翼状胬肉切除联合结膜自体移植术中纤维蛋白胶应用的Meta分析

目的 探讨纤维蛋白胶(FG)在翼状胬肉切除联合结膜自体移植术中的临床疗效.方法 应用循证医学的研究方法检索美国国立医学图书馆、荷兰医学文摘、循证医学数据库、中国知网、万方数据库、中国期刊全文数据库及维普中文科技期刊数据库并辅以手工检索,遵循Cochrane Handbook 5.0质量评价原则评价纳入研究的质量,采用RevMan5.0软件进行统计学处理.结果 纳入7项随机对照实验,共366只眼.Meta分析结果显示:与缝线组相比,FG组在术后复发方面,差异有统计学意义[RR=0.28,95%CI(0.10,0.76),P=0.01];在术后并发症方面,两组比较差异无统计学意义[RR=2.53,95%CI(0.47,13.51),P=0.28].结论在翼状胬肉切除联合结膜自体移植术中,应用FG封闭伤口可降低术后复发.(中华眼科杂志,2011,47:550-554)

Abstract：

Objective To evaluate the clinical efficacy of FG for attaching conjunctival autografts in pterygium surgery. Methods Search was conducted in Pubmed, Embase, Cochrane Library, CNKI, Wanfang database, CBM and VIP,and hand-search was also performed, the methodological quality were carried out according to evidence-based medicine (EBM). The qualities of the randomized controlled trials(RCT) were evaluated according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0. The Cochrane Collaboration's software RevMan 5.0 was used for Meta-analysis. Results Only 7 trials, involving 366 eyes, were included. Meta-analysis showed that significant differences were found between the FG and suture in recurrence [RR=0.34, 95%CI(0.15,0.80), P=0.01], but there is no difference in reducing the complications [RR=2.53,95%CI(0.47,13.51),P=0.28]. ConclusionFibrin glue-assisted conjunctival autograft in pterygium surgery reduces postoperative recurrence.     

纤维蛋白胶在眼科应用的新进展

纤维蛋白胶(fibringlueFG),又称纤维蛋白黏合剂(fibrinsealantFS),是一种生物蛋白制剂,主要成分是纤维蛋白和凝血酶,各成分混合后模拟体内凝血的最后阶段,最终形成稳定的纤维蛋白聚体,最早应用于伤口止血,FG对机体不产生毒副作用,不引起炎症反应,组织反应性极小,在促进伤口愈合、封闭组织缺损等方面有着良好的作用。近年来已在临床各科手术中广泛应用。随着眼科医疗技术要求的不断提高,纤维蛋白胶已在多种眼科病的治疗中获得成功应用,并作为一种生物材料支架用于组织工程角膜的构建,有着良好的应用前景。本文就纤维蛋白胶在眼科领域的应…     

组织工程材料在眼表重建中的应用

组织工程近年来已成为眼表重建研究的热点。组织工程材料在眼表重建的应用包括胶原及复合材料、羊膜复合体、壳聚糖复合材料及人工合成可降解材料(聚乳酸、聚羟基乙酸)等诸多材料。本文将介绍上述组织工程材料在眼表重建实验和临床应用的研究现状及进展。     

