小梁切除术中透明质酸钠对角膜内皮细胞的影响

目的探讨小梁切除术中应用透明质酸钠对角膜内皮细胞数量和形态的影响。方法接受小梁切除术的原发性急性闭角型青光眼75例（75眼）,随机分为两组：治疗组37例（37眼）,前房内及巩膜瓣下注入1%透明质酸钠0.1ml并保留;对照组38例（38眼）,则注入平衡盐溶液（BSS）0.1ml。采用非接触型角膜内皮显微镜分别于术前及术后第1周、第3个月进行角膜内皮细胞检查并分析其数量和形态参数的变化,同时观察术后眼压、前房形成情况、滤过泡及并发症。结果治疗组术前、术后第1周及第3个月角膜内皮细胞密度分别为（2183±325）个/mm2、（2096±332）个/mm2、（2112±261）个/mm2;平均细胞面积分别为（462.7±42.8）μm2、（422.9±53.1）μm2、（430.8±55.2）μm2;细胞面积变异系数分别为（47.3±15.7）%、（48.1±12.5）%、（42.6±10.9）%;六角型细胞百分率分别为（52.3±14.8）%、（51.6±13.3）%、（55.7±11.2）%;术后第1周及第3个月各参数与术前比较,差异均无统计学意义（P〉0.05）。对照组术前、术后第1周及第3个月角膜内皮细胞密度分别为（2098±314）个/mm2、（1631±388）个/mm2、（1855±402）个/mm2;平均细胞面积分别为（462.7±42.8）μm2、（562.7±73.8）μm2、（536.6±65.1）μm2;细胞面积变异系数分别为（49.5±14.3）%、（59.2±12.6）%、（58.7±12.3）%;六角型细胞百分率分别为（53.2±16.1）%、（40.4±13.2）%、（42.6±11.8）%,术后第1周及第3个月的各参数与术前比较,差异均有统计学意义（P〈0.05）。术后第1周及第3个月,治疗组的角膜内皮细胞损失率分别为4.0%及3.3%,均低于对照组的17.5%及11.6%（P〈0.05）。治疗组术后浅前房发生的眼数、程度均低于对照组（P〈0.05）。术后第1周及第3个月,不同前房深度组的角膜内皮损失率之间均有统计学差异（P〈0.01）。术后前房深度越浅,角膜内皮细胞的损失率越大,两者有     

玻璃酸钠对角膜地形图结果的影响

目的:评价玻璃酸钠滴眼液对干眼病患者的角膜表面规则性的影响。方法:应用Humphrey角膜地形图仪检测,对结果为可疑圆锥角膜和亚临床期圆锥角膜的患者52例91眼行SchirmerⅠ试验及泪膜稳定性检查,滴玻璃酸钠滴眼液后再行角膜地形图检测,观察角膜表面不规则指数(corneal irregularity measurement, CIM)、形状因子(shape factor, SF)、角膜曲率平均值(mean toric keratometry, TKM)等角膜地形图参数的变化。结果:其中54眼Schirmer试验试纸湿长<10mm或者泪膜破裂时间<10s,滴玻璃酸钠后CIM和SF与用药前比较有显著差异（P<0.01）,TKM与用药前比较无统计学意义（P>0.05）;37眼Schirmer试验及泪膜稳定性试验结果正常,滴玻璃酸钠后CIM,SF,TKM与用药前比较无统计学意义（P>0.05）。结论:玻璃酸钠可通过改善角膜表面光滑度有效降低角膜地形图结果的假阳性率。     

玻璃酸钠眼液治疗角膜异物剔除疗效观察

目的 评价玻璃酸钠眼液对角膜异物剔除术后促进角膜伤口愈合的作用.方法 将我院角膜异物患者共176例分为观察组和对照组,行角膜剔除术后观察组使用玻璃酸钠眼液和盐酸左氧氟沙星眼液滴眼,对照组使用盐酸左眼氟沙星眼液滴眼,观察两组在治疗后一周角膜恢复情况.结果 治疗一周后两组的疗效比较,观察者的治愈率明显高于对照组,有显著性差异(P＜0.05),有效率两组无显著性差异(P＞0.05).结论 玻璃酸钠能加快角膜异物剔除术后角膜创面的愈合.     

