自体角膜缘干细胞联合羊膜移植治疗复发性翼状胬肉

目的　探讨自体角膜缘干细胞联合羊膜移植治疗复发性翼状胬肉的临床效果。方法　将 84例 (84只眼 )复发性翼状胬肉患者随机分为治疗组 (4 6例 )和对照组 (38例 )。治疗组采用自体角膜缘干细胞联合羊膜移植治疗 ,对照组行单纯羊膜移植 ,术后随访 3个月至 2年。结果　角膜上皮均于 1周内完全愈合。治疗组 4 6例中 3例复发 ,复发率为 6 .5 % ;对照组 38例中 9例复发 ,复发率为 2 3.7%。两组相比具有显著性差异 (χ2 =5 .0 0 6 ,P <0 .0 5 )。结论　自体角膜缘干细胞联合羊膜移植抑制了结膜下纤维组织增生 ,重建角膜缘部屏障功能 ,能有效治疗复发性翼状胬肉。     

翼状胬肉不同术式效果观察

目的寻求一种理想的手术方法以减少胬肉术后的复发率。方法对636例726眼采用单纯胬肉切除术(209眼)。带蒂结膜瓣转移术(158眼)，保存羊膜移植术(94眼)，丝裂霉素C应用加带蒂结膜瓣转移术(131眼)，自体角膜缘干细胞移植术(134眼)等方法治疗，随访6月至7年，比较其复发率。结果术后复发率，单纯胬肉切除为29．67％，带蒂结膜瓣转移术为20．25％，保存羊膜移植术为15．96％，丝裂霉素C应用加带蒂结膜瓣转移术为6．11％，自体角膜缘干细胞移植术为3．73％。结论自体角膜缘干细胞移植术和丝裂霉素C应用加带蒂结膜瓣转移术减低了胬肉的复发率。取得了良好的效果，是二种理想的手术方法。值得推广。     

深低温保存异体角膜缘干细胞羊膜移植治疗重度眼表疾病

目的 应用以羊膜为载体的深低温保存的角膜缘干细胞同种异体移植术治疗重度眼表疾病。方法 19例19眼重度眼表疾病患者采用羊膜移植联合深低温保存的角膜缘干细胞同种异体移植，2例术后半年行穿透性角膜移植术，随访观察术后疗效。结果 14例平均随访超过一年，眼表结构恢复正常，整个角膜上皮未见结膜杯状细胞，保存了眼球，视力均有不同程度的提高；1例植片脱落；4例发生角膜自溶的免疫排斥反应。结论 羊膜移植联合深低温保存的角膜缘干细胞同种异体移植术对于重度眼表疾病患者能快速、稳定的促进角膜表面重新上皮化，是一项可采纳的技术。     

The role of Tenonplasty in the management of limbal and scleral ischemia due to acute ocular chemical burns

Of the various manifestations of ocular chemical burns (OCBs), ischemia of the limbus and the peri-limbal sclera indicates poor prognosis and in severe cases threaten the integrity of the globe. Tenonplasty is a surgical procedure which involves advancing the Tenon’s capsule over the ischemic areas to provide a vascular supply and to enable migration of the conjunctival epithelium. This review aims to provide an overview of the diagnosis of limbal ischemia and its management with Tenonplasty. A literature review was conducted using the keywords “Tenonplasty,” “Tenon’s capsule,” “ocular chemical injury,” “ocular thermal injury,” “Tenon advancement,” “scleral ischemia,” and “limbal ischemia,” and outcomes were studied from seven selected articles. In addition to clinical evaluation, in vivo imaging techniques such as anterior segment optical coherence tomography angiography can provide an objective method of measuring and monitoring the ischemia and re-perfusion of the peri-limbal vasculature. Tenonplasty can be performed in eyes with acute OCBs with scleral or limbal ischemia by dissecting the Tenon’s layer from the orbit and securing it to the limbus. The indications, mechanism of action, peri-operative considerations, surgical technique, and post-operative care of Tenonplasty are discussed in detail. The average time for post-operative re-epithelization ranges from 1 to 6 months with the formation of a symblepharon being the most common complication. In conclusion, Tenonplasty is a globe-salvaging procedure in cases with severe limbal and scleral ischemia because of OCBs and has good anatomical outcomes priming the globe for subsequent re-constructive and vision-restoring surgeries.     

