羊膜移植治疗对眼表烧伤患者视力及角膜恢复的影响

目的 探讨羊膜移植治疗对眼表烧伤患者视力及角膜恢复的影响.方法 选择眼表烧伤患者30例(38眼),采取羊膜移植术治疗,术后随访3个月,记录患者的视力及角膜恢复情况.结果 术后随访3个月,所有患者的视力均得到不同程度的提高.38眼中,术后最佳视力达到1.0,视力＞0.3者17眼(50.00％).患者角膜恢复透明13眼(34.21％),出现角膜云翳14眼,出现角膜斑翳7眼,出现角膜白斑4眼.术后2～3周,陆续有5眼出现角膜新生血管,且向瞳孔区蔓延.术后＜21 d,有30眼(78.95％)的角膜上皮得到全部愈合;术后21d～28 d,有6眼的角膜上皮得到全部愈合;术后32 d,严重碱烧伤2眼角膜上皮得以愈合.结论 羊膜移植术治疗眼表烧伤的疗效显著,术后患者的视力及角膜恢复良好,临床应值得推广实施.     

自体富血小板凝胶在眼表烧伤治疗中的应用

目的：观察自体富血小板凝胶治疗轻、中度眼表烧伤的疗效。方法选取该科收治的眼化学烧伤、热烧伤患者41例（54眼）为研究对象,按照数字随机法分为自体富血小板凝胶治疗组（APG组）和对照组,APG组19例（26眼）,对照组22例（28眼）。对照组采用常规局部和全身药物治疗,APG组在此基础上加用自体富血小板凝胶外用滴眼。比较两组患者平均创面的愈合时间、角膜新生血管的发生率及视力恢复情况。结果对照组6眼（21.4%）出现感染,APG组1眼（3.8%）;对照组平均愈合时间为（24.7±6.5） d,APG 组平均愈合时间为（19.1±3.5） d,APG 组平均愈合时间、感染率显著低于对照组（P〈0.05）。对照组3个月后各有1眼出现角膜斑翳和角膜云翳,6眼出现角膜新生血管;APG组未出现角膜斑翳和角膜云翳病例,2眼出现角膜新生血管。 APG组角膜新生血管发生率显著低于对照组（P〈0.05）。 APG组和对照组治疗后视力均得到不同程度的恢复,两组比较无显著差异（P〉0.05）。结论自体富血小板凝胶可缩短眼表修复时间,降低感染率和角膜新生血管发生率,不影响视力恢复,是轻、中度眼表烧伤治疗的新选择。     

自拟消翳汤治疗角膜瘢痕302例

目的 观察自拟消翳汤治疗角膜瘢痕的临床疗效.方法 选择患眼角膜荧光素染色阴性,角膜云翳、斑翳患者病程＜3个月,角膜白斑患者病程＜6个月者均纳入观察病例.自拟消翳汤随证加减,水煎分服,3周为一疗程,治疗时间为1～3疗程.结果 观察共计243例302眼,其中角膜白斑34眼,斑翳122眼,云翳146眼.经过1～3个疗程自拟消翳汤治疗,患眼角膜病变减轻,视力有不同层度的提高,角膜云翳、斑翳患者治疗疗效明显优于角膜白斑患者.结论 自拟消翳汤治疗角膜瘢痕临床有较好疗效.     

角膜碱烧伤的综合治疗评价

目的评价角膜碱烧伤药物及手术治疗的疗效。方法回顾性总结1998年1月-2006年12月不同程度80例92眼角膜碱烧伤患者的药物及手术治疗，对其治疗效果进行回顾性分析。结果80例92眼，男性青壮年为主；所有患眼角膜上皮均修复；视力恢复到1．0以上者56眼，0．6～0．8者12眼，0．1～0．5者22眼，0．05者2眼；无一例发生角膜穿孔及睑球粘连，仅部分残留角膜薄翳、斑翳。结论联合应用各种药物及手术治疗角膜碱烧伤，有效避免感染、渍疡等并发症的发生，成功地挽救了患者的视功能。     

早期羊膜移植治疗重度眼表烧伤23例

目的 观察羊膜移植治疗重度眼表烧伤的效果.方法 23例（34眼）眼表烧伤的患者入院后1～2 d即行眼表清创并羊膜移植手术治疗,术后使用药物控制感染和炎症,促进愈合.结果 术后随访3～6个月,23例（34眼）无一例角膜穿孔,25眼视力＞0.1,6眼睑球粘连（＜1/4结膜囊）.结论 早期清创并羊膜移植治疗重度眼表烧伤,可以促进愈合,减少并发症.     

