抽空房水C3F8充填前房全眼球保存角膜在穿透角膜移植中的应用

为验证抽空房水前房内注入Ｃ３Ｆ８全眼球湿房保存角膜延长角膜内皮细胞的存活时间。取人尸体眼球３０只，保存平均４．３天，行同种异体部分穿透角膜移植术，术后随访平均８．８个月。通过角膜透明度，角膜厚度，角膜内皮细胞的活体观察等证明内皮细胞的存活情况及功能。结果术后观察期间内角膜植片均透明，角膜厚度术后１个月恢复正常，内皮细胞密度在１５００～５３００个／ｍｍ２，术后有３例发生排斥反应，及时治疗得到控制。结论：抽空房水前房内注入Ｃ３Ｆ８全眼球湿房保存角膜７天内内皮细胞活性良好，并可应用于临床。     

角膜中期保存液的基础研究及初步临床应用

目的研制一种配方简单、适合我国国情的角膜中期保存液。方法人角膜27片、23片分别保存于角膜中期保存液与Optisol GS液,保存结束取周边角膜行苔盼兰和茜素红联合染色,计算角膜内皮细胞密度及角膜内皮细胞活性率,比较两组数据,保存7d和14d各取2片角膜进行扫描电镜检查。取8片角膜保存于中期保存液,所保存角膜用于临床角膜移植,对患者定期进行裂隙灯检查,角膜内皮照相。结果角膜中期保存液组平均保存时间（8.39±0.72）d,角膜内皮细胞平均密度为（2743.48±366.54）个/mm^2;Optisol GS液组平均保存时间（7.58±0.34）d,角膜内皮细胞密度为（2568.95±245.47）/mm^2,两组比较,差异无统计学意义;角膜中期保存液组的内皮细胞平均活性率（96.65±2.59）%高于Optisol GS液组（93.47±3.81）%,差异具有统计学意义。角膜中期保存液所保存角膜用于临床,4例病人术后随访4d～11m,角膜平均内皮细胞计数（2285.75±534.05）个/mm^2。结论角膜中期保存液可活性保存人角膜片长达2w,其保存效果与Optisol GS液相似,初步临床使用显示了较好的效果。     

改良中期保存法角膜内皮细胞的扫描电镜观察

目的:通过扫描电镜观察抽空房水、前房注入C_3F_8气体全眼球湿房保存角膜不同保存时间角膜内皮的超微结构。方法:兔眼球来源于4只新西兰白兔(即摘取眼球),实验组为右眼,对照组为左眼。实验组(兔眼4只,人眼6只)抽空房水,随即注入等量的C_3F_8气体,充填前房,然后将全眼球置4℃湿房条件下保存。4只兔眼中2只(1只用于实验性同种异体穿透性角膜移植)保存7天,其它2只分别保存10和14天;人眼球3对(6只)均为死后1小时内摘除眼球,经常规湿房保存4～7小时后转入实验组方法保存。分别保存0、3、5、7、10、14天。对照组兔眼球4只,取下带1mm巩膜环的角膜片,置于Optisol营养液中4℃保存,保存时间同实验组。保存后剪下角膜片行扫描电镜检查。结果:兔角膜保存7天内皮细胞只是轻度水肿,10及14天内皮细胞形态有改变,细胞表面微绒毛近消失,有少部分细胞溶解。人角膜保存7天内内皮细胞结构无明显改变,只是细胞增大,随着保存时间延长,内皮细胞形态及结构均有不同的改变。结论:此法保存7天的角膜内皮结构无明显改变。眼科学报 1995;11:186—188。     

白内障超声乳化对糖尿病患者角膜内皮的影响

目的:探讨白内障超声乳化对糖尿病患者角膜内皮细胞的影响。方法:糖尿病组:白内障合并糖尿病患者50例(58眼);对照组:白内障非糖尿病患者64例(70眼)。应用角膜内皮显微镜于术前及术后1d;1wk;1,3mo测量角膜内皮细胞密度、六角形细胞比率,分析结果。结果:与术前相比,糖尿病组术后角膜内皮细胞密度、六角形细胞比率均显著降低(P<0.05)。糖尿病组和对照组内皮细胞密度、六角形细胞比率术前差异无统计学意义(P>0.05),但在术后1d;1wk;1,3mo,糖尿病组患者角膜内皮细胞丢失均明显高于对照组(P<0.05),糖尿病组患者角膜内皮细胞中六角形细胞比率均明显低于对照组(P<0.05)。结论:白内障手术对角膜内皮细胞具有一定的损伤性,糖尿病患者较非糖尿病者角膜内皮易损伤。     

