Peripheral deep anterior lamellar keratoplasty using a cryopreserved donor cornea for Terrien's marginal degeneration

Objective： To evaluate the clinical efficacy of peripheral deep anterior lamellar keratoplasty （DALK） using a cryopreserved donor cornea for Terrien＇s marginal degeneration （TMD）. Methods： Thirty-one eyes of 27 patients with TMD underwent peripheral DALK using cryopreserved donor corneas, According to the distance between the inner edge of the lesion and the limbus, a ring-shaped or D-shaped DALK was performed. All grafts were stored at -20 ℃. Cryopreserved comeoscleral rims were prepared for ring-shaped grafts and cryopreserved whole eyeballs were prepared for D-shaped grafts. The general conditions, intraoperative performance, postoperative corneal reconstruc- tion, astigmatism, best corrected visual acuity （BCVA）, and various complications were analyzed. Results： Ring-shaped DALK was performed in 28 eyes and D-shaped DALK was performed in 3 eyes. Postoperative follow-up time was （28.4±24.8） months. There was evidence of inflammation before surgery in 12 eyes （38.7%） and intraoper- ative perforation occurred in 13 eyes （41.9%）. The corneal structures of all eyes were reconstructed. Postoperative astigmatism and BCVA showed improvement （both P=0.00） except for cases that underwent D-shaped DALK. Ten eyes （32.2%） developed transient ocular hypertension and one eye （3.2%） developed secondary glaucoma. No pri- mary disease recurrence or corneal allograft rejection was observed. Conclusions： Peripheral DALK for TMD using cryopreserved donor tissue is an effective technique that eliminates rejection and extends the use of donor eyes. Inflammatory history or intraoperative perforation has no adverse effect on graft recovery. However, D-shaped DALK did not achieve good visual outcomes.

Central corneal epithelium self-healing after ring-shaped glycerin-cryopreserved lamellar keratoplasty in Terrien marginal degeneration

Dear Sir, I am Dr Yan-Long Bi, from the Department of Ophthalmology, Tongji University Affiliated to Tongji University School of Medicine, Shanghai, China. I write to present a case report of total limbal stem cells deficiency after treatment with ring-shaped lamellar keratoplasty secondary to Terrien marginal degeneration. During 3 years

The Treatment of Terrien Marginal Degeneration Using Lamellar Keratoplasty with Dried Corneosclera

Purpose: To treat the Terrien marginal degeneration using lamellar keratoplasty with dried corneosclera and evaluate the clinical effect of this operation.Methods: The study included 78 cases with Terrien marginal degeneration who underwent the lamellar keratoplasty with dried corneosclera. Among them, 48 cases in experiment Ⅰ group and 30 cases in experiment Ⅱ group underwent lamellar keratoplasty with glycerin-preserved corneosclera and anhydrous calcium chloride-storeded corneosclera respectively. All the patients were followed-up from 6 months to 10 years. The control group consisted of 38 cases with Terrien marginal degeneration electively undergoing lamellar keratoplasty with fresh corneosclera simultaneously.Results: The area of the corneal thinning was mended and the eyeball was saved. The corneal astigmatism of the patients was corrected obviously.The patient’s vision was improved significantly. No recurrence and rejection were observed after the operation.There is no significant difference between the experiment group (experiment Ⅰ group or experiment Ⅱ group) and control group. (P > 0.05), despite longer duration of postoperative corneal edema in experiment group.Conclusions: The lamellar keratoplasty with dried corneosclera for treatment of Terrien marginal degeneration is a safe and effective operation. It is an alternative to lamellar keratoplasty with fresh corneosclera for treatment of Terrien marginal degeneration. It is suitable to be popularized in the local hospital of our country.