维生素C钠治疗眼化学伤的临床研究

目的观察维生素C对眼化学伤的治疗效果。方法回顾分析我院眼科2003～2005年收治的76例(87眼)病例,接诊后对没作现场冲洗的患者或冲洗不彻底患者立即给予冲洗,每眼使用500ml生理盐水稀释维生素C钠胶囊15粒冲眼,时间10 min以上,将眼球表面及结膜囊残留异物及坏死脱落物质冲洗干净。充分冲洗后,口服维生素C钠胶囊。另选2005～2006年收治的碱烧伤15例(16眼)为对照组,用500 ml生理盐水烯释维生素C 5 g冲服,冲洗干净后用眼药水点眼,全身用药治疗比较2组疗效。结果随访1～3个月,角膜透明,或形成云翳,染色阴性,视力恢复,矫正视力1.0以上为65只眼(75%);轻度角膜斑翳,上皮完整,染色阴性,无其他合并症17只眼(19.5%);角膜缘少许新生血管留有角膜自斑5只眼(5.5%),无1例角膜穿孔。治疗后恢复时间:I度烧伤平均3 d,Ⅱ度烧伤平均6 d,Ⅲ度烧伤平均12 d,Ⅳ度烧伤平均35 d。结论维生素C钠治疗眼化学伤具有良好的临床效果,与维生素C疗效相当。可安全、有效地应用于临床。     

保存人羊膜移植治疗眼表疾病

目的：探讨保存人羊膜治疗难治性眼表疾病的有效性及实用性。方法：采用保存人羊膜移植术治疗陈旧性眼化学烧伤（2例,3眼）及角膜溃疡（8例,8眼）。结果：术后随访3－6个月,11眼中9眼角膜透明或半透明,术后视力不同程度提高,仅一蚕蚀性角膜溃疡病人术后13天溃疡复发。结论：保存人羊膜能有效修复角膜基质及上皮的缺损,是眼表重建的理想材料,羊膜移植术能有效治疗眼表疾病。     

羊膜移植联合角膜缘干细胞移植治疗重度眼烧伤

目的 评价适时进行羊膜移植或联合角膜缘干细胞移植治疗重度跟烧的疗效.方法 选择 2003年1月～2005年12月在我科住院的眼烧伤病人18例,22眼,其中酸碱烧伤12例,热烧伤6例.Ⅲ度烧伤12眼,Ⅳ度烧伤10眼.在Ⅳ度烧伤中.角膜缘缺血达四个象限者3眼,角膜缘缺血＜4个象限者7跟,结膜严重坏死累及巩膜者6眼.对于Ⅲ度眼烧伤者,仅行单纯羊膜移植治疗,对于Ⅳ度眼烧伤者,行羊膜移植联合自体或异体角膜缘干细胞移植治疗.对术后每1d、3d、1周、2周、1个月、3个月、6个月、12个月、18个月及24个月患者的视力、角膜溃疡及上皮愈合时间、角膜水肿及透明度、羊膜愈合或脱落情况、角膜新生血管、假性胬肉形成及睑球粘连等眼表情况,角膜缘干细胞的成活或排斥等进行裂隙灯显微镜检查.结果 4例失访.在随访到的14例17眼中,角膜上皮愈合时间为9～16(28.8±16d),所有患眼均有新生血管长人,假性胬肉形成者8眼,睑球粘连者5眼.视力大于0.3者2眼,0.1～0.3者3眼,0.02～0.1者6眼,0.02以下者6眼.角膜缘四个象限均缺血者.行羊膜移植联合角膜缘干细胞移植无效.结论 重度眼烧伤通过羊膜移植或联合角膜缘干细胞移植,可以有效缩短角膜上皮愈合时间,减少角膜新生血管、假性胬肉及睑球枯连的形成,并能不同程度的保存部分视力.     

