Effect of corneal graft diameter on therapeutic penetrating keratoplasty for fungal keratitis

AIM: To evaluate the effect of corneal graft diameter on therapeutic penetrating keratoplasty(PKP) for fungal keratitis. METHODS: A total of 116 patients (116 eyes) suffered from fungal keratitis underwent PKP at the Affiliated Hospital of Medical College Qingdao University from May 2006 to May 2010. They were divided into two groups according to the corneal graft diameter. 64 eyes' corneal graft diameter was 8.00mm or larger and 52 eyes' graft diameter was smaller than 8.00mm. The follow-up time was 2 years. The postoperative visual acuity and complications were documented and compared. RESULTS: Sixty-two (96.88%) eyes and fifty (96.15%) eyes preserved eyeballs respectively in two groups. There was no statistical difference in postoperative visual acuity (P = 0.961), corneal graft dear rate (P=0.132) or the incidence of recurred fungal infection (P=0.770) between two groups. But there was a higher incidence of graft rejection (P=0.020) and secondary glaucoma (P=0.039) in group with corneal graft diameter 8.00mm or larger. CONCLUSION: PKP is an effective treatment approach for fungal keratitis. There is a higher incidence of complications in large-diameter PKP for fungal keratitis.Effective, preventive and therapeutic measures can improve the prognosis.

Changing trends in corneal graft surgery： a ten-year review

AIM：To review indications and corneal tissue use for penetrating and lamellar surgery between 2002 and 2011.·METHODS：The surgical reports of corneal grafts performed during 2002-2011,using tissues supplied by the Eye Bank of Piedmont（Italy）,were reviewed retrospectively.Patient demographic data,date of intervention,indication for surgery,and surgical technique used were recorded.Surgical techniques included penetrating keratoplasty（PK）,deep anterior lamellar keratoplasty（DALK）and endothelial keratoplasty（EK）.The2test was used to compare the distribution of indications and types of surgical technique used,for corneal grafts done during 2002-2006 versus those done during 2007-2011.·RESULTS：The number of corneal grafts increased by30.7%from 2002-2006 to 2007-2011（from 1567 to 2048）.Comparing the two periods,both main indications and surgical techniques changed significantly.In 2007-2011,the proportion of interventions for aphakic/pseudophakic bollous keratopathy（from 16.8%to 21.3%）,graft failure（from 16.4%to 19.1%）and Fuchs endothelial dystrophy（from 12.8%to 16.7%）all increased significantly（〈0.05）,while those for keratoconus decreased significantly（from35.6%to 27.3%;〈0.001）.In 2007-2011,the proportion of PK decreased significantly（from 92.4%to 57.2%;〈0.001）while that of EK and DALK went from 0.4%to48 30.2%（〈0.001）and from 7.2%to 12.6%（〈0.001）respectively.·CONCLUSION：During 2002-2011 the number of interventions increased significantly for corneal endothelial diseases and graft failure.The growing demand for interventions for these diseases corresponded to the widespread adoption of EK techniques.The use of DALK also increased,but more moderately than EK procedures.

Corneal graft melting: a systematic review

Corneal graft melting is a severe complication of keratoplasty.This review is to summarize the incidence,the pathogenesis,the risk factors,the prognosis and the prevention of corneal graft melting after keratoplasty.We systematically searched PubMed,Web of Science and WanFang database to retrieve potentially eligible articles about relevant clinical reports and animal experiments.We read the full texts to identify eligible articles.The selection of studies and data extraction were performed independently by two reviewers.In conclusion,the pathogenesis of corneal graft melting is complicated,and many risk factors are closely related to corneal graft melting.Analysis of pathogenesis and risk factors of corneal graft melting can facilitate the development of targeted therapies to better guide clinical practice.

Evaluation of corneal graft survival in mice model

AIMTo investigate the characteristics and criterion of graft rejection in mice model.