胶联羊膜移植治疗兔角膜深层损伤的研究

目的 探讨胶联羊膜治疗兔角膜深层损伤的效果,分析其促进角膜损伤愈合的机制.方法 新西兰大白兔45只,均以右眼作为实验眼,实验前采用裂隙灯显微镜检查排除角膜疾病,建立兔角膜深层损伤模型.采用单纯随机抽样法,将兔分为胶联羊膜组、普通双层羊膜组及损伤对照组,每组15只.前两组行嵌合式羊膜移植.术后观察记录羊膜溶解脱落时间,角膜荧光素染色,角膜混浊及新生血管等情况,并进行临床疗效评定.术后第7、14、28天,行苏木素-伊红染色组织病理学检查;原位末端标记法检测角膜基质凋亡细胞.两个实验组和对照组各时间点参数评分以及末端脱氧核苷酸转移酶介导的脱脲苷三磷酸缺口末端标记法(TUNEL)阳性细胞表达值分别进行正态性检验,方差齐性检验,采取的统计方法为两独立样本t检验.结果 胶联羊膜覆盖于角膜创面的时间(20.00±2.43)d,明显长于普通双层羊膜(13.15±2.68)d(t=8.470,P=0.000).术后第28天,胶联羊膜组角膜创面全部恢复正常厚度,角膜上皮荧光素染色均为阴性,角膜透明度高,新生血管较少.而普通双层羊膜和对照组尚有部分动物角膜荧光素小片浅层着色,角膜混浊明显,瘢痕致密,粗大新生血管长入角膜中央.胶联羊膜组和对照组术后第14、28天,角膜混浊和新生血管总评分比较,差异有统计学意义(术后第14天:胶联羊膜组2.62,对照组5.19,t=3.986,P=0.004;术后第28天:胶联羊膜组2.87,对照组4.78,t=3.608,P=0.007).整个观测期,胶联羊膜组损伤角膜无感染穿孔;而普通双层羊膜组和对照组分别有3例和2例,因角膜上皮迁延愈合导致感染穿孔.组织病理检查显示胶联羊膜组损伤角膜全部正常上皮化,基质胶原纤维排列整齐.在各观察时间点上,胶联羊膜组角膜基质凋亡细胞均明显少于对照组(术后第7天:t=8.153,P=0.000;术后第14天:t=9.693,P=0.000;术后第28天:t=14.050,P=0.000).而普通双层羊膜组与对照组比较,仅在术后第7天,差异有统计学意义(术后第7天:t=5.474,P=0.000).结论 胶联羊膜对兔角膜深层损伤具有良好的治疗效果,可显著促进角膜损伤愈合,抑制新生血管和瘢痕形成,抑制角膜基质细胞凋亡.

Abstract：

Objective To treat deep layer corneal damage using fibrin glue and amniotic memrbane transplant. Methods Forty-five rabbits were given deep lamellar keratectomies to cause deep layer corneal damage in their right eyes and were then randomly divided into 3 groups. The first group was given doublelayer amniotic membrane transplants where fibrin glue was used to connect the two layers of amniotic membrane. The second group was given double-layer amniotic membrane transplants where no fibrin glue was used. The third group was given no treatment. Clinical outcome was graded by corneal integrity, opacity and neovascularization, and detachment of amniotic membrane was recorded. The expression of apoptosis was monitored to assess the changes of morphology and histology on the 7th, 14th and 28th days after surgery.Results While the double-layer amniotic membrane without fibrin glue covered the cornea for (13. 15 ±2. 68 ) d, the double-layer amniotic membrane using fibrin glue covered the surface of the cornea for (20. 00 ± 2. 43 ) d ( t = 8. 470, P = 0. 000 ). The corneas in the first group recovered smoothly and transparently, maintained normal thickness and less neovascularization, whereas the corneas in the other two groups recovered irregularly, lost their transparency, became turbid and showed higher levels of neovascularization. There were statistically significant differences between the first and third groups for corneal opacity and neovasculariazation, where the 14th day after surgery, the first group scored 2. 62 and the third group scored 5. 19 (t =3. 986, P =0. 004), and the 28th day after surgery, the first group scored 2. 87 and the third group scored 4. 78 (t =3. 608, P=0. 007). Perforation did not appear in the first group,but the second group had 3 cases and the third group had 2 cases, all due to infection. The changes of morphology and histology showed that the damaged corneas were contained normal epithelial cells and regularly arranged fibrous cells on the 28th day after surgery. The apoptosis in corneas of the first group was less than that of the third group at all observed points (7th day: t =8. 153, P =0.000; 14th day: t =9. 693, P =0. 000; 28th day: t = 14. 050, P =0. 000), however, apoptosis in corneas in the second group was only different from that in the third group on the 7th day after surgery while other observed points showed no difference (7th day: t =5.474, P=0. 000). Conclusion Using bio-engineered fibrin glue in amniotic membrane transplants can repair deep layer corneal damage, reduce neovascularization, scarring and corneal apoptosis.     