羊膜移植联合带结膜的角膜缘移植治疗早期眼表化学伤的疗效观察

目的探讨羊膜移植联合带结膜的角膜缘移植手术治疗早期眼表化学伤的临床疗效。方法用人羊膜移植联合带结膜的角膜缘移植手术治疗早期眼表化学伤16例(16眼)。带结膜的角膜缘组织来源于自体对侧健眼。结果16例患者随访平均8.7月,术后羊膜组织及带结膜的角膜缘移植片均全部成活,均无排斥反应。受伤眼角膜不同程度地恢复了透明,抑制角膜新生血管,视力获得了提高或稳定。球结膜移植部位无粘连,未发现角膜坏死穿孔。结论羊膜移植联合带结膜的角膜缘移植对于构筑角膜缘再生基底,再造角膜表面,防止睑球粘连及上皮角化,保持有用视力有一定的作用,是治疗眼表化学伤的重要手段。     

羊膜移植治疗眼表疾病

目的观察羊膜移植治疗严重眼表疾病的作用及探讨其可行性。方法采用新鲜或甘油保存的人羊膜治疗严重眼表疾病11例（11眼）。包括严重化学烧伤、热烫伤、感染性或非感染性角膜渍疡、睑球粘连及复发性翼状胬肉等。其中2倒严重的化学烧伤采用了新鲜的羊膜移植，其余采用甘油保存的人羊膜治疗。手术时尽量去除眼表面的坏死组织使植床保持健康，根据情况移植羊膜或联合板层角膜移植和中央穿透性角膜移植术。结果 11例羊膜移植后均获成功。急性化学烧伤的眼表面迅速稳定，炎症在3-10d得到控制。避免了角膜穿孔或溃疡的进一步加深。随访10个月，1例再行穿透性角膜移植术取得成功，获得较好视力。其余视力也都得到了不同程度的提高。睑球粘连及复发性翼状胬肉得以改善和解除，眼球运动障碍消失。结论羊膜移植治疗化学烧伤、热烧伤可以减轻角膜急性烧伤期的炎症反应，阻止眼表的进行性渍烂和融解，治疗复发性翼状胬肉或睑球粘连效果较好，无排斥反应发生，且取材容易、操作简便，易于在基层医院推广应用。     

羊膜移植治疗眼表化学烧伤

目的探讨羊膜移植治疗眼表化学烧伤的疗效。方法通过对18例24眼眼表化学伤患者,均早期施行羊膜移植术,术后早期应用糖皮质激素治疗,2例因不能完全上皮化,经再次行羊膜移植术。结果随访3～24月,所有术眼获得上皮化愈合,视力均有不同程度提高,眼表稳定,上皮化。无一例出现角膜溃疡,穿孔,眼球摘除。结论羊膜移植联合早期糖皮质激素应用,是治疗眼表化学烧伤的有效方法。     

眼球酸碱烧伤的治疗与护理

目的 眼球酸碱烧伤的治疗与护理.方法 对50例70眼眼球酸碱烧伤进行了抢救治疗和护理,并进行了3个月至2年的随访.结果 有51眼轻度烧伤完全康复16眼中度烧伤视力不同程度的恢复,2眼重度烧伤进行角膜移植后视力分别为0.1,0.3,1眼行眼球摘除加义眼座植入.结论 眼球酸碱烧伤后经过及时的抢救治疗和护理可以将损伤减小到最小,最大程度的恢复患者的视功能.     

眼部碱烧伤126例综合治疗临床分析

目的：探讨眼部碱烧伤综合治疗的效果。方法回顾性分析解放军白求恩国际和平医院2009年1月—2014年12月收治的采用综合疗法治疗的126例(179只眼)眼部碱烧伤患者的临床资料。结果眼部碱烧伤患者角膜上皮修复时间Ⅱ度<Ⅲ度<Ⅳ度。Ⅱ度眼部碱烧伤患者全部脱残,预后良好,无严重并发症发生。Ⅲ度眼部碱烧伤患者视力恢复情况优于Ⅳ度患者,并发症发生率低于Ⅳ度患者。术后3个月随访,45例早期行羊膜移植术者19例出现角膜血管化,其中2例半年后再次住院行穿透性角膜移植术,术后视力恢复良好。结论综合疗法治疗眼部碱烧伤效果满意,疗效及预后与患者眼部碱烧伤程度相关。     

早期新鲜羊膜移植治疗难治性角膜溃疡疗效观察

目的：探讨羊膜移植术在难治性角膜溃疡中的临床治疗效果。方法：患者角膜病灶清创后,将制备好的新鲜羊膜移植,共治疗难治性角膜溃疡25例（25眼）,术后随访3～36个月。结果：25例角膜溃疡患者术后均未见排斥反应,角膜感染得到有效控制,3～4周角膜溃疡上皮愈合,角膜溃疡区留下不同程度的瘢痕,角膜溃疡患者视力均有不同程度的提高,无一例角膜溃疡复发,未出现角膜穿孔病例。结论：新鲜羊膜移植治疗难治性角膜溃疡是一种有效的治疗方法。     

Surgical rehabilitation following ocular chemical injury

Purpose: The purpose of this study is to evaluate the management of limbal stem cell deficiency (LSCD) secondary to chemical ocular burns.

