组织工程化角膜支架的研究进展

近20年来,应用组织工程技术构建角膜组织——组织工程化角膜的构建取得了较大的进展。然而,能够广泛应用于临床的组织工程化角膜的构建仍不够完善。组织工程化角膜支架是构建组织工程化角膜的重要组成部分之一。探寻生物相容性好、可降解并具有足够生物力学强度的支架材料是组织工程化角膜研究领域亟待解决的课题。就组织工程化角膜支架的发展历程进行概括总结,评价不同支架材料的优缺点,拓展理想支架材料的研发视野,为可广泛用于临床的组织工程化角膜的研制提供信息。     

部分环状板层角膜移植治疗蚕蚀性角膜溃疡

目的 观察部分环状板层角膜移植治疗早期药物治疗无效的进展性蚕蚀性角膜溃疡的临床疗效.方法 回顾性系列病例研究.10例(11眼)常规给予局部及全身免疫抑制剂和对症治疗1周及以上、病灶不断扩散的蚕蚀性角膜溃疡患者,行部分环状板层角膜移植手术,角膜供体选自部分穿透性角膜移植术后残留的环形供体角膜.手术方法:采用7.75～8.00 mm的环钻在角膜中央压痕,在彻底切除病灶后,覆盖与病灶范围相同的供体角膜.随访6～36个月,观察患者的视力、角膜植片愈合时间及是否复发等.采用重复测量方差分析比较手术前后视力变化.结果 患者裸眼视力术后1个月平均提高(1.36±1.21)行,术后3个月平均提高(1.72±1.47)行,术后6个月平均提高(1.86±2.04)行;最佳矫正视力术后1个月平均提高(0.46±0.93)行,术后3个月平均提高(0.73±1.10)行,术后6个月平均提高(1.55±1.75)行.手术前后裸眼视力(F=5.630,P＜0.05)与最佳矫正视力(F=5.925,P＜0.05)差异均有统计学意义.术后患者角膜植片上皮平均愈合时间为(7.00±5.31)d;1例患者术后角膜植片上皮愈合不良,行羊膜移植术后20 d愈合;1例患者术后19个月复发,行二次部分板层角膜移植.所有患者随访期间未发生免疫排斥反应等并发症.结论 使用环形供体角膜的部分板层角膜移植能有效控制早期药物治疗无效的蚕蚀性角膜溃疡的发展,保存视轴区透明角膜,术后视觉效果良好,同时节约角膜供体材料.     

组织工程角膜研究和应用进展

中国角膜供体材料的严重缺乏导致众多的角膜盲患者不能通过角膜移植来复明仍是临床棘手的问题。近年来,细胞生物学、组织工程学和材料学的发展为替代人角膜材料开辟了更广阔的前景;而且以深板层移植和内皮移植为代表的成分板层移植的推陈出新从临床技术上有力地推动了组织工程角膜的研发。现就脱细胞角膜基质板层材料、上皮细胞和内皮细胞组织工程的基础研究和临床应用进展进行述评。     

55例眼表黑痣样肿物的临床及病理分析

目的：分析结膜和角膜表面黑痣样肿物的临床特征及组织病理学特点,并探讨其治疗方法。方法对2012年1月到2015年3月收治并经病理学证实的55例（55只眼）结膜及角膜表面黑痣样肿物患者的临床特征、病理类型、手术方法及治疗效果进行回顾性分析。结果55例结膜及角膜表面黑痣样肿物中,黑色素痣患者48例,恶性黑色素瘤7例。对55例患者行手术切除联合术中冰冻病理控制切缘,且对7例恶性黑色素瘤进行术后局部和全身化疗。术后随访1年,48例黑痣复发2例,经再次手术切除联合病理检查显示为黑色素瘤。7例黑色素瘤中3例复发,及时切除后联合化疗效果稳定。结论通过对病理样本的病理学特征分析,有助于临床对眼表黑痣样肿物的诊断和治疗。     