胶联羊膜移植治疗兔角膜深层损伤的研究

Objective To treat deep layer corneal damage using fibrin glue and amniotic memrbane transplant. Methods Forty-five rabbits were given deep lamellar keratectomies to cause deep layer corneal damage in their right eyes and were then randomly divided into 3 groups. The first group was given doublelayer amniotic membrane transplants where fibrin glue was used to connect the two layers of amniotic membrane. The second group was given double-layer amniotic membrane transplants where no fibrin glue was used. The third group was given no treatment. Clinical outcome was graded by corneal integrity, opacity and neovascularization, and detachment of amniotic membrane was recorded. The expression of apoptosis was monitored to assess the changes of morphology and histology on the 7th, 14th and 28th days after surgery.Results While the double-layer amniotic membrane without fibrin glue covered the cornea for (13. 15 ±2. 68 ) d, the double-layer amniotic membrane using fibrin glue covered the surface of the cornea for (20. 00 ± 2. 43 ) d ( t = 8. 470, P = 0. 000 ). The corneas in the first group recovered smoothly and transparently, maintained normal thickness and less neovascularization, whereas the corneas in the other two groups recovered irregularly, lost their transparency, became turbid and showed higher levels of neovascularization. There were statistically significant differences between the first and third groups for corneal opacity and neovasculariazation, where the 14th day after surgery, the first group scored 2. 62 and the third group scored 5. 19 (t =3. 986, P =0. 004), and the 28th day after surgery, the first group scored 2. 87 and the third group scored 4. 78 (t =3. 608, P=0. 007). Perforation did not appear in the first group,but the second group had 3 cases and the third group had 2 cases, all due to infection. The changes of morphology and histology showed that the damaged corneas were contained normal epithelial cells and regularly arranged fibrous cells on the 28th day after surgery. The apoptosis in corneas of the first group was less than that of the third group at all observed points (7th day: t =8. 153, P =0.000; 14th day: t =9. 693, P =0. 000; 28th day: t = 14. 050, P =0. 000), however, apoptosis in corneas in the second group was only different from that in the third group on the 7th day after surgery while other observed points showed no difference (7th day: t =5.474, P=0. 000). Conclusion Using bio-engineered fibrin glue in amniotic membrane transplants can repair deep layer corneal damage, reduce neovascularization, scarring and corneal apoptosis.     

胶联羊膜移植治疗兔角膜深层损伤的研究

Objective To treat deep layer corneal damage using fibrin glue and amniotic memrbane transplant. Methods Forty-five rabbits were given deep lamellar keratectomies to cause deep layer corneal damage in their right eyes and were then randomly divided into 3 groups. The first group was given doublelayer amniotic membrane transplants where fibrin glue was used to connect the two layers of amniotic membrane. The second group was given double-layer amniotic membrane transplants where no fibrin glue was used. The third group was given no treatment. Clinical outcome was graded by corneal integrity, opacity and neovascularization, and detachment of amniotic membrane was recorded. The expression of apoptosis was monitored to assess the changes of morphology and histology on the 7th, 14th and 28th days after surgery.Results While the double-layer amniotic membrane without fibrin glue covered the cornea for (13. 15 ±2. 68 ) d, the double-layer amniotic membrane using fibrin glue covered the surface of the cornea for (20. 00 ± 2. 43 ) d ( t = 8. 470, P = 0. 000 ). The corneas in the first group recovered smoothly and transparently, maintained normal thickness and less neovascularization, whereas the corneas in the other two groups recovered irregularly, lost their transparency, became turbid and showed higher levels of neovascularization. There were statistically significant differences between the first and third groups for corneal opacity and neovasculariazation, where the 14th day after surgery, the first group scored 2. 62 and the third group scored 5. 19 (t =3. 986, P =0. 004), and the 28th day after surgery, the first group scored 2. 87 and the third group scored 4. 78 (t =3. 608, P=0. 007). Perforation did not appear in the first group,but the second group had 3 cases and the third group had 2 cases, all due to infection. The changes of morphology and histology showed that the damaged corneas were contained normal epithelial cells and regularly arranged fibrous cells on the 28th day after surgery. The apoptosis in corneas of the first group was less than that of the third group at all observed points (7th day: t =8. 153, P =0.000; 14th day: t =9. 693, P =0. 000; 28th day: t = 14. 050, P =0. 000), however, apoptosis in corneas in the second group was only different from that in the third group on the 7th day after surgery while other observed points showed no difference (7th day: t =5.474, P=0. 000). Conclusion Using bio-engineered fibrin glue in amniotic membrane transplants can repair deep layer corneal damage, reduce neovascularization, scarring and corneal apoptosis.     