Repair of Spontaneous Corneal Perforation in Pellucid Marginal Degeneration Using Amniotic Membrane

A 47-year-old woman with a history of pellucid marginal degeneration was referred for management of hydrops and peripheral perforation of the right cornea. The initial management with cyanoacrylate tissue adhesive and bandage contact lens did not preclude aqueous leakage the next day. Amniotic membrane grafting using both a surgical graft and a bandage patch was thus performed in the operating room the following day. There was no aqueous leakage on the first post-operative day. The corneal integrity was restored with resolution of the corneal edema;and the visual acuity improved from 20/400 before surgery to 20/40 three months later. This case illustrates the clinical efficacy of amniotic membrane grafting as an effective alternative in the management of spontaneous corneal perforation resulted from pellucid marginal degeneration.

反板层角膜移植的临床应用研究

目的 探讨反板层角膜移植治疗大泡性角膜病变、Terien's角膜变性及对眼化学伤急救处理的疗效。方法 大泡性角膜病变 2 0眼 ,Terrien's角膜变性 12眼 ,眼化学伤 10眼 ,术中切除病变的角膜板层组织 ,同时将甘油冷冻保存的反板层角膜植片复水 ,将处理后的植片后弹力层向上 ,粗糙的基质层向下 ,用 10 - 0尼龙线间断或连续缝合 ,植片的直径较植床大 0 .5～ 1.0 m m。结果 除 1眼 (化学伤 )发生排斥反应外 ,其余 41眼反板层植片在术后一段时间内 (2～ 4wk)经历不同程度的水肿阶段后 ,都能与植床紧密贴合 ,随访 1～5 a,植片保持半透明甚至透明状态。其中大泡性角膜病变 2 0眼疼痛症状完全消失 ;12例 Terrien's角膜变性中 11眼术后4wk视力明显改善 (视力表检查提高 2～ 3行 ) ;10例眼化学伤中 4眼视力明显改善 (视力表检查提高 2～ 3行 )。结论 反板层角膜移植可成功应用于治疗大泡性角膜病变、Terrien's角膜变性及眼化学伤的急救处理 ,疗效满意。

用深低温保存的角膜材料行板层角膜移植术治疗边缘性角膜变性

目的:探讨用深低温保存的角膜材料行板层角膜移植术治疗边缘性角膜变性的效果。方法:对角膜边缘已经很薄,接近穿孔或已经穿孔的27例边缘性角膜变性患者,用深低温保存的角膜材料行板层角膜移植术治疗,观察术后视力,眼压,植片愈合及并发症等情况,随访时间为2a。结果:术后角膜边缘病变均未发展,术后1wk视力基本与术前相同,1.0者11例,0.6～0.8者6例,0.3～0.5者8例,0.05～0.25者2例。原穿孔的病例有术后一过性高眼压、前房反应、瞳孔欠圆等并发症。2a内只有3例发生了术后排斥反应。结论:用深低温保存的角膜材料完全可以用来进行板层角膜移植治疗边缘性角膜变性,弥补了新鲜角膜的来源限制与时效限制,是治疗边缘性角膜变性的理想材料。

羊膜移植联合自体角膜缘移植治疗角膜缘功能衰竭症

目的探讨羊膜移植术联合自体角膜缘移植术治疗角膜缘功能衰竭症临床效果。方法用人羊膜移植术联合自体角膜缘移植术治疗角膜缘功能衰竭症41例(41眼),均为单眼发病;包括复发性及巨大翼状胬肉29例,眼酸碱化学烧伤7例,热烧伤5例。术后随访420mo。结果随访期内角膜缘植片成活,眼表面光滑,角膜上皮稳定,透明性增强,翼状胬肉仅2眼复发,复发率7%。烧伤组部分患者视力提高,5例视力达0.01以上。结论羊膜移植联合自体角膜缘移植对于构筑角膜缘再生基底,再造角膜表面,抑制角膜新生血管,减少翼状胬肉复发,防止瘢痕形成,是一种行之有效的方法,是治疗角膜缘功能衰竭症的重要手段。