不同保存方法对角膜内皮细胞活性的影响

目的:探索简易安全的中长期保存供体角膜方法,评价不同保存方法保存后角膜内皮细胞活性,为临床提供优质角膜材料。方法:建立简易中期保存液,深低温保存法保存大鼠角膜。将30只鼠眼随即分为3组。分别为湿房保存,中期保存液和深低温保存。采用活性染色对角膜内皮细胞进行评价。判定3种方法保存的角膜内皮细胞的活性状态。结果:使用中期保存液和深低温保存后复温的角膜植片内皮细胞密度和活性率与湿房保存组比较差异无显著性(湿房组细胞密度个/mm2为2729.5±158.0,ESR%为88.9±3.5;中期保存组分别为2646.8±217.2和86.9±2.7;深低温组分别为2706.2±184和287.3±3.3,P>0.05)。结论:简易中期保存液和深低温保存后角膜具有较好的内皮细胞活性和临床应用价值。     

玻璃体切割联合白内障手术对DR患者角膜内皮细胞的影响

目的:探讨玻璃体切割联合白内障超声乳化手术对糖尿病视网膜病变(diabetic retinopathy,DR)患者角膜内皮细胞的影响.方法:采用回顾性研究.选取2015-01/2017-02我院收治的DR患者160例160眼,根据有无合并白内障分为两组.单纯玻璃体切割组患者74例74眼,联合手术组患者86例86眼,行玻璃体切割联合白内障超声乳化人工晶状体植入术.采用非接触角膜内皮显微镜于术前1d和术后1mo时检查两组患者术眼中央角膜内皮细胞密度,并比较两组患者角膜内皮细胞的平均细胞面积、面积变异系数和六角形细胞比率.结果:单纯玻璃体切割组患者手术前后角膜内皮细胞密度、角膜内皮细胞的平均细胞面积和面积变异系数、六角形细胞比率的差异无统计学意义(P>0.05);联合手术组手术后角膜内皮细胞密度和六角形细胞比率较手术前下降,细胞平均面积和变异系数高于术前,差异有统计学意义(P<0.05).两组患者手术后角膜内皮细胞密度、角膜内皮细胞的平均细胞面积和面积变异系数、六角形细胞比率比较,差异有统计学意义(P<0.05).结论:玻璃体切割联合白内障超声乳化人工晶状体植入治疗糖尿病视网膜病变合并白内障对角膜内皮细胞有一定影响,针对有适应证的患者,术中应注意保护角膜内皮细胞.     

糖尿病患者白内障超声乳化术后角膜内皮的变化

目的:应用共聚焦显微镜观察糖尿病患者行白内障超声乳化术前后角膜内皮的变化。方法:随机选取年龄相关性白内障合并糖尿病患者(糖尿病组)50例56眼和单纯年龄相关性白内障患者50例60眼(对照组),行白内障超声乳化摘除联合折叠式人工晶状体植入术。术前及术后1wk;1,3mo应用共聚焦显微镜分别对中央角膜厚度、内皮细胞密度、内皮细胞变异系数及六角形内皮细胞百分比进行观察,分析结果。结果:两组术前中央角膜厚度、内皮细胞密度、内皮细胞变异系数、六角形内皮细胞百分比差异无统计学意义(P>0.05);跟术前相比,术后两组角膜厚度、内皮细胞变异系数均增加,内皮细胞密度、六角形细胞百分比均呈下降趋势;术后1wk;1,3mo糖尿病组中央角膜厚度均高于对照组(P<0.05),内皮细胞密度均低于对照组(P<0.05);术后1wk;1,3mo糖尿病组六角形内皮细胞百分比明显低于对照组(P<0.01),内皮细胞变异系数明显高于对照组(P<0.01)。结论:合并糖尿病的年龄相关性白内障患者超声乳化术后角膜内皮的损伤更严重,且创伤愈合的速率和效率均差于单纯相关性白内障患者。     

抽空房水C3F8充填前房中期全眼球湿房角膜保存的实验研究

采用抽空房水Ｃ３Ｆ８（全氟丙烷）充填前房全眼球湿房保存角膜内皮细胞活性。通过内皮细胞显微照相、内皮细胞活性染色（锥蓝联合茜素红染色）、扫描电镜、保存后的兔角膜行实验性同种异体穿透角膜移植，证实保存７天内皮细胞结构完整，功能良好。     