Materials and methods: The charts of 48 eyes of 40 patients with grade 2 or higher chemical injury were evaluated retrospectively. Subjects with follow-up longer than 1 year were included. Medical treatment, surgical correction of abnormalities of ocular adnexial structures, limbal stem cell transplantation from patient’s fellow eye, from living relatives or from cadaveric donor, amniotic membrane transplantation, conjunctival epitheliectomy, chelation with ethylenediaminetetraacetic acid and penetrating keratoplasty were the treatment modalities. Outcome measures were ocular surface stability and corrected distance visual acuity (CDVA). Failure was defined as the appearance of persistent epithelial defect (nonhealing epithelial defect for more than 2 weeks) with progressive corneal conjunctivalization/vascularization and thinning, and also progression of conjunctivalization to the central 6?mm of the cornea in eyes with subsequent keratoplasty.

Results: The mean age of 31 male and 9 female patients were 32.32?±?12.6 years. LSCD was bilateral in 8 cases. The mean follow-up was 77.2?±?35.1 months. The presentations were in acute phase in 37.5%, in subacute phase in 32.5% and in chronic phase in 30% of the patients. Only 13 of 48 (27.1%) eyes obtained sufficient ocular surface stability through medical treatment; however, only 5 of these eyes achieved CDVA of less than 0.7 logMAR. Limbal stem cell transplantation was performed in 26 eyes as conjunctival limbal autograft, living-related conjunctival limbal allograft and keratolimbal allograft or as a combination of these transplantations. At the last visit, 30 eyes (62.5%) had an intact and stable ocular surface. Clear cornea was achieved in 11 (78.6%) of 14 eyes with grade 2 injury, in 9 (60%) of 15 eyes with grade 3 injury, in 5 (50%) of 10 eyes with grade 4 injury, in 1 (16.6%) of 6 eyes with grade 5 injury and in 1 (33.3%) of 3 eyes with grade 6 injury. The CDVA that was 1.66?±?0.99 logMAR initially improved to 0.87?±?0.85 logMAR at the last visit (p?Conclusion: While patients with low-grade chemical injury seem to benefit quite well from the medical treatment, amniotic membrane transplantation, limbal graft transplantation and subsequent keratoplasty; patients with severe injuries seem to be more prone to failure after all of the available treatment modalities.     

翼状胬肉切除联合自体球结膜移植术后角膜散光度及视力变化

目的：探讨翼状胬肉切除联合自体球结膜移植术后角膜散光度及视力的变化。方法收集本院眼科2012年8月~2013年8月收治的70例（84眼）翼状胬肉患者,术前对70例患者行视力、散光度、翼状胬肉侵入角膜的长度等检查,对84患眼行翼状胬肉切除联合自体球结膜移植术,术后1个月复查患眼的视力及散光度,比较其变化。结果术前84患眼存在不同程度的散光,散光以顺规散光为主。对84患眼行翼状胬肉切除联合自体球结膜移植术治疗1个月后复查,患眼的散光度明显下降,视力明显提高,所有患眼治疗前后的散光度及视力比较差异有统计学意义（P〈0.05）。结论翼状胬肉对角膜的散光度及视力均存在影响,对此类患者行翼状胬肉切除联合自体球结膜移植术可以使患者的散光度及视力得到明显改善。     

白内障超声乳化术后角膜水肿的护理

目的:减少老年性白内障超声乳化术后的并发症.方法:对897例957眼老年性白内障手术病人加强术前心理护理和宣教,术中配合,术后角膜观察、作好专科护理及出院指导.结果:297眼老年性白内障手术病出现角膜水肿,其中,Ⅰ级角膜水肿238眼,2天内全部恢复透明,Ⅱ级角膜水肿45眼,4天内消退恢复透明,Ⅲ级角膜水肿10眼,6～10天内消退恢复透明,Ⅳ级角膜水肿4眼,10～25天内消退恢复透明,14眼霞度角膜水肿者晶体核硬度均为V级核.结论:晶体核硬度与术后角膜水肿的轻重密切相关,做好术前护理、术中配合、术后作好裂隙灯下角膜观察及护理,有利于手术后视力的提高,防止大泡性角膜病及角膜变性的发生.     

