眼表面碱烧伤后羊膜移植疗效观察

目的　观察眼表面碱烧伤后羊膜移植的疗效。方法　对眼表面碱烧伤 10例 (14只眼 )行羊膜移植术 ,术后观察眼表面重建 ,视力恢复 ,睑球粘连情况。结果　术后 1个月上皮细胞修复率和视力提高率分别达到 85 %、75 %。结论　羊膜移植治疗眼表面碱烧伤 ,早期可以促进角膜上皮细胞修复 ,有效防止睑球粘连     

上皮移植治疗严重的眼表面疾患

角膜缘上皮移植是治疗角膜缘功能缺陷产生的严重眼表面疾患的有效手术，在国外已逐渐应用于临床，本文就干细胞缺陷的理论基础，上皮移植治疗眼表面疾患的分类，角膜缘移植的手术方法，术后处理和预后等方面作一综述。     

表面麻醉在眼前段外伤手术中的应用

目的评估表面麻醉在眼前段穿通伤手术中的应用效果。方法于术前5~10 min滴用0.5%爱尔凯因眼液行表面麻醉。结果143例中118眼麻醉效果满意,无任何痛感;22眼有轻度不适,需术中追加表麻药;只有3眼由于无法忍受疼痛而改为其他麻醉方法。本组病例未见任何与表面麻醉相关的并发症。结论在表面麻醉下行眼前段外伤手术是安全有效的。     

正常人眼及戴角膜接触镜眼的结膜表面细胞变化

我们采用结膜印迹细胞学(eonjunctival impression cytology，CIC)方法研究正常人及配戴角膜接触镜患者眼的结膜杯状细胞数量、密度，上皮细胞的形态及角化程度与其年龄间的关系。     

前房注入1%利多卡因辅助表面麻醉在眼前段内眼手术中的应用

目的探讨前房注入1%利多卡因作为表面麻醉的一种辅助麻醉在眼前段内眼手术中的麻醉效果。方法对29例42眼患者眼前段内眼手术,在手术进入前房前,通过1mm前房穿刺或侧切口注入1%利多卡因,观察麻醉效果及术中术后并发症。结果Ⅰ级手术中完全无疼痛,手术配合良好;Ⅱ级术中疼痛轻微,可以耐受配合手术完成;Ⅲ级术中疼痛较剧,难以忍受。Ⅰ级者40眼,Ⅱ级者2眼,Ⅲ级者0眼,术中、术后无出现并发症。结论表面麻醉联合前房注入1%利多卡因是一种安全、有效、并发症少的麻醉方法。     

眼免疫赦免的现代概念及临床意义

眼的免疫赦免是一极其复杂和动态的免疫调节过程。维持其存在的主要生理特征有：完整的血－眼屏障、抗原缺乏淋引流而直接通过血液途径转至脾脏、局部的免疫抑制微环境。     

表面麻醉下眼前段外伤手术临床报告

目的 探讨表面麻醉下施行眼前段外伤手术的可行性，对其安全性和可靠性作一初步分析。方法 在表面麻醉下完成120例(120只眼)眼前段外伤手术。结果 所有病例患者术中均能耐受和配合，镇痛效果良好无麻醉并发症发生。结论 表面麻醉避免了多种并发症的发生，适用于多数眼前段外伤手术，安全有效。     

Innate immunity of the ocular surface and ocular surface inflammatory disorders

Ocular surface epithelial cells selectively respond to microbial components and induce limited inflammation, whereas immune competent cells such as macrophages can recognize various microbial components through Toll-like receptors (TLRs), induce inflammation, and, thereby, exclude microbes. The difference between macrophages and ocular surface epithelial cells could be due to their dissimilarity in coexistence with commensal bacteria. The unique innate immune response of the ocular surface epithelium might contribute to its coexistence with commensal bacteria. Moreover, we suspect that some ocular surface inflammatory disorders might be caused by abnormality of the mucosal innate immunity. We considered the possibility that there is an association between Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN)--a severe variant of SJS--and a disordered innate immune response. In gene expression analysis of CD14 cells, we found that interleukin-4 receptor (IL-4R) gene expression was different between patients with SJS/TEN and normal control subjects upon lipopolysaccharide (LPS) stimulation: it was downregulated in the former and slightly upregulated in the latter. Furthermore, expression of mRNA specific for IkappaBzeta and interleukin (IL)-1alpha was lower in patients with SJS/TEN than in normal controls after 1-hour culture. We next performed single nucleotide polymorphism (SNP) association analysis of IL-4R, IkappaBzeta, and IL1alpha genes and TLR2 and TLR3--genes associated with innate immunity--in 80 Japanese patients with SJS/TEN and 160 Japanese healthy volunteers. IL4R SNP Gln551Arg (rs.1801275) (P = 0.0004), TLR3 rs.3775296T/G SNP (P = 0.0001) and TLR3 rs.3775290A/G SNP (P = 0.009) showed a significant association with SJS/TEN. IkappaBzeta SNP rs.595788G/A showed a weak inverse association (P = 0.04). Genetic and environmental factors may play a role in an integrated etiology of SJS/TEN, and there is possibly an association between SJS/TEN and a disordered innate immunity.     

