异体巩膜用于结膜囊成形的实验研究

目的 探讨异体巩膜在结膜囊成形中的应用。方法 18只新西兰大白兔随机分为6组，每组3只，每只兔行右眼球除＋义眼胎植入＋异体巩膜植入全结膜囊成形术。左眼局部球结膜切除，异体巩膜植入替代术。结果 结膜上皮可沿植片上生长，且移植片逐渐溶解吸收，被新生的结缔组织所取代，形成一个新的结膜囊。结论 异体巩膜能够作为支持物起支架作用，结膜组织附于其上生长并愈合形成新的结膜囊。     

异体巩膜用于无眼球结膜囊成形术的实验研究

目的　为异体巩膜结膜囊成形用于临床探索科学依据。方法　将经酒精灭活处理的兔保存巩膜进行兔部分结膜囊成形及全结膜囊成形术 ,对巩膜移植后的组织学变化进行光镜 ,电镜系统观察。结果　无论是光镜还是电镜均显示植入后 1～ 2周出现细胞反应阶段 ,2周～ 2个月为细胞浸润和纤维替代阶段 ,植入后 2～ 3个月出现瘢痕组织形成阶段。即异体巩膜在结膜囊成形术中开始作为支架 ,此后随着自身的溶解 ,同时也诱导自体新生结缔组织移入 ,最终被结缔组织完全替代 ,形成新的结膜囊。结论　异体巩膜用于结膜囊成形术方便、安全、可行     

异体巩膜用于无眼球结膜囊成形术的临床观察

目的：为结膜囊成形术提供一新材料。方法：临床上对32例无眼球伴有结膜囊狭窄的病人进行经基磷灰石眼台植入 异体巩膜结膜囊成形术。结果：临床上32例异体巩膜结膜囊成形术全部成功。由肉眼及裂隙灯下观察到早期巩膜起支架作用，术后半个月至5个月，巩膜开始溶解，结缔组织逐渐向巩膜表面增长，延伸，面积逐渐增大直至完全覆盖巩膜，形成新的结膜囊。即异体巩膜在结膜囊成形术中开始作为支架，此后随着自身的溶解，同时也诱导自体新生结缔组织移入，最终被结缔组织完全替代。结论：异体巩膜用于结膜囊成形术方便、安全。     

异体巩膜移植治疗结膜囊狭窄17例临床观察

目的 观察异体巩膜移植治疗结膜囊狭窄的临床效果.方法 对17例眼球摘除术后无法安装义眼的结膜囊狭窄患者行异体巩膜移植结膜囊成形术.结果 术后随诊6月至2年,10例手术术后能安装成品义眼,2例结膜囊水平径偏短的患者能配戴定制义眼片,对合并有眼窝凹陷的5例患者均二期行羟基磷灰石义眼台植入并配置合适的义眼片.结论 异体巩膜用于结膜囊成形术是一种使用安全、方便、制备保存容易的生物材料.     

羟基磷灰石义眼台眶内植入术临床观察

目的 观察巩膜包裹羟基磷灰石义眼台植入法的临床效果.方法 用白体或异体巩膜包裹义眼台后眶内植入.Ⅰ期用自体巩膜植入12例,Ⅱ期用异体巩膜植入6例.结果 随访3月～2年,1例结膜囊狭窄,配置仿真义眼片困难,其余义眼活动良好,配戴仿真义眼片后眼外观满意.18例均无发生义眼台感染、排斥.结论羟基磷灰石义眼台眶内植入术,是眶美容的一种理想方法,自体巩膜包裹较异体巩膜包裹义眼台的义眼活动度及外观较好,尽量行Ⅰ期植入.     

