板层角膜移植治疗翼状胬肉及角膜皮样瘤

为观察板层角膜移植治疗翼状胬肉及角膜皮样瘤的疗效,我们对17例(17只眼)翼状胬肉患者及5例(5只眼)角膜皮样瘤患者进行了板层角膜移植。术后随访1～4年。翼状胬肉组和角膜皮样瘤组植片透明率分别为82.4%及100%。翼状胬肉组排斥反应发生率为17.6%,角膜皮样瘤组无一例发生排斥反应。所有病例角膜中央厚度手术前后差异无显著性意义(P>0.05)。两组病例术后角膜散光均较术前降低,差异均有显著性意义(P<0.05)。两组病例术后视力均有不同程度提高。翼状胬肉组术后复发率为11.8%。结果表明板层角膜移植可使角膜完整、植片透明、减少散光、提高视力并降低术后翼状胬肉的复发率,是一种理想的治疗方法,值得推广。     

Endothelial cell transplantation and growth behavior of the human corneal endothelium

Background: The human corneal endothelium has a limited proliferative capacity in vivo. Until now it has only been possible to replace damaged endothelium by transplantation of a donor cornea. After establishing methods for the isolation and in vitro cultivation of human corneal endothelial cells, transplantation of these cells my be an alternative therapeutic option. Materials and methods: In this review methods for the in vitro cultivation of human corneal endothelial cells and their transplantation on the Descemet membrane of donor corneas are described. Results: In vitro proliferation of human adult corneal endothelial cells was achieved by the development of defined cell culture conditions, including supplementation of culture medium with specified growth factors and substances. Dependent on the culture conditions, as well as independent of them, in vitro cultured endothelial cells showed phenotypic changes and different proliferative behavior. Thus, molecular biological examinations revealed a different expression pattern of growth factor receptors in fibroblast-like endothelial cells (dedifferentiated) compared to typical endothelial cells (differentiated). Moreover, the proliferative capacity of the cells differed, dependent on their corneal location. Cells isolated from the peripheral part of donor corneas have a higher proliferative capacity than cells obtained from the central part. The propagation of corneal endothelial cells in vitro offered the possibility of their transplantation on donor corneas in an in vitro model. After transplantation, these cells formed a monolayer whose morphology and cell density depended on the differentiation of the cells. DNA synthesis was predominantly detectable in cells of the corneal periphery. Conclusions: Our findings are the basis of the following hypothesis: the periphery of the cornea represents a regenerative zone of the corneal endothelium. The fact that early after transplantation corneal endothelial cells form a monolayer on the natural extracellular matrix (ECM), which shows contact inhibition, suggests that inhibitory factors are released by the Descemet membrane that influence the proliferation of the cells. Further studies on the regulation of the proliferation and differentiation of human corneal endothelial cells in vitro and after transplantation might offer the possibility to establish a selective procedure for the treatment of corneal endothelial cell loss in the near future.      

外伤角膜瘢痕无晶状体眼戴角膜接触镜后的角膜地形图改变

目的 探讨外伤性角膜瘢痕无晶状体眼戴硬性透气性接触镜前,后角膜表面的改变。方法 对戴该镜者１７眼及对照组（不戴镜）１２眼,在戴镜前后进行角膜地形图检测。结果 戴镜后平均８．４月,角膜散光减少（Ｐ〈０．０１）,角膜表面变得比较规则（Ｐ〈０．０５）,角膜表面的屈光度有变得相对比较平均的趋势。结论 戴硬性透气性角膜接触镜能使角膜瘢痕所致角膜散光减少,角膜表面变得较为规则。     

新鲜羊膜移植术治疗角膜溃疡

目的探讨新鲜羊膜移植术治疗角膜溃疡的临床疗效。方法采用新鲜羊膜移植治疗角膜溃疡共14只眼，其中细菌性角膜溃疡8只眼(其中穿孔2只眼)，病毒性角膜溃疡4只眼，真菌性角膜溃疡2只跟。结果术后1周内炎症控制，2～3周溃疡愈合。所有病例视力较术前均有提高，遗留有不同程度的角膜斑翳。2例溃疡穿孔瘢痕愈合，前房恢复。结论新鲜羊膜移植是治疗角膜溃疡的一种有效手段。     

超声乳化白内障手术对角膜知觉的影响

目的 观察颞侧透明角膜切口的超声乳化白内障手术对角膜知觉的影响。方法 随机抽取行颞侧透明角膜切口超声乳化白内障吸出术的老年性白内障患者30例(30只眼)，分别于术前、术后1天、术后1、3、6月、术后1年行角膜知觉检查，用Cohet—Bonnet角膜知觉计分别测量角膜中央、上方、下方、鼻侧、颞侧的角膜知觉阈值(以测定器的尼龙丝长度表示)。结果 术后1天全部病人角膜知觉显著减退，中央减少40．4％、颞侧减少39．9％，上方、下方和鼻侧分别减少33％、28．5％、28．7％。上方、下方、鼻侧角膜知觉术后6个月恢复，中央及颞侧角膜切口知觉术后1年恢复。结论 小切口超声乳化白内障手术可影响角膜知觉，但术后角膜知觉恢复较快。     