角膜外伤修复中贝复舒应用的效果

目的：探讨贝复舒滴眼液在角膜外伤修复中应用的效果。方法：观察角膜外伤88例（88眼），随机分成治疗组，滴贝复舒滴眼液，44例，对照组，滴角膜宁滴眼液，44例，疗程2周，每天观察角膜缺损修复，荧光素角膜染色及眼局部症状等指标。结果：贝复舒治疗的有效率高于对照组（P＜0．05），有效率93．18％，未见局部刺激症状或严重不良反应。结论：贝复舒滴眼液有很强的促进角膜外伤修复愈合的作用。     

角膜层间烧灼术治疗大泡性角膜病变

目的 探讨角膜层间烧灼术对大泡性角膜病变的治疗效果.方法 对7例(7眼)大泡性角膜病变施行角膜层间烧灼术.结果 6眼角膜大泡完全消失,角膜无水肿,症状完全改善,1眼仍发生局部的大泡性病变,重复行角膜层间烧灼术后获得良好效果.结论 对于不能实行穿透性角膜移植术或角膜内皮移植术的大泡性角膜病变,视力严重受损,角膜刺激症状明显者,角膜层间烧灼术是一种有效的方法.     

角膜板层烧灼术治疗大泡性角膜病变

目的:观察板层角膜烧灼术治疗大泡性角膜病变(bullous keratopathy,BK)的手术疗效。方法:对12例12眼BK患者采用角膜板层烧灼术治疗,由老年性白内障囊外摘除后房型人工晶状体植入术后发病3例,白内障超声乳化术后发病4例,青光眼白内障联合术后1例,绝对期青光眼引起3例,眼外伤引起1例,术前眼部刺激症状明显,视力6例无光感,2例光感,光定位不准确,4例眼前手动。均行角膜板层切开,层间烧灼角膜实质层术。结果:术后1d,眼部疼痛等刺激症状缓解,刺激症状消失。术后5～7d裂隙灯下见角膜水肿减轻,上皮水泡消失。随访2mo～2a,术后视力由术前的光感及眼前手动提高至眼前指数及0.02,刺激症状消失。裂隙灯下见角膜层间有灰白色混浊。均未发现BK复发及并发症的发生。结论:此手术方法疗效肯定,可有效地控制BK的症状,防止BK的复发,患者创伤较小,治疗费用较低。是治疗BK可供选择的有效方法。     

Role of topical chemotherapy for primary acquired melanosis and malignant melanoma of the conjunctiva and cornea: review of the evidence and recommendations for treatment

Surgical excision with cryotherapy is a well-established treatment option for malignant melanoma or primary acquired melanosis (PAM) with atypia of the conjunctiva and cornea. Topical chemotherapeutic agents such as mitomycin C (MMC) however, are increasingly finding use in clinical practice. A search was performed of Medline and Pubmed databases for English language articles from 1980 to the present in this field. Relevant studies were reviewed with regards to treatment regimen, rates of recurrence and metastasis, side effect profile and length of follow up. A total of 22 and 16 unique cases of biopsy proven PAM with atypia and malignant melanoma, respectively, treated with topical MMC were identified. Topical MMC was well tolerated and shows considerable promise, particularly in the treatment of diffuse PAM with atypia. However, long-term data are lacking and further studies are required.     