异体巩膜移植联合自体结膜瓣覆盖术治疗无菌性巩膜融解的研究

目的评价异体巩膜移植联合结膜瓣覆盖术治疗眼科手术后无菌性巩膜融解的临床效果。方法对因眼部手术后发生无菌性巩膜融解10例（10只眼）的临床资料进行回顾性分析。进行巩膜坏死组织涂片,微生物培养,及血清学检查。采用异体巩膜移植联合自体结膜瓣覆盖术,术后局部滴眼。结果术前10只眼巩膜坏死组织的细菌及真菌培养均未见微生物生长,仅1只眼类风湿因子异常高表达,8只眼患有干眼。实施异体巩膜联合自体结膜瓣移植术后,8只眼术后32～50d巩膜坏死区愈合,2只眼于术后40d及48d后发生巩膜植片融解。结论全身胶原血管性疾病及手术刺激等所致的免疫反应可能是眼部手术后产生无菌性巩膜融解的主要原因;异体巩膜移植联合自体结膜瓣移植可控制及修复巩膜融解,有效保留眼球的完整性。     

新鲜羊膜移植治疗义眼台暴露

目的评价新鲜羊膜移植冶疗羟基磷灰石义眼座暴露的临床疗效。方法彻底分离眼球筋膜囊缝合深埋或用异体巩膜覆盖暴露的义眼座,新鲜羊膜移植修补结膜囊缺损区。结果12例（12眼）羊膜植片生长良好,无感染,无融解。2月后结膜上皮覆盖羊膜表面,结膜囊愈合,全部安装义眼片。结论羊膜作为一种生物膜可以减轻炎症反应,阻止巩膜融解,有利于促进结膜上皮的爬行修复,用新鲜羊膜移植治疗义眼座暴露效果良好。     

异体巩膜贴敷修补羟基磷灰石义眼台暴露

目的研究早期羟基磷灰石义眼台暴露的修复方法。方法时46例（46眼）行羟基磷灰石义眼台植入的8例发生暴露者采用异体巩膜贴敷，结膜边缘刮除修补。结果随访6月～5年，8例全部愈合，结膜囊成形好，义眼活动自如。结论异体巩膜贴敷法效果好，患者无痛苦，减少经济支出，材料广。     

义眼台联合皮片包裹眼模植入的结膜囊成形术

目的　观察联合中厚皮片包裹眼模倒向植入的义眼台植入结膜囊成形术的疗效。方法　对 41例 (4 1眼 )因外伤或炎症而摘除眼球致结膜囊完全闭锁或大部分消失的患者 ,行联合中厚皮片包裹眼模倒向植入的义眼台植入结膜囊成形术。结果　 41例 (4 1眼 )术后 3月切开睑裂及眼模表面的皮片 ,取出眼模。 40例新形成的结膜囊均能充分容纳义眼片 ,且可上、下、左、右转动 ,1例眼台顶部暴露。结论　联合中厚皮片包裹眼模倒向植入的义眼台植入结膜囊成形术是治疗结膜囊严重狭窄的有效方法。     

异体巩膜在结膜囊成型术中应用

异体巩膜在结膜囊成型术中应用本溪市中心医院眼科（１１７０００）韩雪梅眼球摘除术后未能及时安装义眼使结膜囊狭窄或其它原因造成无眼球睑部粘连，临床治疗很棘手。为了减少眼球摘除术为造成美容方面缺陷，我院自１９８５年以来采用异体巩膜治疗无眼球结膜囊狭窄疗效满...     