翼状胬肉不同手术方法患者泪液功能的临床分析

目的探讨两种不同手术方式治疗翼状胬肉对泪液功能的影响及影响因素。方法选取翼状胬肉患者40例(40只眼)随机分成两组:A组20个病人(20只眼)翼状胬肉切除联合冻干羊膜移植术;B组20个病人(20只眼)翼状胬肉切除联合带自体角膜缘干细胞结膜瓣移植术。术前,术后1mo,术后3mo行泪膜破裂时间(BUT)、泪液分泌试验(SchirmerI)、角膜荧光素染色(CSF),评价翼状胬肉及翼状胬肉切除术后泪膜功能变化对患者生活质量的影响。结果两组病人术后1moBUT缩短,角膜荧光素染色增多,差异有统计学意义(p<0.05),而术后SchirmerI与术前相比无统计学意义,两组术后3moBUT,SchirmerI,CFS与术前相比无统计学意义,翼状胬肉切除联合带自体角膜缘干细胞结膜瓣移植术组术后早期泪膜稳定性优于翼状胬肉切除联合冻干羊膜移植术,差异具有统计学意义(p<0.05)。结论翼状胬肉切除术早期对泪膜功能有影响。翼状胬肉切除联合带自体角膜缘干细胞结膜瓣移植术早期对泪膜的影响小于翼状胬肉切除联合冻干羊膜移植术。     

生物羊膜移植与带角膜缘的自体结膜移植治疗翼状胬肉的疗效观察

目的 观察生物羊膜移植和带角膜缘的自体结膜移植两种手术方式治疗翼状胬肉的疗效.方法 77例(101只眼)患者随机分为两组,A组40例(52只眼)行翼状胬肉切除联合生物羊膜移植,B组37例(49只眼)行翼状胬肉切除联合带角膜缘的自体球结膜移植,术后炎症明显者加用0.02％丝裂霉素C点眼.术后随访10～36个月,观察两组复发率,比较两组角膜创面修复时间和术后使用丝裂霉素C的情况.结果 A组8只眼复发,复发率15.38％,B组2只眼复发,复发率4.08％;A组术后角膜创面平均修复时间(4.48 ±0.87)d,B组术后角膜创面平均修复时间(4.04±1.10)d,二者间差异有统计学意义(t=2.23,P＜0.05);A组术后使用丝裂霉素C 14只眼(26.9％),B组术后使用丝裂霉素C3只眼(6.12％),二者间差异有统计学意义(x2=7.80,P＜0.01).结论 生物羊膜或者是带角膜缘的自体结膜移植,联合术后丝裂霉素C点眼均能减少翼状胬肉切除术后复发,但带角膜缘的自体球结膜移植术后角膜修复时间更短,局部炎症反应更轻.     

Rapid tissue engineering of biomimetic human corneal limbal crypts with 3D niche architecture

Limbal epithelial stem cells are responsible for the maintenance of the human corneal epithelium and these cells reside in a specialised stem cell niche. They are located at the base of limbal crypts, in a physically protected microenvironment in close proximity to a variety of neighbouring niche cells. Design and recreation of elements of various stem cell niches have allowed researchers to simplify aspects of these complex microenvironments for further study in vitro. We have developed a method to rapidly and reproducibly create bioengineered limbal crypts (BLCs) in a collagen construct using a simple one-step method. Liquid is removed from collagen hydrogels using hydrophilic porous absorbers (HPAs) that have custom moulded micro-ridges on the base. The resulting topography on the surface of the thin collagen constructs resembles the dimensions of the stromal crypts of the human limbus. Human limbal epithelial cells seeded onto the surface of the constructs populate these BLCs and form numerous layers with a high proportion of the cells lining the crypts expressing putative stem cell marker, p63α. The HPAs are produced using a moulding process that is flexible and can be adapted depending on the requirements of the end user. Creation of defined topographical features using this process could be applicable to numerous tissue-engineering applications where varied 3-dimensional niche architectures are required.     