Evaluation of corneal graft survival in mice model

·AIM: To investigate the characteristics and criterion of graft rejection in mice model. ·METHODS: C57BL/6 or BALB/c mice corneal grafts were grafted onto BALB/c hosts. Each group was divided into two subgroups according to the corneal opacity scores 12d after transplantation. The characteristics of opacity and neovascularization were observed. Mice of the 12 th , 50 th day after transplantation, the grafts biopsy of mice in allogeneic group 1, which opacity score exceed 3, were prepared for histological observation and those restore transparent were endothelial stained. ·RESULTS: There was no difference of corneal opacity score on the 7 th and 12 th day after operation; the histological results had no disparity between syngeneic group and allogeneic group. On the 12 th day after surgery, the turbidity curve was apparent in grafts with opacity score 【2. Mononuclear cells were shown in grafts with opacity score reached 3 in allogeneic group 1. Different rejection performance was observed in tissue sections on the 50 th day after surgery. ·CONCLUSION: Grafts, opacity score exceeds 3 from the 7 th to the 12 th day after operation could not be judged as a rejection. We should pay more attention to the variation of grafts opacity since 12d after corneal transplantation.·

Corneal blindness and current major treatment concerngraft scarcity

According to World Health Organization, the global prevalence of blindness in 2010 was 39 million people, among which 4% were due to corneal opacities. Often, the sole resort for visual restoration of patients with damaged corneas is corneal transplantation. However, despite rapid developments of surgical techniques, instrumentations and immunosuppressive agents, corneal blindness remains a prevalent global health issue. This is largely due to the scarcity of good quality corneal grafts. In this review, the causes of corneal blindness, its major treatment options, and the major contributory factors of corneal graft scarcity with potential solutions are discussed.

Lymphocyte infiltration and activation in iris-ciliary body and anterior chamber of mice in corneal allograft rejection

AIM: To investigate the infiltration and activation of lymphocyte in iris-ciliary body and anterior chamber after allogenic penetrating keratoplasty (PK), for further revealing the role of iris-ciliary body in corneal allograft immune rejection. METHODS: In the mice models of PK, BALB/C mice received orthotopic isografts (n =35) or C57BL/6 donor allografts (n=25). Grafts were examined daily for 3 weeks by slit-lamp microscopy and scored for opacity. The infiltration of CD4(+) T lymphocyte in iris-ciliary body and anterior chamber was examined by immunohistology and the mRNA of CD80 and CD86 in both cornea graft and iris-ciliary body by RT-PCR was analyzed in allograft recipient at days 3, 6, 10 and the day when graft rejection occurred. Isograft recipients were examined as control at the corresponding time points. Transmission electron microscope was used to study the ultrastructure, especially cell infiltration, of iris-cilary body and corneal graft at day 3, 7 and the day when rejection occurred after allogenic PK. RESULTS: Rejection was observed in all the allograft recipients followed more than 10 days, at a median time of 15 days (range 12-18 days), but not in any of isografts. CD4(+) T cells were first detected at day 6 after transplantation in limbus and Ciliary body, and then in the stroma of recipient, iris, anterior chamber and corneal allograft with an increased number until graft rejection occurred. CD80 and CD86 mRNA were detected under RT-PCR examination in both graft and iris-ciliary body of allograft recipient, but not in any of isograft recipient. Three days after operation, lymphocytes and monocytes macrophages were visible in iris blood vessels and the anterior chamber, and vascular endothelial cell proliferation and activation were significant under transmission electron microscopy examination. At day 7, corneal endothelial cells became thinner. Lymphocytes and mononuclear macrophages were found with great number in the anterior chamber and adhered to the corneal endothelium. Blood vessels in iris increased and were filled with lymphocytes. And lymphocytes were detected to migrate through endothelial cell gap out of vessels. When allograft rejection occurred, macrophages attached to endothelial cells with large number of lymphocytes and macrophages infiltrating in iris. CONCLUSION: Lymphocyte infiltration and activation occurred in iris-ciliary body after allogenic PK, and the lymphocytes could migrate from iris blood vessel to the anterior chamber, which might play an important role in corneal allograft immune rejection.