结膜旷置法治疗Ⅱ期义眼台植入时结膜囊缩窄的疗效观察

目的:观察新的结膜旷置法行Ⅱ期义眼台植入,同时处理结膜囊缩窄的治疗效果.方法:2008-01/2014-07期间,我院收治的114例114眼眼球摘除术后眼窝内陷、结膜囊缩窄患者,在行Ⅱ期义眼台植入后同时处理结膜囊,从筋膜表面充分分离结膜至穹隆处,将预先制作的透明薄壳眼模置入结膜囊,使结膜瓣后退形成上、下穹窿,同时眼睑闭合时无明显张力.取出透明眼膜,并评估结膜缺损面积(即筋膜暴露面积),根据缺损区垂直径长度分为4组,Ⅰ组:缺损长0~5 mm;Ⅱ组:缺损长6~10 mm;Ⅲ组:缺损长11~15 mm;Ⅳ组:缺损长≥16 mm.对所有病例采用旷置球结膜中央缺损区的方法,在上下结膜瓣后退的位置将结膜间断缝合于筋膜上,在义眼台的前部出现筋膜暴露区.如下穹窿浅,联合行下穹窿成形术;如眼睑闭合张力较大或结膜瘢痕较重,考虑术后结膜挛缩严重的患者联合行睑缘缝合术.结膜囊内涂抗生素眼膏后置入合适的眼模.结果:所有患者暴露的筋膜区域于术后逐渐缩小并被结膜覆盖.平均于术后1 mo内旷置的结膜区被新生的结膜覆盖完全.结膜缺损区垂直径<5 mm均能在2 wk内完全移行覆盖,结膜囊形成良好,无需再次手术处理.结膜缺损区垂直径6~10 mm能在3 wk之内填补覆盖完全,少数患者结膜囊会有少量的收缩,但不影响配戴义眼片.结膜缺损区垂直径11~15 mm能在4 wk内移行生长覆盖完全,但结膜囊会轻度收缩,可配戴磨小的义眼片,部分术前结膜瘢痕较严重的患者需再次行结膜囊成形术.结膜缺损区垂直径≥16 mm也能在6 wk以内完全覆盖整个筋膜暴露区域,结膜囊会有较明显收缩,需再次行结膜囊成形联合睑缘缝合术,3 mo后拆除睑缘缝线后能够配戴义眼片.有2例出现义眼台暴露,行义眼台暴露修补联合结膜囊成形术,术后结膜囊成形好.结论:新的结膜旷置法能够很好地处理Ⅱ期义眼台植入时轻到中度结膜囊缩窄,无需任何移植物,患者损伤轻,减少多次手术.对于处理重度结膜囊狭窄,再手术风险较大,尚需进一步临床观察.     

羟基磷灰石复合人工骨片植入联合唇黏膜移植结膜囊成形术

目的 探讨同期羟基磷灰石复合人工骨(HA)植入联合唇黏膜移植结膜囊成形术的手术方法及临床效果.方法 对16例HA义眼座植入术后眼座内陷及下移、结膜囊缩窄患者行HA人工骨植入及唇黏膜移植结膜囊成形术,观察术后义眼座内陷和(或)下移矫正、上睑沟凹陷矫正、结膜囊成形情况,义眼座有无外露、感染及HA人工骨有无移位.结果 移植唇黏膜全部成活,眼座内陷、移位及上睑沟凹陷基本矫正,眼座无外露,人工骨无移位,患者基本满意.结论 羟基磷灰石复合人工骨片植入联合唇黏膜移植结膜囊成形术是治疗HA义眼座植入术后眼座内陷及下移、结膜囊缩窄的理想方法.     

Ⅱ期义眼座植入联合羊膜移植治疗眼窝内陷结膜囊狭窄

目的探讨Ⅱ期义眼座植入联合保存羊膜移植治疗眼球摘除和眼内容物剜除术后眼窝内陷伴结膜囊狭窄的手术方法及临床效果。方法对2001年4月至2004年4月收治32例眼内容物剜除术后(A组)和24例眼球摘除术后(B组)眼窝内陷结膜囊狭窄患者共56例行Ⅱ期义眼座植入联合保存羊膜移植手术。观察术后眼窝内陷矫正、结膜囊成形情况,义眼座活动度、有无眼座外露、感染,义眼配戴情况。随访10-18月。结果术后所有患者眼窝内陷明显好转,结膜囊成形良好,穹窿深浅正常,义眼配戴后无脱落,义眼活动度水平方向>5mm,垂直方向>3mm,A组30例(93.75%),B组10例(41.67%)两组比较,差异有显著性(P<0.05)。配戴义眼片3月后复诊B组2例(8.33%)出现义眼座外露。论结Ⅱ期义眼座植入联合保存羊膜移植是目前治疗眼球摘除术后出现眼窝内陷、结膜囊狭窄的理想方法。     