Assessing the ocular surface microbiome in severe ocular surface diseases

PurposeThere is growing evidence for a critical role of the microbiome in ocular health and disease. We performed a prospective, observational study to characterize the ocular surface microbiome (OSM) in four chronic ocular surface diseases (OSDs) and healthy controls.MethodsSterile swabs were used to collect samples from each eye of 39 patients (78 eyes). Sterile technique and multiple controls were used to assess contamination during DNA extraction, amplification and sequencing. Concurrent use of topical antibiotics, steroids, and bandage contact lenses (BCLs) was documented.ResultsDespite the low biomass of the ocular surface, 47/78 (60%) eyes sampled had positive sequencing reads. We observed that half of patients (8/17, 47%) had distinct microbiomes in each eye. Healthy controls had a Lactobacillus/Streptococcus mixture or significant Corynebacterium. Staphylococcus predominated in 4/7 (57%) patients with Stevens-Johnson Syndrome (SJS) in at least one eye, compared to 0/10 healthy controls. Interestingly, 8/11 (73%) eyes with SJS were using BCLs, including 4/5 (80%) eyes dominated by Staphylococcus. Lax eyelid syndrome (LES) and Dry Eye Disease (DED) patients had similar OSMs, with Corynebacterium being the most prevalent bacteria. Alpha diversity was higher in controls and ocular graft-vs-host (oGVHD) patients compared to the other OSDs.ConclusionsOnly 50% of the 39 patients had similar microbiomes in each eye. A majority of healthy eyes had a Lactobacillus/Streptococcus mix or Corynebacterium microbiome. Staphylococcus predominated in SJS, Lactobacillus in oGVHD, and Corynebacterium in DED and LES. There may be an association between different OSDs and the microbiome.     

Glaucoma and ocular surface

Topical eye-drops remain the cornerstone of treatment for ocular diseases, including glaucoma. Preservatives are added to multi-dose medication bottles to reduce the risk of microbial contamination, to extend the validity of the product and to allow an easily use of the bottles. However the repetitious use of ophthalmic medications containing preservatives, particularly when treating chronic diseases, has been linked to adverse effects and ocular surface disease (OSD). Therefore, this presentation provides an overview of glaucoma and OSD, the role of preservatives in ophthalmic preparations, and the impact of preservatives on the ocular surface.     

眼表铁过载小鼠干眼模型的构建和机制研究

目的:通过给小鼠腹腔注射右旋糖酐铁,建立小鼠铁过载干眼模型并初步探索其可能的机制。方法:将40只雄性C57BL/6小鼠(取右眼为实验眼)用随机数字表法将小鼠分为4组：对照组10只,每次腹腔注射生理盐水0.2mL;低剂量组、中剂量组、高剂量组各10只为模型组,每次分别腹腔注射浓度为12.5、25、50mg/mL的右旋糖酐铁溶液0.2mL。每3d注射1次,共注射28d。注药后第7、14、28d观察各组小鼠眼表炎症指数、角膜荧光素染色、泪膜破裂时间(BUT)及泪液分泌量(SⅠt),评估干眼及眼表炎症程度。28d后处死小鼠,取角膜、结膜及泪腺组织,进行HE染色、普鲁士蓝染色以及组织铁检测,评估小鼠炎症反应及铁过载情况;采用酶联免疫吸附试验(ELISA)检测炎症因子白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶-9(MMP-9)的表达情况。结果:与对照组相比,模型组小鼠出现一系列干眼症状,小鼠眼表炎症指数增高,角膜荧光素染色评分增加,BUT缩短,泪液分泌量减少(均P<0.05);模型组小鼠角膜、结膜及泪腺组织均受到不同程度的损伤,各组织眼表铁沉积情况较对照组...     

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.     

Radiotherapy-induced ocular surface disease

Today radiation is routinely used as a therapeutic modality for select tumors of the orbit, adnexa, paranasal sinus, and nasopharynx. Despite significant improvements in mechanisms of delivery and protective shielding, acute and chronic complications of radiation can affect different segments of the eye. In this report, we provide an overview of ocular damage secondary to radiotherapy. We identify the characteristic clinical changes and underlying pathophysiologic mechanisms involving the ocular surface and provide a rational approach to their prevention and treatment.     

About ocular surface damage

Tear film maintain ocular surface health and functional through nutritional support, anti-bacterial properties, viscoelastic protection, smooth optical surface and increase of lubrication. The ocular surface may be affected after surgery (cataract, glaucoma, refractive surgery) or chronic glaucoma treatment.     

Dynamics of ocular surface topography

PURPOSE: To investigate fluctuations in the ocular surface, we used high-speed videokeratoscopy (50 Hz) to measure the dynamics of the ocular surface topography. METHODS: Ocular surface height difference maps were computed to illustrate the changes in the tear film in the inter-blink interval. Topography data were used to derive the ocular surface wavefront aberrations up to the fourth radial order of the Zernike polynomial expansion. We examined the ocular surface dynamics and temporal changes in the ocular surface wavefront aberrations in the inter-blink interval. RESULTS: During the first 0.5 s following a blink, the ocular surface height at the upper edge of the topography map increased by about 2 mum. Temporal changes occurred for some ocular surface wavefront aberrations and appeared to be related to changes in the distribution of tear film. CONCLUSION: In the clinical measurement of ocular surface topography using videokeratoscopy or optics of the eye using wavefront sensors, care should be taken to avoid the initial tear film build-up phase following a blink to achieve more consistent results.