：对临床上经刮片或共焦显微镜检查，确诊为真菌性角膜溃疡和疑为真菌性角膜溃疡患者，给予局部及全身抗真菌治疗，对病情不能控制，角膜溃疡直径≥7mm的患者55例，用甘油或干燥保存的角膜组织行角膜移植术，对术中取下的角膜做组织病理学检测。结果：随访3～6个月，55例(55只眼)均经一次手术有效控制角膜炎症，成功恢复角膜外形。视力有进步者48例，其中视力可达0．1～0．3者16例。55例真菌培养均阳性。经鉴定，镰刀菌属35例，曲霉菌属13例，烟曲菌属2例，孢子菌属2例，其它丝状菌属3例。共焦显微镜检查，显示出无损伤，快速，阳性率高的优点。结论：对真菌性角膜溃疡患者，及时应用甘油或干燥保存的角膜组织行手术治疗，不仅控制炎症，缩短病程，且为复明奠定基础，因此具有重要临床应用价值。     

病灶切除联合结膜移植治疗真菌性角膜溃疡

目的 探讨病灶切除联合结膜移植术治疗真菌性角膜溃疡的适应症及临床效果。方法 选择药物治疗无效病灶位于角膜中浅层的真菌性角膜溃疡患者28例，彻底切除病灶，依病灶大小自患眼角膜上方切取游离结膜瓣或带蒂结膜瓣缝合于植床。结果 治愈27例（96．43％），复发1例（3．57％），术后3月矫正视力0．02－0．05者6例；0．1－0．2者15例；≥0．3者8例。结论 该手术治疗真菌性角膜溃疡疗效肯定，对于中浅层溃疡，可替代板层角膜移植术。     

穿透性角膜移植术后并发真菌性角膜溃疡的护理

真菌性角膜溃疡是一种致盲率很高的感染性眼病。此病占感染性角膜疾病的1．9％。由于本病不易诊断且无特效的局部抗真菌药物，治疗较困难，往往使病人失明或角膜溃疡穿孔以致摘除眼球。而穿透性角膜移植术后并发角膜植片真菌感染更为凶险。现将护理体会总结如下。     

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.     

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.     

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.     

角膜中期保存过程中细胞凋亡的初步研究

目的 搪塞角膜中期保存过期中细胞凋亡现象,为改进角膜保存方法提供理论依据。方法采用Ｍ－Ｋ液、Ｍ－Ｋ＋ＥＧＦ液和Ｏｐｔｉｓｏｌ３种保存２液保存兔和人角膜,用光镜、电镜及Ｔ ＵＮＥＬ标记技术检测细胞凋亡发生情况。中保存液保持３、５、７天的兔角膜上皮、项质及内皮细胞层均可见细胞凋亡发生。结论细胞凋 角膜中期保存２过程中细胞失丧失的另外一种可能机制;细胞凋亡的发生对角膜中期保存效果存在一定的影响;表皮生长     

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。