糖尿病视网膜病变光凝术后角膜知觉的改变

目的 探讨糖尿病视网膜病变患者在全视网膜光凝术后的角膜知觉改变及影响因素。方法 32例(32只眼)糖尿病视网膜病变患者应用倍频ND：YAG激光行全视网膜光凝，光凝斑大小：200～300／μm，光凝时间：0．2～0．4秒，光凝斑强度以达到中等强为标准。采用Cochet--Bonnnnet角膜知觉测量仪测量光凝前及光凝后1、2、3、4、5、6周及2个月的角膜知觉。结果 糖尿病视网膜病变患者术前的角膜知觉为2．27cm，术后1、2、3、4、5、6周及2个月的角膜知觉分别为1．42cm、1．60cm、1．58cm、1．92cm、1．71cm、2．19cm和2．23cm。与术前相比，术后1～5周的角膜知觉减退值与术前的角膜知觉的相关系数为0．82。结论 糖尿病视网膜病变行全视网膜光凝后的角膜知觉有明显减退，在光凝后6周恢复至术前水平，角膜知觉的减退值与光凝的范围及术前的角膜知觉有关。     

两种微角膜刀所制角膜瓣对LASIK术后角膜循规性散光的影响

目的　探讨两种微角膜刀所制角膜瓣对LASIK术后角膜循规性散光的影响。方法　循规性近视散光患者 96人 ( 180眼 )随机分为Ⅰ、Ⅱ两组 ,分别采用MoriaLSK -One平推式气动微角膜刀和MoriaM 2旋转式微角膜刀制做角膜瓣 ,然后进行激光手术。术后 6个月观察患者的角膜散光及角膜散光轴的变化。结果　术后 6个月 ,Ⅰ组、Ⅱ组角膜散光值分别为 0 3 6± 0 13D和 0 5 2±0 0 9D ,与术前相比 ,分别下降 1 3 5± 0 11D ,1 0 8± 0 10D ,差异显著 (P <0 0 1)。而散光轴无明显改变。结论　与MoriaLSK -One平推式气动微角膜刀相比 ,MoriaM 2旋转式微角膜刀所制角膜瓣有产生循规性角膜散光的趋势     

Involvement of the Anterior Segment of the Eye in Patients with Mucopolysaccharidoses: A Review of Reported Cases and Updates on the Latest Diagnostic Instrumentation

Mucopolysaccharidoses (MPS) are a heterogeneous group of rare inherited disorders, characterized by the lack or malfunction of lysosomal enzymes necessary for glycosaminoglycan (GAGs) catabolism, and their subsequent accumulation in many tissues and organs throughout the body. An overview of the current knowledge of corneal and anterior segment manifestations in patients with MPS was provided and clinical guidelines for their diagnosis and management were furnished. The anterior segment of the eye is usually involved in every subtype of MPS, with major complications including varying degrees of corneal opacification and raised intraocular pressure (IOP) with development of glaucoma. Their recognition and management can be very useful in the diagnosis of MPS. Novel techniques are available to objectively measure the grade and extent of corneal clouding and give information about the anatomy of the anterior chamber and the structures of the angle beyond the clouded cornea. It is advisable to take advantage of this new instrumentation in order to obtain thorough information on the ocular involvement and its related anterior chamber complications for a better management of patients with MPS, both in terms of visual prognosis and therapeutic outcome.     

Queratopigmentación quirúrgica intraestromal con tinta para tatuaje cutáneo

Case reportA 31-year-old woman who had undergone surgery for a congenital cataract as a newborn developed bilateral malignant glaucoma, which was refractory to medical-surgical treatment. The patient currently has terminal glaucoma and severe band keratopathy. For aesthetic purposes, we performed intrastromal keratopigmentation surgery using ink for skin tattoos supplied in sterile single-dose vessels. No secondary effects or complications were observed.DiscussionKeratopigmentation or corneal tattooing can now be used as a last resort in patients who are unable to tolerate cosmetic contact or intraocular lenses, or in whom corneal transplant is contraindicated.     

Sheets glide-assisted versus Busin glide-assisted insertion techniques for descemet stripping endothelial keratoplasty (DSEK): A comparative analysis

BackgroundThe donor lenticule insertion techniques play a crucial role in outcomes following descemet stripping endothelial keratoplasty (DSEK) and the current study is aimed to compare two of the commonly performed donor lenticule insertion techniques in DSEK.MethodDescemet stripping endothelial keratoplasty was performed in 48 eyes of 48 patients at two tertiary eye care centers from January 2014 to December 2016. At one center (Group 1), 26 patients had Sheets glide-assisted lenticule insertion whereas at other center (Group 2), 22 patients had Busin glide-assisted insertion of donor lenticule. Best corrected visual acuity (BCVA), manifest spherical equivalent, manifest cylinder, endothelial cell density (ECD) and percentage of endothelial cell loss (ECL) were compared between the two groups at 6 months after DSEK. In addition, intraopertaive and postoperative complications were also compared.ResultsAt 6 months after DSEK, an insignificant difference was observed in BCVA [Group 1: 0.48 logarithm of the minimum angle of resolution (log MAR); Group 2: 0.50 log MAR (p = 0.74)], mean manifest spherical equivalent [Group 1: 0.64 diopter (D); Group 2: 0.59 D (p = 0.74)], mean manifest cylinder [Group 1: 1.35 D; Group 2: 1.32 D (p = 0.92)] and mean ECL [Group 1: 26.75%; Group 2: 28.76 (p = 0.44)] between the two groups. In addition, the rate of complications is similar between the two groups.ConclusionsBoth Sheets glide-assisted and Busin glide-assisted donor lenticule insertion techniques are associated with similar surgical outcomes after DSEK.