板层角膜移植术治疗角膜边缘变性的临床疗效观察

目的观察板层角膜移植术对角膜边缘变性的治疗效果。方法选取2002年至2008年我院收治的Terrien角膜边缘变性患者17例(28眼)进行板层角膜移植术,年龄20～63岁,病史3～20a。其中双眼发病11例,单眼发病6例;角膜穿孔13眼。对未发生角膜穿孔的15眼进行手术前后角膜地形图检查。手术方法:根据病变的范围,采用甘油保存的角膜材料作板层角膜移植。术后随访6个月～6a。结果28眼术后植片平整光滑,均恢复病变区角膜正常厚度,病变区得到有效控制,均无复发。术后21眼(75%)视力提高,7眼(25%)视力无明显变化。角膜地形图检查显示术后角膜散光度及角膜曲率均较术前有所下降,差异均具有显著统计学意义(均为P=0.00)。结论采用甘油保存角膜材料行板层角膜移植术可以有效控制角膜边缘变性的病情发展,预防及修补角膜穿孔,重建角膜的正常厚度和曲率、减少散光且远期疗效稳定,是治疗Terrien角膜边缘变性安全有效的方法。

Terrien角膜边缘退行性变56例的临床特征分析

目的:分析Terrien角膜边缘退行性变(TMD)的临床特征。方法:选取我院2013-01/2015-01收治的56例90眼TMD患者作为观察组,选取同期进行眼角膜健康检查的健康人56例88眼作为对照组,分析Terrien角膜边缘退行性变患者的临床特征,使用免疫组织化学术及酶联免疫法(ELISA)对两组研究对象血液中HLA-DR、HLA-DQ以及肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)的表达量进行分析。结果:TMD患者早期、进展期、膨隆期、穿孔期的眼部透光程度、脂质沉积程度有统计学差异(χ2=10.85、65.32,均P<0.05);TMD患者早期、进展期、膨隆期、穿孔期的眼部散光有统计学差异(P<0.05);观察组患者的炎性因子TNF-α的表达量显著高于对照组,差异有统计学意义(t=19.86,P<0.05);HLA-DQ、HLA-DR表达差异有统计学意义(t=23.564、45.326,均P<0.05)。结论:Terrien角膜边缘退行性变是一种以外周血TNF-α升高,伴有HLA-DQ、HLA-DR水平增高,以眼透明度下降,散光及脂质沉着为主要临床特征的炎症性病变,本研究为进一步解释Terrien角膜边缘退行性变发病机制提供试验依据。

Degenerations of Jordan Algebras and“Marginal”Algebras

We describe all degenerations of the variety ■3 of Jordan algebras of dimension three over C.In particular,we describe all irreducible components in ■3.For every n we define an n-dimensional rigid“marginal”Jordan algebra of level one.Moreover,we discuss marginal algebras in associative,alternative,left alternative,non-commutative Jordan,Leibniz and anticommutative cases.

Anterior Segment Optical Coherence Tomography Indices and Their Value in Diagnosing Corneal Ectasia

Purpose: To determine the diagnostic value of the anterior segment optical coherence tomography (AS-OCT) indices in differentiating normal from ectatic corneas. Material and Methods: Two groups of patients—with corneal ectasia and normal controls were compared. Each group consists of 80 eyes of 43 age and sex-matched patients. All of them underwent corneal topography with OCULUS Keratograph 5M and corneal pachymetry with AS-OCT with RTVue-100. The indices generated by the AS-OCT pachymetric scans were analyzed. Results: There was a statistically significant difference for all the examined indices between the two groups with p values <0.001 and a confidence interval of 95%. The minimal corneal thickness (Min) was the best performing index according to the ROC analysis with an area under the curve of 0.976 and a combination of sensitivity and specificity of 0.925 and 0.911 respectively, and a “cut-off” value of 484 microns, followed by the indices of focal thinning—Min-Med and Min-Max with an area under the curve of 0.973 and 0.971 and sensitivity/specificity of 0.938/0.962 and 0.938/0.937 respectively. The rest of the examined parameters had an area under the curve in the range between 0.950 for the central corneal thickness and 0.814 for the outer superior segment. Conclusion: The anterior segment OCT indices showed excellent capability in differentiating ectatic from normal corneas.