角膜保存的进展

介绍角膜保存方法的研究进展。非活性保存是一种防腐保存,常用的脱水干燥剂有变色硅胶、分子筛、无水氯化钙以及甘油,而它只能用于板层角膜移植。活性保存就能使角膜内皮细胞存活率达到70％以上,可用于穿透角膜移植术。根据保存时间的不同,活性保存分为短期、中期与长期3类。短期保存是将全眼球消毒无菌处理后湿房4℃保存。中期保存一般采用角膜片组织营养液4℃保存,最常用培养液为M-K液。本院眼库在1980年代初研究使用改进的RPMI1640营养液,对人角膜有效保存时间4—5d,最长7d,并且于临床穿透角膜移植效果满意。近年国外报导改进出几种其他角膜保存液,以提高组织质量和延长保存时间,如K-SOK、CSM、Dexsol和Optisol。以器官培养法保存角膜用于临床角膜移植一般在保存4周内、最长保存至7周。临床效果包括角膜透明率,内皮细胞密度,植片厚度及脱水情况优于其他保存方法。长期保存此法由Caopella和Kaufman(1972年)首先详细报告其临床应用。本院眼科在1980年代中期已经成功地将人角膜冷冻保存,最长保存时间为1a以上,并用于临床穿透角膜移植,获满意疗效。但其保存过程中所需费用昂贵,一般眼库和基层医院难于开展这项工作。鉴于此,本院眼库近年又研究一冷冻保存方法-全眼球甘油冷冻保存。该方法既克服了竞用经济     

白内障超声乳化吸除术后角膜内皮细胞变化的研究

目的:观察不同类型白内障患者超声乳化吸除术后角膜内皮细胞的变化。方法:随机选取我院老年性白内障、糖尿病性白内障及高度近视并发性白内障患者各30例30眼,均行白内障超声乳化吸除联合人工晶状体植入手术,于术前及术后1wk采用非接触型角膜内皮显微镜行角膜内皮细胞密度及六角形细胞比例检查。结果:三组术前角膜内皮细胞密度及六角形细胞比例比较,差异无统计学意义(P>0.05)。三组术后1wk角膜内皮细胞密度分别为2 496.86±298.96/mm2,2 379.51±375.13/mm2,2 425.38±312.68/mm2,六角形细胞比例分别为(46.20±12.03)%,(43.44±13.99)%,(44.35±8.13)%。三组术后1wk角膜内皮细胞密度及六角形细胞比例均较术前减少,其差异均有统计学意义(P<0.05)。术后各组间比较,糖尿病性白内障组和高度近视并发性白内障组术后均较老年性白内障组术后降低,其中糖尿病性白内障组术后角膜内皮细胞密度和六角形细胞比例降低较明显,与老年性白内障组比较,其差异有统计学意义(P<0.05)。结论:糖尿病性白内障及高度近视并发性白内障患者角膜内皮对超声乳化手术的耐受性降低,对角膜内皮细胞应行准确术前评估及术中保护。     

羊膜卷填塞治疗角膜穿孔羊膜的演变及对角膜内皮细胞的影响

目的 观察羊膜卷填塞联合C3F8气体填充治疗角膜穿孔术后羊膜的演变及其对角膜内皮细胞的影响.方法 因各种原因所致角膜穿孔而施行羊膜卷填塞联合前房C3F8气体填充术共56例（56眼）.术中以20％C3F8气体填充前房.术后观察前房深度、房水渗漏情况、气泡维持时间、角膜内皮细胞密度及形态,以及羊膜卷与角膜融合情况.结果 56例角膜穿孔均得到修复,羊膜卷无脱落,术后2个月时羊膜卷与角膜逐渐融合,其间无明显缝隙,C3F8气体在前房存留时间5～16 d,平均（8.2±4.8）d.术前与术后1个月、2个月时角膜内皮细胞密度差异均无统计学意义（t=1.02,1.71,P ＞0.05）,六角形细胞比例术后1个月时低于术前（t=2.13,P＜0.05）,术后1个月与术后2个月时差异无统计学意义（t=1.65,P＞0.05）.结论 羊膜卷填塞联合前房C3F8气体填充可有效修复角膜穿孔,术后羊膜卷与角膜融合好,C3F8气体能较长时间维持前房深度,防止房水渗漏,对角膜内皮细胞影响甚小.     