The effects of denatured sodium hyaluronate on the corneal endothelium in cats

In an in vivo cat model, wide-field specular microscopy and scanning electron microscopy were used to observe whether heat-denatured sodium hyaluronate causes cell damage to the corneal endothelium. The endothelial cell toxicities of various drugs, including 0.01% benzalkonium chloride, 0.2% chlorhexidine digluconate, and 0.5% lidocaine, mixed with intact or untreated sodium hyaluronate were also investigated. Neither heat-denatured nor intact or untreated sodium hyaluronate alone had any adverse effect on the corneal endothelium in cats, whereas 0.01% benzalkonium chloride and 0.2% chlorhexidine digluconate, mixed with sodium hyaluronate, caused substantial endothelial morphologic changes, which resulted in corneal edema. By comparison, 0.5% lidocaine with sodium hyaluronate was found to have minimal effect on the corneal endothelium in cats. These findings indicate that some chemical contaminant with sodium hyaluronate, not heat-denatured sodium hyaluronate, induces an immediate onset of pseudophakic bullous keratopathy.     

The corneal epithelium basement membrane complexes after alkali burn: an ultrastructural study

Chemical burns were produced using a 4 N NaOH solution in 21 rabbit corneas. The ultrastructural findings were examined under an electron microscope five minutes and 1, 2, 4, 8, 15, and 30 days after the burn. A morphologic disturbance of the basement membrane and its complexes was detected from the first day of the experiment. These findings suggest that the basement membrane plays an important role in the pathogenesis of corneal recurrent erosions and ulcer formation after chemical burns.     

The effect of gentamicin on the corneal endothelium. An experimental study

Gentamicin sulfate with preservatives was injected into the anterior chamber of a rabbit eye to evaluate its effect on the corneal endothelium. Endothelial toxicity was evaluated by contact specular microscopy and transmission electron microscopy 48 h after injection. The results suggest that doses ranging from 100 to 400 micrograms of gentamicin are not toxic to the corneal endothelium. Endothelial toxicity occurred when 1,000 micrograms of gentamicin was injected.     

Ultrastructural effects of sodium chloride on the corneal epithelium

Ten excised rabbit corneas were bathed posteriorly with glutathione bicarbonate Ringers solution (GBR), while anteriorly the bathing solution was either GBR or sodium chloride solution (NaCl). All solutions had an osmolarity of 305 +/- 2 mOsm/kg. The corneas were fixed after 150 min exposure to the solutions, and prepared for electron microscopy. Morphometric analysis of the electron micrographs was conducted by an observer unaware of the anterior bathing solution. In each case, the epithelium was examined along a 1500 micron stretch of the basement membrane. Cells were categorized as normal, abnormal, and sloughing. Abnormal cells showed cytoplasmic and nuclear pallor, and disrupted cell membranes. Sloughing cells showed partial separation from the underlying epithelium. Corneas exposed to NaCl showed statistically significant differences from those exposed to GBR; the differences occurred in both the number of abnormal cells, and the number of sloughing cells. All observed ultrastructural changes were limited to the surface region of the epithelium. It is concluded that sodium chloride solution is inadequate at maintaining the epithelial surface.     

透明质酸钠联合抗氧化剂中期保存兔角膜

目的 研究透明质酸钠联合抗氧化剂(还原型谷胱甘肽和维生素C)在角膜中期保存中的作用,以探讨一种简便有效的角膜中期保存液,为临床应用提供动物实验依据.方法 以自制MK液为对照组,以添加透明质酸钠和抗氧化剂的改良MK液为实验组,分别对保存3d、7d、10d、14d的兔角膜行大体形态观察、角膜中央厚度测量、台盼蓝-茜素红联合染色及电镜观察.结果 应用透明质酸钠和抗氧化剂的各实验组保存的角膜均较对照组透明度好,水肿轻,电镜观察角膜内皮细胞连接紧密,活细胞百分率高,2组差异比较有显著性(P＜0.001).结论 透明质酸钠及抗氧化剂有减轻角膜组织损伤,保持细胞活性的作用,将2者联合应用于角膜中期保存液中,可显著提高保存效果.     

Low-molecular-weight sodium hyaluronate in the treatment of bacterial corneal ulcers

A double-blind clinical trial was performed on 26 patients suffering from corneal ulcers of proven (i.e., culture-positive) bacterial etiology. After their recruitment, the subjects were randomly assigned to one of the following treatment protocols: (1) tobramycin (15 mg/ml) in saline applied at 1 drop/h or (2) tobramycin (15 mg/ml) in low-molecular-weight hyaluronic acid applied at 1 drop/h. The sample size was adjusted according to a type I error of 0.01 and type all error of 0.05 for a minimal expected difference of 35%. The healing time was calculated from the beginning of treatment to the day on which a follow-up fluorescein test proved to be negative. The mean healing time (±SD) was 3.5 ±0.9 days in the sodium hyaluronate group and 5.9 ± 1.5 days in the saline group (P < 0.001). These results suggest that treatment with an antibiotic dissolved in low-molecular-weight sodium hyaluronate can further shorten the clinical course of a bacterial corneal ulcer.This study was supported by grants from the Ministero della Pubblica Istruzione, Rome, Italy, and was presented at the 1990 Meeting of the Association for Research in Vision and Ophthalmology, Sarasota, Florida Offprint requests to: S.A. Gandolfi     