Terrien角膜边缘变性的手术治疗

目的观察指环状或部分指环状板层角膜移植对Terrien角膜边缘变性的治疗效果.方法 2000年1月～2003年3月角膜组病房收治Terrien角膜边缘变性患者15例共17只眼.其中男性10例,12只眼,女性5例,5只眼.年龄29～65岁.病史3～20年.患眼视力为指数～0.2不等.手术方法:根据病变的范围,作指环状或部分指环状板层角膜移植.结果术后一周内,植片可轻度水肿,以后渐变清亮,厚度为正常角膜厚度,术后观察6月～3年,未见病变复发者.术后视力均有明显提高,术后6月,视力1.0以上5只眼,＞0.5～1.0者6只眼,0.1～0.5者6只眼.结论指环状或部分指环状板层角膜移植术可以控制Terrien角膜边缘变性的病情发展,恢复病变区角膜正常厚度,减少散光,改善角膜曲率,提高患眼视力,预防角膜穿孔,远期疗效稳定,是治疗Terrien角膜边缘变性安全有效的疗法.

Terrien边缘性角膜变性发生隐匿性穿孔的临床研究

目的采用眼前节全景OCT分析Terrien边缘性角膜变性发生隐匿性穿孔的情况，为临床诊治提供依据。方法对2007年8月至2013年6月在深圳市眼科医院就诊患者采用眼前段全景OCT观察Terrien边缘性角膜变性的溃疡病灶，发现溃疡灶内口角膜组织缺损则定为隐匿性穿孔，并测量穿孔内径。结果眼前节全景OCT发现Terrien边缘性角膜变性隐匿性穿孔的发生率为22．2％（4／18），隐匿性穿孔内口直径最小为1．5mm，最大为4．3mm，平均为（3．1±1．3）mm。结论对Terrien边缘性角膜变性患者进行眼前节全景OCT检查，有助于发现隐匿性穿孔的情况，对于评估患者的预后及手术方案的设计有重要作用。

Terrien角膜边缘变性板层角膜移植疗效分析

目的 :评价板层角膜移植治疗Terrien角膜边缘变性的临床疗效。方法 :对北京同仁医院 1998年至 2 0 0 0年 3年间经角膜板层移植治疗的 73例Terrien角膜边缘变性的临床资料作回顾性分析。结果 :行新月形或指环形板层角膜移植术73例 ,视力明显改善 ,角膜屈光度改变。结论 :板层角膜移植手术是治疗Terrien角膜边缘变性有效、安全、理想的治疗方法 。

角膜基质透镜用于周边板层角膜移植术的临床效果

目的探讨冰冻保存的角膜基质透镜作为角膜移植材料应用于周边板层角膜移植术的临床效果。方法对Terrien边缘角膜变性3例及Mooren角膜溃疡2例，以角膜基质透镜为植片进行周边板层角膜移植术。基质透镜来自飞秒激光小切口基质透镜取出术（SMILE）。术后随访6个月，观察视力、植片情况及并发症。结果术后角膜基质透镜植片与植床均贴合良好，无植片浑浊、层间积血积液、植片移位、继发感染或植片排斥反应等并发症发生。结论在角膜供体缺乏的情况下，以角膜基质透镜作为周边板层角膜移植材料安全有效。

双眼角膜边缘变性破裂伴晶状体脱位一例

角膜边缘变性(marginal degeneration of cornea,Terrien's marginal degeneration,TMD)为一较罕见的双眼慢性进行性角膜变薄性病变,此病起源于角膜边缘,故也称为扩张性角膜边缘营养不良或者角膜周边部沟状变性,其特点是周边部角膜慢性进展性变性、变薄,角膜穿孔是其最严重的并发症之一 [1]o双眼角膜边缘变性破裂伴晶状体脱位的病例报道尚不多,现报道如下。