氯化锂通过TGFBI促进角膜基质成纤维细胞增殖和自噬

目的：研究TGFBI和微管相关蛋白轻链3(LC3)在角膜营养不良患者中的表达,及氯化锂(LiCl)通过TGFBI对角膜基质成纤维细胞增殖能力的影响。

方法：用免疫组化和Western-blot方法检测角膜营养不良及正常角膜组织中TGFBI和LC3的表达。实验构建了TGFBI过表达载体并转染角膜基质成纤维细胞,分别以5、10、20、40mmol/L LiCl作用于突变型TGFBI转染的角膜基质成纤维细胞,检测不同时间(0、1、6、12h)后,TGFBI与LC3蛋白表达变化,并用CCK-8法检测细胞增殖活性。

结果：TGFBI和LC3在角膜营养不良患者角膜组织中显著高表达。TGFBI过表达抑制角膜基质成纤维细胞增殖活性(P<0.05)。LiCl抑制突变型TGFBI转染的角膜基质成纤维细胞中TGFBI和LC3蛋白表达,并增强其细胞增殖活性(P<0.05)。

结论：LiCl可以促进角膜基质成纤维细胞增殖活性和自噬,其作用机制与下调TGFBI和LC3的表达有关。     

三种角膜屈光手术对近视患者角膜内皮细胞的影响

目的：对比角膜板层刀制瓣的前弹力层下准分子激光角膜磨镶术(SBK)、飞秒激光制瓣的SBK术(FS-SBK)与飞秒激光小切口角膜基质透镜取出术(SMILE)对近视中央角膜内皮细胞的短期及长期影响。

方法：我院近视34例34眼行SBK术; 41例41眼行FS-SBK术; 49例49眼行SMILE术,术前和术后1wk,1a利用SP-1P型非接触角膜内皮显微镜检查角膜内皮细胞,统计分析各组中央角膜内皮细胞密度(ECD)、内皮细胞面积的变异系数(CV)和六边形内皮细胞百分比。

结果：三组间术前、术后1wk,1a裸眼视力及屈光度均无差异(P>0.05)。术后1wk三组中央ECD均较术前减少(P<0.01),术后1a各组均较术前无差异(P>0.05); 术前及术后各随访时间点,三组间中央角膜内皮细胞面积CV及六边形内皮细胞百分比均无差异(P>0.05); 不同组内,术前及术后各随访时间点结果均无差异(P>0.05)。

结论：SBK、FS-SBK和SMILE手术对近视内皮细胞的安全性确切,术后早期各组中央角膜ECD均轻度降低,1a后恢复; 术后各组中央角膜内皮细胞面积CV及六边形内皮细胞百分比较术前无明显改变。     

可视化角膜生物力学分析仪评价FS-LASIK、SBK、LASEK术后生物力学变化

目的：研究3种角膜屈光手术在手术前后角膜生物力学的变化及不同术式间的差异。方法：前瞻性研究。对2016年2-4月南京医科大学附属南京医院眼科行准分子激光手术的患者64例（125眼）手术前后的角膜生物力学参数进行分析,其中55眼行飞秒激光制瓣准分子激光原位角膜磨镶术（FS-LASIK）,47 眼行准分子激光前弹力层下角膜磨镶术（SBK）,23眼行准分子激光上皮下角膜磨镶术（LASEK）。应用可视化角膜生物力学仪（CST）对患者进行测量,选取其中第一压平时间（AT1）、第二压平速度（Vout）、最大压陷曲率半径（HC-radius）、最大压陷幅度（DA）、眼压（IOP）进行分析。术后1 d、1 周、3 个月进行随访。采用单因素方差分析、Pearson相关分析、配对t检验进行数据分析。结果：FS-LASIK组中各项生物力学参数与中央角膜厚度（CCT）（ AT1：r=0.455,P<0.001;Vout：r=-0.286,P=0.034;HC-radius：r=0.357,P=0.007;DA：r=-0.341,P=0.011;IOP：r=0.436,P=0.001）、角膜剩余基质床厚度（RST）（ AT1 r=0.563,P<0.001;Vout：r=-0.417,P=0.007;HC-radius：r=0.552,P<0.001;DA：r=-0.395,P=0.012;IOP：r=0.516,P<0.001）、最大切削深度（AD）（ AT1：r=-0.721,P<0.001;Vout：r=0.466,P=0.002;HC-radius：r=-0.407,P=0.009;DA：r=0.596, P<0.001;IOP：r=-0.612,P<0.001）均有较强相关性。SBK组中各项生物力学参数均与CCT（AT1：r=0.364,P=0.012;Vout：r=0.408,P=0.004;HC-radius：r=0.326,P=0.025;DA：r=-0.362,P=0.012;IOP：r=0.387,P=0.007）有较强的相关性。LASEK组中仅AT1（r=0.625,P=0.001）、IOP（r=0.624,P=0.001）与CCT有相关性。3 组的AT1、HC-radius、IOP和CCT较术前均减小（均P<0.05）,Vout、DA较术前均增加（均P<0.05）。3组间比较,术后1 周时FS-LASIK组的AT1、IOP值明显大于LASEK组（AT1：F=7.313,P=0.001;IOP：F=4.979,P=0.009）,Vout和DA值明显小于LASEK组（Vout：F=3.420,P=0.038;DA：F=9.024,P<0.001）,SBK组的各项参数值位于2 组之间,与FS-LASIK组差异无统计学意义;术后3 个月时,3 组间差异无统计学意义。结论：在角膜厚度足够时,3 种手术方式均能安全可靠地矫正近视。FS-LASIK由于飞秒激光切削的精确性和优越性,术后能够更快恢复生物力学的稳定性。LASEK的生物力学变化与剩余基质床厚度和切削深度的相关性较低,在患者近视度数较高,角膜相对较薄时,可以优先考虑该术式。     