The effect of concentrated antibiotics on the rabbit's corneal epithelium

The effect of concentrated antibiotics on the healing rate of epithelial erosions in rabbit was measured by serial standardized photography. Histological studies were also performed.Our results suggest that Kanamycin 30 mg/ml (p<0.001), Penicillin 100,000 units/ml (p<0.001) and Vancomycin 31 mg/ml (p<0.01) administered six times a day retard the epithelial wound healing compared with control animals which received isotonic NaCl.Presented at the Fifth International Congress of Eye Research, Eindhoven, The Netherlands, October 3–8, 1982     

透明质酸钠在真菌性角膜溃疡治疗中的作用

目的:回顾性分析透明质酸钠在真菌性角膜溃疡治疗中的效果。方法:2006-06以来,在我院接受药物治疗的真菌性角膜溃疡患者共178例178眼,其中2006-06/2008-06期间共81例81眼作为对照组,接受以那他霉素及氟康唑为主的传统抗真菌方案治疗;2008-06/2010-03期间97例97眼作为治疗组,在传统治疗方案基础上加用透明质酸钠治疗。对比分析两种治疗方法的效果。结果:治疗组97例,平均住院时间14.15±4.23d,治愈90例,治愈率92.8%,好转5例,占5.2%,无效2例,占2.1%,最终视力>0.3者占51.6%。对照组81例,平均住院时间17.26±6.23d,治愈69例,治愈率85.2%,好转7例,占8.6%,无效5例,占6.2%,最终视力>0.3者占39.5%。经统计学分析,两组的平均住院时间、治愈率、有效率及最终视力差异具有统计学意义(P<0.05),治疗组的平均住院时间短于对照组,治愈率及有效率高于对照组,最终视力好于对照组。结论:透明质酸钠可促进真菌性角膜溃疡愈合,提高治愈率,减少角膜瘢痕形成。     

卡米可林与透明质酸钠在角膜穿孔伤修复中应用

目的探讨在角膜穿孔伤修复手术中,采用卡米可林（卡巴胆碱）缩瞳剂加透明质酸钠的效果。方法在26例（26眼）角膜穿孔伤修复手术中,应用透明质酸钠辅助卡米可林缩瞳,分离虹膜嵌顿及术后防止虹膜前粘连,观察疗效。结果21例（80．77％）瞳孔圆形或接近圆形;5例（19．23％）瞳孔变形明显,其中2例轻度虹膜前粘连,2例虹膜撕裂严重剪除,1例虹膜根部小范同断离。结论此手术方法减少了虹膜恢复的困难及眼内组织损伤,增加了手术的安全性,减少了并发症,效果较满意。     

透明质酸钠及丝裂霉素C用于慢性泪囊炎手术

目的：探讨提高慢性泪囊炎手术成功率的有效方法。方法：应用透明质酸钠注入泪囊，根据泪囊的大小，形态及部位，适当调整骨孔的位置，争取得到较大的泪囊粘膜瓣，并运用丝裂霉素C抑制纤维肉芽组织增生所致的手术通道阻塞。结果：30例手术应用此方法手术成功率100％，结论：本法可有效提高手术成功率。     

The effect of sodium hyaluronate and sodium chondroitin sulfate on the coagulation system in vitro

Healon (sodium hyaluronate) and sodium chondroitin sulfate (CDS) are injected in the ocular cavities in a variety of operations, mainly intraocular lens (IOL) implantation. Both Healon and CDS are structurally similar to heparin. We found that like heparin CDS has an inhibiting action on blood coagulation in vitro. The inhibiting activity is of the antithrombin type. Healon does not possess anticoagulant activity. Since the anticoagulant effect of sodium chondroitin sulfate is observable at concentrations likely to occur in vivo the substance may impair ocular hemostasis.     