小梁切除术对角膜内皮细胞影响的研究

目的探讨小梁切除术对角膜内皮细胞的影响。方法对29例（37眼）青光眼行小梁切除术。分别于术前和术后3月内进行角膜内皮照相并分析其形态和定量指标。结果角膜内皮细胞密度、平均细胞面积、六角形细胞所占比例及变异系数4种指标术前术后差异无统计学意义（P〉0．05）。小梁切除术后正常前房和Ⅰ、Ⅱ度浅前房者，术前术后中央角膜内皮细胞密度差异无统计学意义（P〉0．05）。Ⅱ度浅前房中央内皮细胞丢失率为69．11％。结论正常过程小梁切除术对角膜内皮细胞影响不显著，小梁切除术后浅前房是角膜内皮细胞丢失的主要因素，尤其是Ⅲ度浅前房。     

大鼠角膜碱、酸、热烧伤后房水中TGF-β2的变化研究

目的:通过检测角膜烧伤后前房水中TGF-β2含量的变化,探讨在眼部内环境下TGF-β2与角膜烧伤之间的关系,为角膜烧伤治疗提供依据。方法:制备Wistar大鼠角膜碱、酸、热中度烧伤动物模型,分别于伤后4,8h;1,3,5,7,14,28,49d处死。采集房水:用20g/LBSA包被的毛细管于角膜缘处刺入角膜,吸取房水至20g/LBSA包被的离心管中,-70℃保存。标准品和样品进行酸激活处理。使用ELISA方法检测角膜烧伤后前房水中TGF-β2的水平。结果:大鼠角膜碱烧伤后4hTGF-β2的水平呈现一过性升高,然后下降,3d时TGF-β2含量再次升高,7d时达高峰,持续至7wk时降至正常。大鼠角膜酸烧伤后4hTGF-β2的水平呈现一过性升高,然后下降,低于正常对照组,两者差异显著。7d时房水中TGF-β2升至正常,然后一直保持低平状态。49d时我们检测房水中TGF-β2水平仍低于正常。大鼠角膜热烧伤后4hTGF-β2的水平呈现一过性升高,1d时降至最低,3d时开始增长,直到7d时我们检测仍高于正常,然后缓慢下降。结论:角膜烧伤后前房水中TGF-β2的含量发生变化,致伤原因不同,其变化方式不同。角膜碱烧伤和热烧伤后于7d时出现TGF-β2高峰,说明此时角膜处于免疫功能抑制状态,这对于维持角膜前房的免疫赦免状态非常重要,证明此时机体发挥了自我保护功能,避免产生过度的病理反应。角膜酸烧伤后TGF-β2水平始终低平,其原因尚有待于进一步研究。     

Effect of aqueous humor on apoptosis of inflammatory cell types.

PURPOSE: To determine whether aqueous humor promotes cell death in cells involved in inflammatory responses. METHODS: Multiple immune cell types, most characteristically involved in inflammatory responses, were incubated for 24, 48, and 72 hours in the presence or absence of 50% aqueous humor. Promotion of cell death was assayed by staining for an early indicator of apoptosis. The percentage of cells undergoing apoptosis was measured by flow cytometry. To identify partially the apoptosis inducing factor, aqueous humor was pretreated with proteinase K to degrade protein. In other experiments, aqueous humor was fractionated by centrifugation on filters capable of separating molecules above and below 10 kDa or 30 kDa kilodaltons in size. RESULTS: Rabbit aqueous humor promoted apoptosis in a wide variety of immune cells, including lymphokine-activated natural killer cells, resting T cells, an activated T-cell line, RAW 264.7 and J774A0.1 monocyte-macrophage cell lines, and neutrophils. As previously shown, aqueous humor did not promote apoptosis of murine corneal endothelial cells. Apoptosis was also not induced in human corneal endothelium, mouse corneal epithelium, or iris/ciliary body cell lines. Instead, aqueous humor partially protected these ocular tissues from starvation-induced cell death. Pretreatment with proteinase K inhibited the apoptosis-inducing activity. Moreover, the apoptosis-inducing activity segregated with the aqueous humor fraction containing molecules less than than 10 kDa in size. CONCLUSIONS: These data show that aqueous humor contains a factor or factors that promote death of cells that participate in inflammatory processes. By contrast, ocular tissues, such as the corneal endothelium and iris/ciliary body, are impervious to aqueous humor-induced cell death. The aqueous humor- borne factor(s) may contribute to the immune privilege of the anterior chamber by purging potential inflammatory cells.     