Ⅱ期眼窝凹陷及结膜囊狭窄的联合整复手术

目的 探讨眼球摘除或眼内容物剜出术后眼窝内陷伴结膜囊狭窄的同期整复手术方法及临床疗效。方法 对2007年8月至2010年5月收治35例患者施行Ⅱ期义眼座植入联合结膜囊成形术,其中7例结膜囊轻度缺损采用下、上穹窿结膜划开;23例结膜囊中度缺损采用异体巩膜;5例结膜囊重度缺损采用自体唇粘膜移植。所有病例结膜囊内眼模支撑,轻、中度组行睑缘临时缝合,术后1月拆线,自体唇黏膜移植组行部分睑缘粘连术,术后3个月分开眼睑,试装义眼。观察术后眼窝内陷矫正、结膜囊成形情况。随访3～6月。结果 术后所有患者眼窝内陷明显改善,结膜囊成形良好,穹窿深浅可,均可配戴适合的义眼,活动度可。结论 Ⅱ期义眼座植入联合结膜囊成形术是治疗眼球摘除或眼内容物剜出术后眼窝内陷伴结膜囊狭窄的理想手术。     

Comparison of inferior conjunctival autografting and conjunctival tissue grafting from pterygium itself in the cases of filtering blebs and glaucoma suspects-A retrospective analysis

Purpose:This study aims at comparing the effectiveness of inferior conjunctival autografting (CAG) and conjunctival tissue grafting from pterygium itself (CTG) in the cases of filtering blebs/glaucoma suspects.Methods:One hundered and five eyes of 97 patients who underwent pterygium excision with conjunctival autografting (CAG) in the period from 2010 to 2016 were included. Fifty one eyes had filtering blebs and 54 were glaucoma suspects. Fifty two eyes of 49 patients (Group 1) had undergone pterygium excision with inferior conjunctival autograft (CAG) and 53 eyes of 48 patients (Group 2) had undergone pterygium excision with conjunctival tissue graft (CTG) from the pterygium itself. The minimum follow up period was 6 months.Results:Both groups had 2 eyes with recurrence, which was not statistically significant. Among other complications, graft retraction was seen with a higher incidence in Group 2, which was statistically significant.Conclusion:In situations where sparing of the superior conjunctiva is mandatory, both the techniques of inferior conjunctival autografting and conjunctival tissue graft from the pterygium itself are excellent alternate options with comparable outcomes and no additional risk of significant complications.     

义眼座植入及全厚皮片移植眼窝再造术

目的探讨无眼球重度眼窝狭窄行义眼座植入及全厚皮片移植眼窝再造术的效果。方法8例8眼无眼球重度眼窝狭窄，行一期或二期羟基磷灰石义眼座植入术。术后3—8个月，行全厚皮片移植眼窝再造术。结果随访6个月至3年。7例义眼座位置良好，1例感染而取出。7例皮片完全存活，1例上穹窿部皮片坏死，形成新的上穹窿狭窄，3个月后再次行全厚皮片移植上穹窿成形术，术后效果良好。结论无眼球的重度眼窝狭窄患者行羟基磷灰石义眼座植入术后，二期行全厚皮片眼窝再造术，取材来源广泛，操作简便，术后效果良好。     

组织粘合剂粘合羊膜手术在眼烧伤中的应用

目的:评价组织粘合剂粘合羊膜手术在眼烧伤治疗中的疗效。方法:选择2002年9月～2004年6月在中山眼科中心外伤病区住院的眼烧伤患者29例34只眼。其中Ⅱ度烧伤4只眼,Ⅲ度5只眼,Ⅳ度25只眼。Ⅳ度烧伤中角膜缘100%缺血者7只眼,角膜缘缺血小于100%者18只眼;结膜严重坏死累及巩膜者12只眼。全部患者行组织粘合剂粘合羊膜手术前均予常规的药物治疗。术后随访2～6个月,观察角结膜上皮生长情况,羊膜、组织粘合剂贴附情况,炎症及视力等。结果:Ⅱ、Ⅲ度烧伤及部分Ⅳ度烧伤[角膜缘缺血小于100%有27只眼,手术后全部上皮缺损愈合,缺损愈合时间为术后8～42d,(23.9±8.0)d;Ⅳ度烧伤角膜缘100%缺血角膜溃疡溶解的7只眼,除1只眼失访外,6只眼局部溃疡静止。4只眼视力无变化,29只眼视力均有不同程度的提高。结论:组织粘合剂粘合羊膜手术可以迅速恢复烧伤眼表的完整性,有效地防止持续性角膜上皮缺损,角巩膜溃疡穿孔,睑球结膜粘连等并发症的发生;对于严重的Ⅳ度烧伤(角膜缘100%缺血),组织粘合剂粘合羊膜手术有助于阻止角巩膜溃疡穿孔,重建结膜表面,恢复眼前段血供,防止睑球粘连,但由于角膜缘干细胞完全缺陷,恢复角膜表面的完整性,尚需行角膜缘干细胞移植术。     