羊膜移植联合角膜缘干细胞移植治疗严重眼烧伤

目的观察羊膜移植联合上下角膜缘干细胞移植治疗严重眼烧伤的效果。方法采用新鲜羊膜移植联合上下角膜缘干细胞移植治疗严重眼烧伤患者15例（17眼）。术后随访平均2月，观察其效果。结果视力大于0．05者12眼占70．59％，10眼角膜无明显新生血管，2眼角膜中央留有薄翳，12眼角膜稍有浑浊。17眼全部瘢痕愈合，眼表稳定。结论烧伤早期行羊膜移植联合上下角膜缘干细胞移植可明显减少睑球粘连并可使早期眼表稳定。     

部分板层角巩膜移植术治疗角膜皮样瘤的疗效分析

目的:观察部分板层角巩膜移植术治疗角膜皮样瘤的疗效。方法:我们对15例角膜皮样瘤进行了部分板层角巩膜移植术。术后随访6mo～4a。结果:所有病例术后外观明显改善。15例15眼中14例14眼角膜植片透明。只有1例术后2wk出现排异反应经治疗植片恢复透明。结论:部分板层角巩膜移植术是目前治疗角膜皮样瘤的一种较理想的治疗方法。     

角膜穿孔伤,外伤性白内障,人工晶状体植入联合手术临床观察

目的观察角膜穿孔伤合并外伤性白内障联合手术的效果。方法对13例施行角膜裂伤缝合加外伤性白内障现代囊外摘出及后房型人工晶状植入术。结果出院时矫正视力≥0.5者5例,0.1～0.4者5例,＜0.1者3例。结论此联合手术是治疗角膜穿孔伤合并外伤性白内障的有效措施。     

Surgical outcomes in correction of Brown syndrome

PURPOSE: To evaluate the outcomes of surgery for Brown syndrome. METHODS: We reviewed the charts of 15 patients who underwent surgery for Brown syndrome. The limitation of elevation in adduction (LEA) ranged from -2 to -4 degrees. A superior oblique muscle (SO) tenotomy was performed in 4 patients, a silicone expander was inserted in the SO of 9 patients, and a SO recession was performed in 2 patients. The results of surgery were analyzed with a follow-up period of more than 6 months, 42.3 +/- 48.42 months on average. RESULTS: Nine female patients and 6 male patients with unilateral Brown syndrome were selected for this study. The left eye was the affected eye in 9 patients. The degree of preoperative LEA was -2 to -4 in 4 patients in whom SO tenotomy was performed, -3 to -4 in 9 patients treated with the silicone expander, and -2 to -4 in 2 patients treated with SO recession. The LEA was released after surgery in all patients without postoperative adhesion. However, unilateral overaction of the inferior oblique muscle due to excessive weakening of the SO occurred in 1 patient with tenotomy (25%) and in 1 patient with insertion of a silicone expander (11%). CONCLUSIONS: LEA was released after tenotomy, insertion of a silicone expander and recession of the SO in 13 of 15 patients with Brown syndrome. SO palsy due to overcorrection and under-correction with postoperative adhesion should be avoided.     

角膜层间冷冻联合羊膜移植术治疗大泡性角膜病变的临床研究

目的探讨角膜层间冷冻联合羊膜移植术治疗大泡性角膜病变的临床效果。方法对10例大泡性角膜病变患者行角膜的层间分离并进行层间冷冻后再行羊膜移植术。结果所治病例角膜愈合良好,眼部症状减轻或消失,无不良反应。随访6～24mo,临床疗效稳定。结论角膜层间冷冻联合羊膜移植术能缓解大泡性角膜病变症状。是治疗大泡性角膜病变一种有价值的方法。     

36例重度角膜碱烧伤的治疗效果分析

目的 探讨重度角膜碱烧伤的早期处理方法。方法 回顾性分析我院1998年1月至2004年6月收治的36例(41只眼)重度角膜碱烧伤的治疗方法及效果,观察角膜上皮修复时间、角膜水肿消退情况及并发症发生情况。结果 1只眼因角膜穿孔并发眼内炎行眼球摘除,4只眼行结膜瓣转移遮盖,其余36只眼平均角膜上皮修复时间(8．56±4．62)天,视力不同程度恢复。随访6～12个月,12只眼不同程度角膜新生血管侵入,2只跟并发白内障,1只眼并发青光眼。结论 重度角膜碱烧伤的早期治疗应多措施并举,前房穿刺有利于恢复眼内组织的正常代谢;早期使用皮质类固醇激素有利于角膜水肿的消退,恢复角膜的透明性;羊膜移植可促进角膜上皮的修复,抑制角膜新生血管侵入,防止睑球粘连。     