Safety studies on collagen viscoelastic substance as an auxiliary agent in anterior segment surgery--assays of anti-collagen antibodies in blood and residual concentration of collagen in the anterior chamber of rabbits]

PURPOSE: Alkali-soluble collagen solution was assessed as a possible viscoelastic substance in anterior segment surgery, in terms of its safe applicability by assaying antigenicity, disappearance rate of collagen from the anterior chamber, and histopathological effect on the corneal tissue. METHODS: The aqueous humor of rabbits was replaced with collagen solution three times. Then, follow-up clinical examinations with hand-slitlamp-microscopy, tonometry, pachymetry, and specular microscopy as well as ophthalmic histopathological examination were performed. Remaining collagen concentration in the aqueous humor at 1, 3, 5, 8, 24 and 72 hours after injection was determined to evaluate the disappearance rate of collagen from the aqueous humor with time. In vivo effects of chemical modification of collagen and buffer concentration on the corneal tissue were further studied by using transmission electron microscope (TEM) to find an optimum condition for collagen application. RESULTS: Neither anti-collagen antibody formation, nor inflammatory responses in the anterior segment and systemic symptoms were observed even after 3 injections of collagen solution, except for 1 case which showed corneal opacity. As much as 97.4% of the collagen injected into the anterior chamber disappeared from the eyeball. On the basis of TEM findings, succinylated collagen in diluted phosphate buffer seems to be superior to alkali soluble collagen in terms of corneal tissue protection. CONCLUSION: Collagen specifically prepared for this study showed no antigenecity and disappeared promptly from the anterior chamber. The optimal form of collagen in terms of corneal protection was discussed.     

Influence of vehicle and anterior chamber protein concentration on cyclosporine penetration through the isolated rabbit cornea.

The transcorneal penetration of cyclosporine A has been determined from each of three vehicles across isolated cornea into simulated aqueous humor containing either 50 mg % protein (0.5 mg/ml; as found in a normal eye) or 5000 mg % protein (50 mg/ml; as found in an inflamed eye). Cyclosporine entered the corneal epithelium and stroma/endothelium as well as passed through the cornea from an alpha cyclodextrin vehicle. Entry into the epithelium and stroma/endothelium occurred from an ointment vehicle with limited detectable anterior chamber penetration using 50 mg % protein solution in the anterior chamber. From corn oil vehicle, cyclosporine penetrated across the cornea with a permeability equal to that of alpha cyclodextrin vehicle. The concentration of cyclosporine in both corn oil and ointment vehicles is 8 times greater than that in alpha cyclodextrin vehicle resulting in a flux from corn oil vehicle about 7 or 8 times greater than that seen after alpha cyclodextrin vehicle. The amounts retained in the cornea, however, were relatively low after corn oil compared to cyclodextrin. The penetration of cyclosporine from either the cyclodextrin vehicle or ointment was at least doubled in the presence of 5000 mg % protein in the simulated aqueous humor relative to that seen in 50 mg % protein. This data indicates that the (presumed) absorption and binding of drug by the excess protein in the simulated aqueous humor may have removed free cyclosporine from the solution and sustained a high concentration gradient of free solute across the cornea.(ABSTRACT TRUNCATED AT 250 WORDS)     

Anterior chamber irrigation with an ozonated solution as prophylaxis against infectious endophthalmitis

PURPOSE: To assess the validity of anterior chamber irrigation with an ozonated solution as prophylaxis against endophthalmitis. SETTING: Department of Ophthalmology, Nippon Medical School, Tokyo, Japan. METHODS: Viability of human corneal endothelium in culture was assessed by the WST-8 assay, lactate dehydrogenase (LDH) release assay, and trypan blue exclusion assay after exposure to a 4 to 40 parts per million (ppm) solution for 10 to 60 seconds. The in vivo effect was observed 1 week after irrigation of a 4 ppm solution in the rabbit anterior chamber by trypan blue exclusion assay. Bactericidal efficacy of the anterior chamber irrigation with the 4 ppm solution was examined by bacterial colony count of the aqueous humor following methicillin-resistant Staphylococcus aureus (MRSA) contaminated intraocular lens implantation in the porcine eye. RESULTS: The WST-8 assay revealed no significant reduction of viability with 10-second exposure to a 4 ppm solution. Lactate dehydrogenase release and trypan blue exclusion assays similarly demonstrated little damage after 60-second exposure to a 4 ppm solution. In the rabbit cornea 1 week after treatment, damage caused by 30-second exposure to a 4 ppm solution was not significant. The MRSA colony count documented almost complete bactericidal action with 5-second exposure to the 4 ppm solution when no ophthalmic viscosurgical device existed in the anterior chamber. CONCLUSION: Limited damage to the corneal endothelium after 10-second exposure and potent bactericidal action with 5-second exposure suggests the validity of anterior chamber irrigation with a 4 ppm ozonated solution as prophylaxis against endophthalmitis.     