组织工程技术眼表重建的研究概况

严重的眼表疾病的治疗一直是眼科临床上的难题,组织工程技术的兴起为眼表重建带来了希望。角膜缘干细胞作为角膜上皮组织更新和再生的源泉,在体外选择近似生理条件下培养可生长增殖,获取足量种子细胞;选择促进角膜上皮细胞生长并具有良好组织相容性的载体来种植种子细胞,从而体外构建成复合角膜上皮移植片重建眼表,目前在动物实验及临床应用上都获得了良好的效果,组织工程化角膜上皮为眼表重提供了较理想的方法,存在着许多优势,但目前属于初步研究阶段,仍面临着许多困难和挑战,有待进一步研究。     

眼表粘蛋白的研究进展

眼表粘蛋白是泪膜的重要成分，在维持眼表生理功能和预防眼表病变方面起着重要作用。目前已证实存在于眼表的粘蛋白有MUCl、MUC2、MUCA、MUC5AC、MUC5B、MUC7和MUCl6。对眼表粘蛋白的功能和调节机制的研究将为干眼症的治疗提供新的有效途径。     

眼表组织工程种子细胞的来源及种植技术研究进展

严重的眼表疾病的治疗一直是眼科临床中的难题,组织工程眼表重建技术为治疗各种可导致失明的眼表疾病开辟了新的途径。理想的组织工程化眼表植片是以可降解材料为支架,在体外进行细胞培养,得到类似于供体的组织工程眼表植片,有效修复各种原因导致的眼表损伤。要构建组织工程化眼表植片,关键在于合适的种子细胞和可供细胞粘附生长的生物支架或细胞外基质。本文将对目前组织工程技术眼表重建在种子细胞来源、载体选择方面的研究进展作简要综述。     

角膜眼表重建术的临床研究介绍

近十年来,随着角膜缘干细胞、结膜干细胞、眼表泪膜的生理、病理及细胞生物学特性等方面的深入研究,眼表重建手术已获得长足发展.但有些术者对眼表重建手术的概念及原理不清,手术的适应证选择不当,使手术效果不理想或发生医源性眼表面损伤.因此,应加强眼表重建术基本概念和相关知识的更新,同时重视其基础及应用基础的研究,以促进眼表重建术在我国健康发展.此文着重就眼表重建术之一的角膜眼表重建临床研究作一综述.     

组织粘合剂粘合羊膜手术在眼表重建术中的应用

目的:评价组织粘合剂粘合羊膜手术在眼表重建术中的疗效.方法:对16例17眼由于各种原因造成的角膜上皮持久不愈合的患者实施羊膜手术,术中用组织粘合剂固定羊膜.其中Ⅳ度以下眼化学烧伤4例5眼,外伤或异物剔除术后持续性角膜溃疡4例4眼,局限性蚕蚀性角膜溃疡3例3眼,神经麻痹性角膜溃疡和暴露性角膜溃疡各2例2眼,绝对期青光眼合并大泡性角膜病变1例1眼.全部患者在术前给予常规的药物治疗,术后予加压包扎、局部抗炎等处理.随访2～12 mo,观察视力及局部反应、角膜上皮的生长情况、羊膜的贴附情况等.结果:手术后88%的患眼上皮缺损愈合,愈合时间为9～48(26.7±7.8)d,羊膜贴附的时间约为1mo,83%的患眼视力有不同程度的提高.结论:对于有角膜缘干细胞残存的眼表,组织粘合剂粘合羊膜手术可以恢复眼表的完整性,有效地防止持续性角膜上皮缺损,改善患者局部刺激症状.     

眼表疾病研究进展

眼表疾病是常见的眼科疾病，可以引起视觉障碍。眼表疾病的研究是近年来眼科界发展较快、成果较多的领域之一。本文对近年来眼表疾病研究的新进展进行综述。     

眼表粘蛋白的调节因素

随着对泪膜的深入认识，眼表粘蛋白的重要性及其调节因素日益受到重视。眼表粘蛋白的调节可能受多种因素影响。眼表粘蛋白主要由结膜杯状细胞和角结膜上皮细胞分泌，这些细胞均受副交感神经和交感神经的支配。一些炎症介质也可以刺激粘蛋白的分泌。对粘蛋白及其调节因素的研究可能会为干眼症的治疗提供新的选择。     

Transplantable cultivated mucosal epithelial sheet for ocular surface reconstruction