Early phenotypic features of aniridia-associated keratopathy and association with PAX6 coding mutations

PurposeTo investigate corneal phenotype in aniridia-associated keratopathy (AAK) including its earliest manifestations, in relation to PAX6 mutational status.Methods46 subjects (92 eyes) with congenital aniridia from a German registry were examined using slit lamp biomicroscopy, anterior segment optical coherence tomography, contact esthesiometry and in vivo confocal microscopy. Cytogenetic analysis was conducted by Sanger sequencing of PAX6 exons and/or MLPA analysis. Measured parameters included AAK grade, distance-corrected visual acuity (DCVA), central corneal thickness (CCT), corneal sensitivity, subbasal nerve density, mature dendritic cell (DC) density and corneal epithelial phenotype.Results46 subjects (age range: 1–64 years) were examined, including 23 (50%) children under the age of 18. Five subjects (11.1%) with absent PAX6 coding mutation (non-PAX6 cases) had mild AAK (Grade 0–1) into the fourth decade of life and maintained corneal epithelial phenotype, greater subbasal nerve density (16.8 mm/mm² vs. 3.58 mm/mm², P = 0.01) and better corneal sensitivity (41 ± 11 mm vs. 28 ± 12 mm, P = 0.03) relative to those with PAX6 coding mutations. In five subjects, corneal endothelial cell density ranged from 3245 to 4399 cells/mm². Independent of mutational status, an increased CCT, over tenfold increased mature DC density and reduced corneal sensitivity characterized all subjects.ConclusionsPAX6 coding mutations influence AAK phenotype and progression from the earliest stages of life. A minimal keratopathy present in 100% of congenital aniridia cases is independent of the specific mutation and consists of increased corneal thickness, reduced touch sensitivity, and increased ocular surface immune activity.     

自体角膜缘上皮移植术治疗翼状胬肉的临床分析

目的:比较传统的单纯胬肉切除术与自体角膜缘上皮移植术治疗翼状胬肉的疗效。方法:随机将89例(124只眼)翼状胬肉患者分成A组46例(63只眼)、B组43例(61只眼),A组行自体角膜缘上皮移植术联合翼状胬肉切除术治疗;B组行传统的单纯翼状胬肉切除术,术后随访比较两组术后胬肉复发情况。结果:随访结果,A组5例(5只眼)患者失访,3例患者(3只眼)复发,复发率为5.17%;B组5例(5只眼)患者失访,13例患者(18只眼)复发,复发率为32.14%,组间比较差异具有统计学意义(P<0.001)。结论:自体角膜缘上皮移植术能有效治疗翼状胬肉且能防止复发。     

减少翼状胬肉复发的三种术式疗效比较

目的 比较丝裂霉素C应用加带蒂结膜瓣转移术;羊膜移植术、自体带结膜瓣的角膜缘干细胞移植术治疗初发翼状胬肉的临床疗效,寻求一种理想的手术方法.方法 将95例(110眼)患者随机分为三组,分别采用丝裂霉素C应用加带蒂结膜瓣转移术(MMC组,34眼)、羊膜移植术(AMT组,37眼)和自体带结膜瓣的角膜缘干细胞移植术(ALCT组,39眼),术后随访一年,比较创面修复时间及复发率.结果 ALCT组1眼复发,复发率为2.56%,AMT组3眼复发,复发率为8.11%,两组比较差异无统计学意义(P＞0.05),MMC组9眼复发,复发率为26.47%,与其它两组比较差异有统计学意义(P＜0.05).角膜创面上皮平均修复时间ALCT组为(4.73±1.15)d,AMT组(6.36±1.35)d,MMC组为(8.56±1.15)d,三组比较差异有统计学意义(P＜0.05).结论 自体带结膜瓣的角膜缘干细胞移植术治疗初发性翼状胬肉术后复发率低,角膜创面修复快,是一种理想的手术方法.