Phacoemulsification in eyes with corneal opacities after deep anterior lamellar keratoplasty

To evaluate the maneuverability and efficacy of phacoemulsification and intraocular lens (IOL) implantation in eyes with corneal opacities after deep anterior lamellar keratoplasty (DALK), twelve eyes of 12 patients with mild to moderate corneal opacities after DALK and coexisting cataracts were analyzed retrospectively. Phacoemulsification and IOL implantation assisted with anterior capsule staining, as well as non-invasive optical fiber illumination, were performed on all eyes. No intraoperative or postoperative complications were noted. Mean corrected distance visual acuity (logMAR) improved from 1.24±0.17 to 0.73±0.22. Post-phaco intraocular pressure was maintained between 13 to 20 mm Hg in all cases throughout the follow-up period. Mean endothelial cell density decreased from 2258.42±205.94 to 1906.25±174.23 cells/mm2. Phacoemulsification and IOL implantation are safe and valid in eyes with mild to moderate corneal opacities after DALK and coexisting cataracts when assisted with anterior capsule staining and non-invasive optical fiber illumination.     

Personalized aspheric intraocular lens implantation based on corneal spherical aberration: a review

With the evolution of cataract surgery from visual rehabilitation to refractive surgery, aspheric intraocular lenses (IOLs) are being increasingly used in the field of ophthalmology. This increased use can be attributed to negative or zero spherical aberrations with unique optical designs, which counteract some of the positive spherical aberrations of the cornea. These alterations reduce the total spherical aberration of human eyes and improve the visual acuity in patients with cataract postoperatively. At present, various types of aspheric IOLs are used worldwide. Although the implantation of aspheric IOL is beneficial to the patients who need correction of spherical aberrations, much controversy is still associated with ocular residual spherical aberrations that facilitate the best visual quality for patients postoperatively. In order to provide reference for future clinical work and scientific research, this report reviews the relationship between the ocular residual spherical aberration of human eyes and visual quality.     

Impact of corneal parameters on intraocular pressure measurements in different tonometry methods

AIM: To evaluate the impact of central corneal thickness (CCT) and corneal curvature on intraocular pressure (IOP) measurements performed by three different tonometers. METHODS: IOP in 132 healthy eyes of 66 participants was measured using three different tonometry techniques: Goldmann applanation tonometer (GAT), Pascal dynamic contour tonometer (DCT), and ICare rebound tonometer (RT). CCT and corneal curvature were assessed. RESULTS: In healthy eyes, DCT presents significantly higher values of IOP than GAT (17.34±3.69 and 15.27±4.06 mm Hg, P<0.0001). RT measurements are significantly lower than GAT (13.56±4.33 mm Hg, P<0.0001). Compared with GAT, DCT presented on average 2.51 mm Hg higher values in eyes with CCT<600 μm and 0.99 mm Hg higher results in eyes with CCT≥600 μm. The RT results were lower on average by 1.61 and 1.95 mm Hg than those obtained by GAT, respectively. Positive correlations between CCT in eyes with CCT<600 μm were detected for all IOP measurement techniques, whereas a similar relationship was not observed in eyes with thicker corneas. A correlation between IOP values and keratometry in the group with CCT<600 μm was not detected with any of the tonometry methods. In thicker corneas, a positive correlation was found for GAT and mean keratometry values (R=0.369, P=0.005). CONCLUSION: The same method should always be chosen for routine IOP control, and measurements obtained by different methods cannot be compared. All analysed tonometry methods are dependent on CCT; thus, CCT should be taken into consideration for both diagnostics and monitoring.     

