黄斑裂孔性视网膜脱离的手术治疗

目的 不同术式治疗黄斑裂孔性视网膜脱离的疗效。方法 对22例22眼黄斑裂孔性视网膜脱离患者分别行4种术式：A组,单纯玻璃体腔注气（C3F8）10眼;B组,玻璃体切割＋注气术12眼;C组,玻璃体切割＋自体血清滴注＋注气术4眼;D组,巩膜外垫压＋注气术2眼。结果A组5（5／10眼视网膜复位,黄斑孔闭合,最高视力0．7;但5（5／10）眼随访中黄斑裂孔再开。B组11（11／12）眼视网膜复位,最高视力0．4。C组（3（3／4）眼视网膜复位,黄斑孔闭合,最高视力0．4。D组2（2／2）眼网膜均复位,最高视力0．2。结论（1）单纯玻璃体腔注气术简单易行,可重复多次,对黄斑裂孔性视网膜脱主有一定疗效,但术后复发率较高。必要时应联合巩膜外环扎或垫压。（2）玻璃体切割＋注气术与玻璃体切割＋自体血清滴注＋注气术对黄斑裂孔性视网膜脱离均有较好的治疗效果,但增加自体血清滴注并未显示好处,因此是否需要有待进一步观察研究。     

自体血清培养新西兰大白兔关节软骨细胞

目的：改进与探讨新西兰大白兔软骨细胞体外培养的方法。方法：取3月龄新西兰大白兔自体血,制备自体血清备用,无菌条件下取4周龄新西兰大白兔双侧膝关节软骨,采用Ⅱ型胶原酶消化并机械吹打的方法,分离关节软骨细胞并应用新西兰大白兔自体血清进行原代、传代培养;采用形态学观察,甲苯胺蓝染色以及Ⅱ型胶原免疫组织化学方法对膝关节软骨细胞进行鉴定,MTT法检测软骨细胞的增值能力;结果：倒置显微镜下见原代软骨细胞2 h后开始贴壁,8 h可形成单层,24 h即可传代。第1~5代细胞表型稳定,增殖力良好。甲苯胺蓝染色显示培养的软骨细胞核呈深染色,细胞质呈淡蓝色;免疫组织化学显示软骨细胞Ⅱ型胶原呈黄褐色表达,MTT检测显示前5代软骨细胞增值能力强,无明显差异;结论：结果表明自体血培养的前5代新西兰大白兔节软骨细胞均可用于膝骨关节炎的研究。     

Autologous serum therapy in recalcitrant laser-assisted in situ keratomileusis-induced neurotrophic epitheliopathy

Background/Purpose:

To evaluate the efficacy of autologous serum eye drops for patients with recalcitrant laser-assisted in situ keratomileusis (LASIK)-induced neurotrophic epitheliopathy (LINE) unresponsive to conventional treatment, and to determine the possible predisposing risk factors of these patients.

Methods:

We enrolled 10 consecutive patients (20 eyes) undergoing femtosecond-assisted myopic LASIK surgery presenting with recalcitrant LINE for > 1 year. Another 340 patients (713 eyes) receiving femtosecond-assisted myopic LASIK without recalcitrant LINE were set as controls. Possible risk factors associated with recalcitrant LINE were investigated. Twenty percent autologous serum treatment was prescribed to 20 eyes. The efficacy of autologous serum was assessed with ocular surface conditions, tear function, and the change of best-corrected visual acuity.

Results:

Age older than 30 years [odds ratio (OR) = 7.74; 95% confidence interval (CI), 1.74–34.50], flap thickness < 110 μm (OR = 3.47; 95% CI, 1.22–9.73), and a flap diameter < 8.5 mm (OR = 5.38; 95% CI, 1.95–14.85) pose higher risks in femtosecond laser-assisted myopic LASIK. All eyes (100%) achieved remission after autologous serum treatment. The visual acuity before treatment was 0.49 ± 0.41 in LogMAR, and the visual acuity after treatment was 0.14 ± 0.22 in LogMAR. Time to achieve remission was 8.26 ± 11.87 weeks. Mean relapse-free survival after discontinuing autologous serum was 47 weeks.

Conclusion:

Risk factors of recalcitrant LINE in femtosecond laser-assisted myopic LASIK were identified as older age, a thinner flap (<110 μm), and a small flap diameter (<8.5 mm). Autologous serum eye drops can effectively improve corneal surface conditions and postoperative visual acuity.     

角膜板层刀制瓣联合自体血清角膜基质层间注射治疗大泡性角膜病变

目的 观察角膜板层刀制瓣联合自体血清角膜基质上注射治疗大泡性角膜病变的疗效.方法 对8例(8眼)大泡性角膜病变患者采用Moria角膜板层刀制瓣联合自体血清角膜基质上注射治疗,观察术后角膜瓣愈合情况、上皮及基质修复情况及视力变化.结果 8例患者术后眼部疼痛等刺激症状均消失,上皮修复,角膜基质水肿消失,3例术后视力不同程度改善,5例同治疗前无明显变化.随访2～18个月均未发现复发.结论 角膜板层刀制瓣联合自体血清角膜基质上注射治疗大泡性角膜病变手术操作简单、术后愈合快,可有效地控制症状、防止复发,是一种简单易行、安全有效的手术方式.