Application of sodium hyaluronate to the operation of suturing the corneal perforation

AIM: To evaluate the effect of the application of sodium hyaluronate on the operation of suturing the corneal perforation. METHODS: Sodium hyaluronate was used in the operation of suturing the corneal perforation in 76 patients to form the anterior chamber, protect eye tissues and separate the anterior iris synechia. RESULTS: In the procedure of operation, the anterior chamber was stable, the prolapsed iris was easily restored, the corneal wound was easily sutured and there was no damage to the lens. Postoperatively, the corneal wound was closed well, the anterior chamber formed and there was no anterior iris synechia. Fifty-four cases had round pupils and the pupils of 22 cases were not round with defect of iris. CONCLUSION: Sodium hyaluronate in the operation of suturing the corneal perforation can help form the anterior chamber, protect the eye tissues and make the suturing corneal wound easier. It can reduce the rate of complication and promote the wound healing.     

海水浸泡对角膜爆炸穿孔伤后角膜上皮细胞超微结构的影响

目的 观察海水浸泡对兔角膜爆炸穿孔伤后角膜上皮细胞超微结构的影响.方法 健康灰兔12只,爆竹致兔角膜爆炸伤并于角膜中周部全层切开,切口长约3mm.右眼为实验眼,对侧眼为对照眼.实验眼将海水通过角膜切口注入前房,海水持续灌注角结膜面30 min.对照眼使用生理盐水注入前房和灌注眼表.使用光镜及电镜分别观察造模后1d、3d、5d、7d、10 d、14 d两组角膜上皮细胞和基质层超微结构的变化.结果 实验组造模后1d至14 d,角膜上皮细胞胞浆出现不同程度的空泡样变性,微绒毛状突起消失或部分消失,染色质增多,线粒体肿胀,细胞核固缩、碎裂、崩解,基质层胶原纤维排列紊乱,胞核空泡样变性,其中3d改变最明显,10 d、14 d可见部分上皮细胞增生;相同时间段对照组改变明显轻于实验组,对照组7d、10 d大部分上皮细胞增生,14 d无明显异常改变.结论 角膜爆炸穿孔伤合并海水浸泡后角膜上皮细胞的超微结构改变明显重于对照组,提示海水浸泡加重角膜上皮细胞的损伤.     

超声乳化术中两种黏弹剂对角膜内皮细胞的影响

目的 比较2种黏弹剂(透明质酸钠和DuoVise)在白内障超声乳化手术中对角膜内皮细胞的影响.方法 选择我院就诊的老年性白内障患者72例86眼,按选用的黏弹剂不同,随机分为2组:透明质酸钠组和DuoVisc组,均采用超声乳化术摘出白内障,同时植入折叠型人工晶状体.术前、术后1周、4周、12周分别测量角膜内皮细胞并计数,进行统计学分析.结果 术前角膜内皮细胞计数:透明质酸钠组(2 601.5±191.2)mm-2和DUOVisc组(2 579.6±232.0)mm-2,经比较差异无统计学意义.术后1周、4周、12周DuoVisc组的角膜内皮细胞平均计数分别为(2 371.5±215.3)mm-2、(2 377.8±220.6)mm-2、(2 416.3±213.2)mm-2高于透明质酸钠组(2 098.1±151.4)mm-2、(2 189.7±147.6)mm-2、(2 219.4±151.2)mm-2,差异有统计学意义(P＜0.01).术后不同时间DuoVisc平均角膜内皮细胞丢失量均低于透明质酸钠组.结论 白内障超声乳化手术中DuoVisc对角膜内皮细胞的保护能力高于透明质酸钠.     

超声乳化术中不同粘弹剂(Viscoat和透明质酸钠)对角膜内皮细胞的影响

目的　比较两种粘弹性物质Viscoat和透明质酸钠在白内障超声乳化手术中对角膜内皮的影响。方法　老年性白内障 49人 68眼 ,其中透明质酸钠组 2 5人 3 4眼 ,Viscoat组 2 4人 3 4眼 ,两组患者无内眼病史、眼外伤及眼内手术史 ,无糖尿病等全身疾病史。采用超声乳化术摘出白内障同时植入折叠性人工晶体 ,术前术后用非接触型角膜内皮显微镜观察测量角膜内皮细胞密度。结果　二组一般情况包括年龄 ,晶体核硬度及超声能量与时间的乘积无显著性差异 (P >0 0 5 ) ;透明质酸钠组术前和术后的角膜内皮细胞丢失率为 15 % ,经统计学处理有统计学意义 (P <0 0 5 )。Viscoat组术前和术后的角膜内皮细胞丢失率为 9% ,经统计学处理没有显普性差异 (P >0 0 5 )。结论　在白内障超声乳化手术中粘弹剂Viscoat对角膜内皮细胞的保护能力强于透明质酸钠