穿透性角膜移植术后角膜内皮细胞之命运

地２组猴行５。５→５．０ｍｍ穿透性角膜移植术，异种组４只，同种组４只，术前用冷冻创伤＾３Ｈ－ＴｄＲ标记法标记受生角膜内皮细胞，术后１４周摘除眼球，用放射自显影法显示银颗粒的分布。     

Contact lens fitting following corneal graft surgery

Contact lens fitting may be required following keratoplasty for either optical or thera‐peutic reasons. Optical indications for contact lens fitting include the correction of irregular astigmatism, high regular astigmatism, anisometropia and secondary aniseikonia, as well as simple ametropia, where the patient desires to wear contact lenses in preference to spectacles. Therapeutic lenses are not routinely fitted following kerate plasty, although this management is advised in certain cases, such as when there are protruding sutures or epithelial healing is impaired. Designing a contact lens for a patient who has undergone keratoplasty will require the practitioner to carefully assess all the relevant features of the corneal graft. In this regard, there are many factors that need to be considered including the diameter of the graft zone, the topographical relationship between the host cornea and donor cornea, the corneal (graft) toricity and the location of the graft. Special designs, such as reverse geometry lenses, or more complex contact lens modalities, such as piggyback contact lens systems, may be required to achieve success in fitting.     

Transmission of corneal collagen during arf excimer laser ablation

The time-resolved transmission of collagen films and 10-μm sections of bovine cornea during ArF laser ablation has been investigated. The film studies were performed on thin layers of extracted bovine corneal collagen, the principal chromophore in 193 nm photoablation. Transmission measurements were made on both dry and water-saturated films to assess the sensitivity of the ablation process to hydration. Distinct transient optical changes were observed in both fully desiccated and rehydrated films. Dehydrated films exhibit rapid reduction in film absorption over the time-course of the ablating laser pulse, presumably due to chromophore bleaching or annihilation. In contrast, rehydrated films demonstrate a short-lived enhancement of the attenuation. In either case, a single ablative laser pulse increased the long-term transmission of the film, although this increase was a factor of five greater for dehydrated films than for rehydrated samples. Results obtained from corneal tissue sections were essentially identical to those derived from hydrated collagen films. © 1993 Wiley-Liss, Inc.     

环孢霉素A滴眼预防高危角膜移植免疫排斥的效果

目标 探讨环孢霉素Ａ（ＣｓＡ）联合地塞米松局部滴眼预防高危穿透角膜移植（ＰＫＰ）免疫排斥反应的效果。方法 将７７眼高危ＰＫＰ分为ＣｓＡ组（３７眼）;２％ＣｓＡ蓖麻油溶液联合地塞米松滴眼;对照组（４０眼）单独使用地塞米松滴眼。采用生存曲线进行比较。结果 术后２年,两组植片存活率分别为８９％和６０％,差异有显著性（Ｐ〈０．０５）。结论 ２％ＣｓＡ蓖麻油溶液联合地塞米松溶液局部滴眼是预防高危ＰＫＰ免疫排     

Donor to host transmission of disease via corneal transplantation

A literature search was conducted to report all cases of documented transmission of infectious diseases from donors to recipients of corneal transplants. Fourteen such cases have been reported. There is no experimental or clinical evidence to suggest the transmissions of either hepatitis or syphilis via corneal grafting. Available evidence regarding a number of neurologic and other disorders in which a slow virus etiology has been implicated were reviewed. On the basis of this review, we are able to draw certain conclusions and guidelines for selection or rejection of donor material for transplant surgery.     

First experiences with HLA-matched corneal grafts in high risk cases

In highly vascularized corneas the number of graft failures caused by irreversible rejections is higher than in non- or slightly vascularized corneas. The importance of antigen compatibility is demonstrated, especially in these high risk cases.Ten highly vascularized corneas were grafted with HLA-matched donor material; only one reversible rejection was seen in this group.Nine non- or slightly vascularized corneas were grafted with donor material chosen at random. Retrospective HLA matching was performed. Three irreversible rejections were seen in this group. The number of HLA incompatibilities was high.     

穿透性角膜移植术治疗坏死性基质角膜炎23例

目的:探讨穿透性角膜移植术(penetratingkeratoplasty,PKP)治疗坏死性基质角膜炎(necrotizingstromalkeratitis)的手术适应证及其临床效果。方法:按照Holland等的HSK新分类法,选择确诊坏死性基质角膜炎患者,予以局部及全身药物治疗。对病情不能控制,药物治疗无效的患者22例(23眼),其中角膜溶解穿孔3眼,用新鲜角膜组织行穿透性角膜移植术,并随访观察术后疗效。结果:随访3mo～3a,22例(23眼)中,术后视力提高者18眼,其中矫正视力达到0.1～0.5者12眼,0.05～0.1者6眼;无改善者5眼。角膜植片透明17眼,半透明2眼,植片混浊4眼,植片透明率为74%。术后3眼植片发生排斥反应,3眼原发病灶复发。2眼术后因排斥反应及原发病灶反复发作,植片完全混浊,行2次角膜移植术。结论:对坏死性基质角膜炎患者,药物保守治疗无效、角膜坏死穿孔或行将穿孔,及时用新鲜角膜组织行穿透性角膜移植术治疗,不仅能控制炎症,缩短病程,而且能保存眼球,恢复部分视力,因此具有重要临床应用价值。     

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.     

Incidence and risk factors for post-penetrating keratoplasty glaucoma

Purpose:To carry out a prospective study to analyze the incidence and various preoperative, intraoperative, and postoperative risk factors for the development of PPKG.Methods:A total of 207 patients were analyzed prospectively, who were operated for penetrating keratoplasty (PK) in a tertiary eye care hospital between the time period of August 1, 2017 and February 28, 2018 and were followed up till the sixth month. Each patient was analyzed at every visit to determine the factors responsible for post-keratoplasty glaucoma.Results:Out of 207 eyes, post-PK glaucoma developed in 84 cases, which yielded an incidence of 41%. Incidence of PPKG (Post PK glaucoma) in various conditions was as follows: in repeat PK 62%, in perforated corneal ulcer 33%, in nonperforated corneal ulcer 29%, in corneal scar including adherent leukoma 37.2%, and in pseudophakic bullous keratopathy and aphakic bullous keratopathy, 14% and 80%, respectively. In age- and sex-adjusted multivariate analysis, the significant risk factors were age (P-value- 0.006), presence of PAS (P-value 0.001), and fellow eye glaucoma (P-value 0.04). Aphakia and combined surgery were not found to be significantConclusion:Our study recommends a meticulous examination of the fellow eye to assess the presence of glaucoma as it can increase the suspicion of glaucoma in the eye to be operated. The presence of PAS and age are important risk factors for developing PPKG. The risk of developing PPKG increases exponentially as the number of risk factors increases, but the presence of more than three risk factors does not add to the development of PPKG.