Bioadhesive sulfacetamide sodium microspheres: Evaluation of their effectiveness in the treatment of bacterial keratitis caused by Staphylococcus aureus and Pseudomonas aeruginosa in a rabbit model

The aim of this study was to prepare bioadhesive sulfacetamide sodium (SA) microspheres to increase their residence time on the ocular surface and to enhance their treatment efficacy on ocular keratitis. Microspheres were fabricated by spray drying method using mixture of polymers such as pectin, polycarbophil and hydroxypropylmethyl cellulose (HPMC) at different ratios. The particle size and distribution, morphological characteristics, thermal behavior, encapsulation efficiency, mucoadhesion and in vitro drug release studies on formulations have been investigated. After optimisation studies, SA-loaded polycarbophil microsphere formulation with polymer:drug ratio of 2:1 was found to be the most suitable for ocular application and used in in vivo studies. In vivo studies were carried out on New Zealand male rabbit eyes with keratitis caused by Pseudomonas aeruginosa and Staphylococcus aureus. Sterile microsphere suspension in light mineral oil was applied to infected eyes twice a day. Plain SA suspension was used as a positive control. On 3rd and 6th days of the antimicrobial therapy, the eyes were examined in respect to clinical signs of infection (blepharitis, conjunctivitis, iritis, corneal oedema and corneal infiltrates) which are the main symptoms of bacterial keratitis and then cornea samples were counted microbiologically. The rabbit eyes treated with microspheres demonstrated significantly lower clinical scores than those treated with SA alone. A significant decrease in the number of viable bacteria in eyes treated with microspheres was observed in both infection models when compared to those treated with SA alone. In conclusion, in vitro and in vivo studies showed that SA-loaded microspheres were proven to be highly effective in the treatment of ocular keratitis.     

The Distribution Kinetics of Topical 14C‐Sulfur Mustard in Rabbit Ocular Tissues and the Effect of Acetylcysteine

Sulfur mustard (2,2‐dichlorodiethyl sulfide; HD), is a potent alkylating agent which in liquid or vapor form is capable of causing severe injuries to skin and respiratory tract, and was shown to cause short‐ and long‐term ocular injuries. N‐Acetylcysteine (NAC) may act as a mucolytic agent, changing the “wetting” and scavenging properties of the cornea and thus the adhesion of HD. Moreover, NAC is a scavenger of HD, an antioxidant and a glutathione precursor, which was shown to reduce HD toxicity in various systems. The ocular distribution of ¹⁴C, after topical application of liquid ¹⁴C‐sulfur mustard (¹⁴C‐HD) to the rabbit cornea, and the role of NAC in reducing HD retention and toxicity are presented in this study. Groups of rabbits were exposed to 0.4 µL of liquid ¹⁴C‐HD, placed at the center of the cornea, with or without NAC treatment. Fifty µL NAC (10% aqueous solution) was topically applied, 10 minutes before and 10 minutes after HD exposure. Three time points were evaluated: 1, 6, and 24 hr after HD exposure, six rabbits per time point. Evaluation consisted of clinical observation, measurement of biochemical parameters in aqueous humor (AQ), counting radioactivity concentration in ocular tissues, and histology of corneal sections. One hour after corneal exposure to liquid ¹⁴C‐HD, approximately 2% of total applied radioactivity was recovered. The highest ¹⁴C concentration was found in the cornea, followed by the tarsal section of eyelid, aqueous humor, nictitating membrane, and the frontal sclera (including conjunctiva). The rate of radioactivity decrease varied from one ocular tissue to the other, the highest rate was found in aqueous and vitreous humors, also in accordance with their higher turnover rates. The NAC treatment reduced the radioactivity in most ocular tissues. The HD exposure caused typical clinical and histological signs of HD intoxication, and increased the aqueous protein and prostaglandin (PGE) content. The NAC treatment lowered eyelid edema but had no effect on AQ protein or PGE content; however, there was some aggravating effect of the NAC treatment on corneal epithelial cells, seen at 1 and 6 hr after exposure.