Conjunctival flora in anophthalmic patients: microbiological spectrum and antibiotic sensitivity

AIM: To identify the spectrum and susceptibility pattern of isolated microorganisms from conjunctival flora of anophthalmic patients. METHODS: A cross-sectional clinical study including 60 patients with unilateral anophthalmia. Patients with use of antibiotic drops in their socket during the last month were also included. From each patient, three microbiological samples were taken from the lower conjunctival sac (healthy eye, pre-prosthesis, and retro-prosthesis space of socket). The 180 samples obtained were cultured. Isolates were identified and their antibiotic sensitivities were determined. RESULTS: A total of 251 isolates were recovered (62 isolates from healthy eye, 93 from pre-prosthesis, and 96 from retro-prosthesis space). The most common organism was Staphylococcus epidermidis, in both healthy eyes (64.5%) and sockets (45.5%). Altogether, coagulase-positive Staphylococci, Streptococci, and Gram-negative bacteria accounted for less than 15% of isolates in healthy eyes and more than 35% in sockets. Regarding the antibiotic sensitivities, there were no significant differences between isolates from sockets and healthy eyes. Nine patients recognized the use of self-prescribed antibiotic drops in their socket. In the healthy eyes of these subjects, Gram-positive microorganisms showed significantly greater resistance to aminoglycosides and tetracycline. CONCLUSION: Sockets of anophthalmic patients show a greater number of pathogens compared to healthy eyes. The use of antibiotic drops in the socket promotes a resistant flora not only in the socket but also in the healthy eye. Quinolones and macrolides may be better therapeutic options than aminoglycosides for treating conjunctivitis of anophthalmic sockets, since these antibiotics are less active against Staphylococcus epidermidis.     

Pterygium surgery: conjunctival rotation autograft versus conjunctival autograft

BACKGROUND AND OBJECTIVES: To compare the safety and efficacy of conjunctival rotation autograft to conjunctival autograft in primary pterygium surgery. PATIENTS AND METHODS: A prospective randomized study was performed of 39 eyes in 31 patients who had undergone pterygium surgery. Nineteen eyes were treated by conjunctival rotation autograft (Group A). Twenty eyes were treated by conjunctival autograft (Group B). Follow up ranged from 8 to 12 months (mean 11 months). Recurrence was defined as postoperative regrowth of 2 mm fibrovascular tissue onto clear cornea in the area of previous pterygium excision. Four eyes were excluded from the study. Delayed wound healing occurred in 11.76% of eyes, and 5.88% of eyes had persistent congestion in Group A. A loose graft was present in 5.55% of eyes, and 5.55% of eyes had dellen formation in Group B. CONCLUSION: We conclude that conjunctival rotation autograft and conjunctival autograft are both equally effective methods to reduce the recurrence rate after pterygium surgery. Conjunctival rotation autograft can be tried as an alternative attractive procedure for pterygium surgery to reduce the chances of recurrence. However, a larger, randomized, prospective double masked study with more patients and a longer follow up will eventually demonstrate the superiority of one procedure over the other.     

羊膜移植治疗义眼座植入术后结膜裂开伴结膜囊狭窄

目的:探讨羊膜移植治疗羟基磷灰石义眼座植入术后结膜裂开伴结膜囊狭窄的临床效果。方法:羟基磷灰石义眼座植入术后结膜裂开伴结膜囊狭窄患者16例16眼,手术松解结膜张力后,行保存羊膜移植于巩膜暴露区。结果:所有患者中,15例术后结膜愈合完全遮盖巩膜,结膜囊恢复理想深度;1例失败。结论:保存羊膜移植是治疗义眼座植入术后结膜裂开、保持理想结膜囊深度的有效方法。