Ocular surface reconstruction by tissue engineering using somatic stem cells is a second-generation therapeutic modality. In view of future treatment of bilaterally affected, severe ocular surface disorders, two types of transplantable cultivated mucosal epithelial sheets can be used for reconstruction. One is an allogeneic corneal epithelial stem cell sheet, and the other is an autologous oral mucosal epithelial cell sheet. We first investigated the feasibility of amniotic membrane as an epithelial carrier, and found that denuded amniotic membrane was the most appropriate substrate for this purpose. Thus, cultivated corneal epithelial stem cell sheets were created by co-culturing with 3T3 fibroblast and air-lifting on amniotic membrane. These epithelial sheets demonstrated positive keratin 3 and 12 specific to in vivo corneal epithelium, light junction related proteins and proliferative activity. The transplanted allogeneic human corneal epithelial sheets existed successfully on the corneal surface, and were quite effective in achieving ocular surface stability in severe ocular surface disorders. A few cases, however, developed immunological reactions or opportunistic infections, etc. Secondly, we established transplantable autologous cultivated oral mucosal epithelial sheets in rabbits. The in vitro oral mucosal epithelial sheets showed histological characteristics similar to those of in vivo corneal epithelial sheets; for example, positive keratin 3 expression. Based on the fact that, the transplanted autologous oral mucosal epithelial sheets resembled corneal epithelium and that we achieved the recovery of corneal transparency in rabbits, we propose that cultivated oral mucosal epithelium may become the substitute for corneal epithelium in ocular surface reconstruction.     

干细胞与角膜眼表重建研究进展

角膜是眼表的重要防护屏障和光学系统的重要组成部分,其完整性和透明性是实现有效视功能的重要前提。各种原因造成的眼表疾病未经及时有效治疗都有可能发展到终末阶段———角膜缘干细胞功能障碍,包括角膜缘干细胞数目的减少和微环境的病理改变。自体角膜移植无疑是治疗角膜缘干细胞功能障碍最有效的方法。但是供体角膜来源十分有限,且切除健眼组织行角膜移植可能会对健眼造成长期损害。随着干细胞研究的不断深入和组织工程技术的兴起,组织工程角膜应运而生,并且迅速发展。其基本原理为选用生物性能良好的支架材料,体外模拟角膜缘干细胞微环境,诱导各类种子干细胞分化为角膜类上皮,然后再行角膜眼表重建。常用种子细胞包括角膜缘干细胞、胚胎干细胞、诱导多能干细胞、骨髓间充质干细胞、皮肤干细胞、口腔黏膜干细胞。本文就上述干细胞在角膜眼表重建中的应用作一综述。     

色素上皮细胞衍生因子在眼科中的作用

色素上皮细胞衍生因子(pigmentepithelium-derivedfactor,PEDF)是由视网膜色素上皮细胞分泌的一种蛋白质,属于丝氨酸蛋白酶抑制基因家族,具有多种生物学活性,PEDF具有营养神经的功效,通过保护神经元免受神经毒性侵害而发挥神经营养因子之作用;PEDF还能抑制血管内皮细胞的移行,具有抗新生血管诱导因子的作用,它能够影响视网膜的分化,发育和成熟,对视网膜的机械损伤.光损伤和缺血性损伤有修复作用,是一种非常有前景的新生血管抑制剂。     

心包移植在眼表重建术中应用的临床效果

目的 探讨心包移植眼表重建术治疗难治性眼表疾病的临床效果。方法 外伤性睑球粘连及假性胬肉30例（30眼）施行同种异体心包移植眼表重建术,术后随访观察6-18月,平均11月。结果 30眼睑球粘连均得到明显改善,23眼恢复正常的眼球运动,假性胬肉复发率降低,角膜新生血管较术前明显减少,角膜透明度改善。结论 心包移植术治疗难治性眼表疾病效果良好。     

视频终端对眼表的损害

视频终端(video display terminal,VDT)已成为生活中必不可少的产品,但视频终端通过引起泪膜、睑板腺等组织器官的一系列损害,产生了如眼干涩、疲劳、酸胀等眼睛不适症状.本文主要对近年来VDT对眼表损害的机制及其治疗做一综述.     

眼表的微生物学

从正常眼表分离的菌丛多为细菌,很少能分离到真菌、病毒和原生动物.从结膜最常分离的细菌包括少量的凝固酶阴性葡萄球菌和类白喉菌属.配戴接触镜个体、HIV阳性个体和免疫缺陷患者的菌丛与正常人相似.慢性眼病患者常携带有更多致病性细菌.几乎所有个体（包括正常个体和患病个体）的正常菌丛都来自于身体其他部位的扩散.