Study on Collagen Viscoelastic Substance as an Auxiliary Agent in Anterior Segment Surgery. Ocular Irritation Study by Replace ment of the Aqueous Humor in Rabbits

Purpose: Collagen solution was assessed as a possible visoelastic substance in anterior segment surgery, in terms of the depth of the anterior chamber and ocular irritation.Methods: The depth of the anterior chamber of enucleated rabbit eyes was evaluated 5 minutes after injection of collagen solution. For ocular irritation test, the aqueous humor of rabbits was replaced with collagen using sodium hyaluronate (HEALON((R))) and phosphate buffer (PB) as controls. Follow-up clinical examinations with hand-slit-lamp-microscopy, tonometry, pachymetry, and specular microscopy were performed for 7 days or 28 days, and then aqueous humor, corneal endothelium, and eye tissues were evaluated by gel electrophoresis, scanning electron microscopy, and light microscopy, respectively.Results: 2.5% to 3% collagen solution was found to be optimal for maintaining the depth of the anterior chamber. No significant differences in clinical findings such as anterior chamber and corneal thickness or in biochemical and histological findings were observed among collagen-, hyaluronate- and PB-treated groups, except for intraocular pressure which was increased in the hyaluronate-treated group, but not in the collagen-treated group.Conclusion: Collagen specifically prepared for this study seems to be an excellent auxiliary agent for anterior segment surgery, providing an appropriate anterior chamber with little ocular irritation. (Jpn Ophthalmol Soc 104:458-65, 2000)     

Study on collagen viscoelastic substance as an auxiliary agent in anterior segment surgery--ocular irritation study by replacement of the aqueous humor in rabbits

PURPOSE: Collagen solution was assessed as a possible viscoelastic substance in anterior segment surgery, in terms of the depth of the anterior chamber and ocular irritation. METHODS: The depth of the anterior chamber of enucleated rabbit eyes was evaluated 5 minutes after injection of collagen solution. For ocular irritation test, the aqueous humor of rabbits was replaced with collagen using sodium hyaluronate (HEALON) and phosphate buffer (PB) as controls. Follow-up clinical examinations with hand-slit-lamp-microscopy, tonometry, pachymetry, and specular microscopy were performed for 7 days or 28 days, and then aqueous humor, corneal endothelium, and eye tissues were evaluated by gel electrophoresis, scanning electron microscopy, and light microscopy, respectively. RESULTS: 2.5% to 3% collagen solution was found to be optimal for maintaining the depth of the anterior chamber. No significant differences in clinical findings such as anterior chamber and corneal thickness or in biochemical and histological findings were observed among collagen-, hyaluronate- and PB-treated groups, except for intraocular pressure which was increased in the hyaluronate-treated group, but not in the collagen-treated group. CONCLUSION: Collagen specifically prepared for this study seems to be an excellent auxiliary agent for anterior segment surgery, providing an appropriate anterior chamber with little ocular irritation.     

多发性角膜深层异物取出临床观察

目的:探讨多发性角膜深层异物取出方法。方法:本组患者42例45眼,其中异物穿透角膜全层并部分伸入前房者13例。磁性异物2例,非磁性异物36例,混合性异物4例。未穿透角膜者可用显微镊直接拔出,或作一浅层角膜切开后拔出。穿透角膜者,充分缩瞳,以15°角膜穿刺刀作前房穿刺,确保无房水外漏,黏弹剂自穿刺口注入前房并加深其深度,以顶退的方式自角膜面将异物稍加送出,露出异物尾端,此时不急以拔除,而以相同的手法处理其余异物,待所有异物尾端均露出角膜面后,再以多个有齿镊同时将异物取出。结果:45眼异物42眼顺利取出,3眼因初始取出经验不足导致术后并发性白内障,8眼合并虹膜炎,10眼发生角膜炎均为伤后超过1wk方来就诊者。在伤后3d内及时就诊的患者,术后视力改善几率明显高于1wk者。结论:对于多发性深层角膜异物,尤其是多发性穿透性角膜异物的取出,应争取尽早就诊手术,手术设计应以保护晶状体为前提,尽量减少手术并发症的发生。