Surgical approaches to correct corneal astigmatism at time of cataract surgery: a mini-review

Among refractive errors, astigmatism is the most common optical aberration, where refraction changes in different meridians of the eye. It causes blurred vision at any distance and includes corneal, lenticular, and retinal astigmatism. Cataract surgery used to cause a progressive increase in the pre-exisiting corneal astigmatism because of creating a surgically induced astigmatism, for example, a large size surgery incision. The development of surgical techniques during last decades has made cataract surgery interchange to treat preoperative corneal astigmatism at time of surgery. Nowadays, three surgical approaches can be used. By placing a sutureless clear corneal incision on the steep meridian of the cornea, a preoperative corneal astigmatism less than 1.0 D can be corrected. Single or paired peripheral corneal relaxing incisions (PCRIs) provide 1.0-3.0 D corneal astigmatism correction. PCRIs are typically used for treating 1.0-1.5 D of regular corneal astigmatism, if more than 2.0 D, the risk of overcorrection and irregular astigmatism is increased. When toric intraocular lenses (IOLs) are unavailable in markets, PCRIs are still a reasonable option for patients with up to 3.0 D of pre-existing corneal astigmatism. Toric IOLs implantation can correct 1.0-4.5 D of corneal astigmatism. Several IOLs are approved to correct a high degree of corneal astigmatism with cylinder power up to 12.0 D. These approaches can be used alone or in combination.     

不同程度近视患者行SMILE术后的有效光学区及角膜高阶像差比较

目的：比较低、中、高度近视患者行飞秒激光小切口基质透镜取出术(SMILE)后的有效光学区和角膜高阶像差。

方法：收集2019-02/2021-02在我院行SMILE手术的患者134例,均取右眼入组,按等效球镜度(SE)分为低度近视组SE>-3.00 D,中度近视组-6.00 D结果：SMILE术后1 mo,三组术后有效光学区均小于预设光学区,随着屈光度数增加,有效光学区越小(P<0.05); 术后1 mo角膜总高阶像差、球差、彗差均高于术前,除低近视度组球差术前与术后1 mo无差异(P>0.05),其余组别均有差异(P<0.05); 角膜总高阶像差、球差和彗差随着屈光度数增加而增加,三组角膜总高阶像差和球差有差异(均P<0.05),高度近视组与中度近视组、低度近视组彗差结果均有差异(P<0.05),中度近视组与低度近视组彗差结果无差异(P>0.05)。

结论：随着手术矫正的屈光度数增加,术后有效光学区减少越多,角膜高阶像差增加越明显; SMILE术后1 mo角膜高阶像差较术前增加。     

美容相关眼部损伤急性期的临床表现

目的：探讨美容相关眼部损伤急性期的临床表现。

方法： 回顾性研究。收集2016-04/2021-10因美容导致的眼部损伤患者53例89眼,分析患者急性期的临床特征,包括性别、年龄、受伤眼别、临床表现、致伤原因、治疗过程及预后。

结果：纳入53例89眼患者均为女性,年龄22-45(平均28.4±6.7)岁。单眼损伤17例,双眼损伤36例。2种或2种以上眼部损伤可累及同一眼。导致眼部损伤的主要美容操作包括：纹眼线38眼(43%); 嫁接睫毛18眼(20%); 去除假睫毛11眼(12%); 涂睫毛膏8眼(9%); 双重睑手术6眼(7%); 其他8眼(9%)。主要眼部损伤类型包括：角膜损伤56眼(63%); 眼睑接触性皮炎26眼(29%); 结膜炎19眼(21%); 眼睑反应性水肿13眼(15%); 眼表异物12眼(14%); 睑缘细菌性感染10眼(11%); 其他5眼(6%),这其中包括因眼周注射玻尿酸导致视网膜中央动脉阻塞1眼(1%)。74眼经过正规治疗可在1-2 wk内痊愈,3眼出现丝状角膜炎,视网膜中央动脉阻塞1眼预后差。

结论：美容相关眼部损伤见于中青年女性,引发眼部损伤最常见的美容操作是纹眼线,最主要损伤类型为角膜损伤。美容相关眼部损伤多数可以预防,治疗方法有效且总体预后良好。