Orbital malignant melanoma associated with nevus of Ota

Nevus of Ota (oculodermal melanosis) is a dermal melanocytic hamartoma with bluish hyperpigmentation along the first and second branches of the trigeminal nerve. Extracutaneous involvement, especially ocular, has been reported. A 45-year-old male presented with malignant melanoma of the left orbit in association with nevus of Ota. Being locally invasive, a modified exenteration with frontal flap repair was done on left eye. Adjuvant chemotherapy was given after wound healing. All pigmented lesions of the eye require close monitoring to help in the early diagnosis. Since malignant transformation has been reported in oculodermal melanosis, close follow-up and patient education will facilitate early diagnosis and prompt management. This case is reported for its rarity and unusual presentation.     

Blood staining of the cornea. Light microscopic and ultrastructural features

Eleven blood-stained corneas were examined by light and transmission electron microscopy at intervals ranging from one month to seven years after initial staining occurred. Blood staining in each case was associated with focal loss of endothelial cells or endothelial degenerative changes and elevated intraocular pressure. Globules of erythrocytic breakdown products penetrated the discontinuous endothelium and intact Descemet's membrane. Large deposits, primarily extracellular, displaced but did not interrupt the stromal lamellae. Keratocytes in blood-stained corneas contained erythrocytic breakdown products and hemosiderin, and were remarkable for extensive degenerative changes in contrast to keratocytes in areas of cleared cornea, which contained smaller amounts of hemosiderin and were relatively normal. After one year, clearing could be seen to involve peripheral and posterior stroma, and to a lesser degree, the anterior stroma. We found no evidence to support the contention that blood-derived macrophages play a role in the clearing of erythrocyte debris. The stereotyped pattern of peripheral, posterior, and anterior stromal clearing observed seems to be consistent with diffusion of hemoglobin breakdown products out of the cornea as the primary mechanism of clearing.     

角膜层间灼烙联合羊膜移植治疗疼痛性大泡性角膜病变

目的：：观察角膜层间灼烙联合羊膜移植治疗疼痛性大泡性角膜病变的手术疗效。方法：选取疼痛性大泡性角膜病( PBK )患者156例156眼(均为单眼),行角膜层间灼烙联合羊膜移植术,术后随访2~3mo,观察患者术眼疼痛症状、角膜上皮水泡、异物感、术后并发症等指标。结果：疼痛症状全部消失,角膜上皮不再出现水泡130例(83.3%);患者剧烈眼疼消失,但偶有异物感等不适,角膜上皮偶有小水泡24例(15.4%);术后2wk内角膜基质发生溶解,再行结膜瓣覆盖后治愈2例(1.3%)。结论：角膜层间灼烙联合羊膜移植术能解除98.7%的PBK患者的痛苦且手术操作简单,值得提倡。     

氯丙嗪球后注射联合角膜层间灼烙治疗绝对期青光眼

目的:探讨氯丙嗪球后注射联合角膜层间灼烙治疗绝对期青光眼的临床效果,以解除绝对期青光眼疼痛问题。方法:对29例(30眼)绝对期青光眼采用球后注射氯丙嗪,对伴发大泡性角膜病变者加用角膜层间灼烙术。结果:29例中14例仅采用球后注射氯丙嗪一种方法就达到止疼目的,15例(16眼)伴发大泡性角膜病变者,因球后注射未完全解除疼痛而加用角膜层间灼烙术后疼痛消失。结论:球后注射氯丙嗪治疗绝对期青光眼引起的疼痛是简单有效的方法,对合并大泡性角膜病变者,于第1次注射氯丙嗪后即需加用角膜层间灼烙术。