Amniotic Membrane Grafts in Pediatric Corneal Limbal Dermoids with Conjunctival Eyelashes: A Case Presentation

Purpose: To report a case of a pediatric corneal limbal dermoid with eyelashes and to describe post-operative changes after excision with reconstruction using amniotic membrane grafting, sutures and fibrinogen-thrombin glue. Case Report: One pediatric patient was identified with a grade II infratemporal corneal-limbal dermoid with conjunctival eyelashes. The dermoid was surgically excised and the cornea reconstructed with amniotic membrane using sutures and fibrinogen/thrombin glue. Preoperative and postoperative measurement of astigmatism, anisometropia and presence of exposure keratopathy were performed.

深板层角膜移植与穿透性角膜移植治疗基质角膜营养不良预后的比较

背景:基质角膜营养不良的传统手术治疗方式为穿透性角膜移植,近年来越来越多的医生开始考虑使用深板层角膜移植治疗基质角膜营养不良。目前国内对比穿透性角膜移植和深板层角膜移植治疗基质角膜营养不良的研究少有报道。目的:比较深板层角膜移植和穿透性角膜移植治疗基质角膜营养不良的疗效。方法:选择2000年1月至2018年1月北部战区总医院收治的基质角膜营养不良患者57例(57眼),男18例,女39例,平均年龄(52.9±20.0)岁,按照手术治疗方式分为深板层角膜移植组(n=21)、穿性角膜移植组(n=36),术后随访观察最佳矫正视力、角膜内皮细胞密度、角膜植片透明度、术中及术后并发症、原病复发情况。结果与结论:①两组患者术后1,3,6,12个月的视力均高于术前(P<0.05),两组间术后不同时间点的视力比较差异无显著性意义(P>0.05);随着术后时间的延长,两组患者角膜内皮细胞密度逐渐降低,穿透性角膜移植组患者术后6,12个月的角膜内皮细胞密度年丢失率均高于深板层角膜移植组(P<0.05);两组患者术后12个月的角膜植片透明率比较差异无显著性意义(P>0.05);②深板层角膜移植组有6例出现并发症,穿透性角膜移植组有14例出现并发症,57例患者术后12个月内均无复发,两组患者术后5年的复发率比较差异无显著性意义(P>0.05),穿透性角膜移植组和深板层角膜移植组术后5年的移植物存活率分别为83%和86%,组间比较差异无显著性意义(P>0.05);③结果表明,基质角膜营养不良的治疗可考虑使用深板层角膜移植替代一部分穿透性角膜移植。

移植物厚度对角膜内皮失代偿行简易后弹力层角膜内皮移植效果的影响

背景:研究表明较薄移植物视力恢复更快、排斥风险更低,国内缺乏对内皮移植术后不同植片厚度的临床疗效分析,因此,确定最佳移植物厚度对于提高手术疗效至关重要。目的:评价简易后弹力层剥离内皮角膜移植术后不同植片厚度对视力恢复及其他预后指标的影响。方法:选取2013年1月至2023年2月在北部战区总医院接受简易后弹力层剥离内皮角膜移植手术治疗的角膜内皮失代偿患者共72例(72眼),其中薄植片组(<100μm)32例(32眼),厚植片组(≥100μm)40例(40眼)。随访1年,观察两组术前及术后1,3,6,12个月的最佳矫正视力,术后1年角膜内皮细胞数、角膜植片透明度、术后并发症、植片生存情况。结果与结论:①两组患者术后视力较术前均有显著提高,薄植片组患者术后3个月最佳矫正视力优于厚植片组(P<0.05);②两组术后1年角膜内皮细胞数及植片透明度比较差异无显著性意义(P>0.05);③两组患者继发性青光眼、植片免疫排斥、植片移位等术后并发症发生率比较差异无显著性意义(P>0.05);④两组术后1年植片生存率比较差异无显著性意义(93.8%,92.3%,P>0.05);⑤结论:简易后弹力层剥离内皮角膜移植术是一种安全有效的角膜内皮移植手术方式,其术后疗效与传统后弹力层剥离内皮角膜移植术相似,而且植片植入方式更为简便。较薄植片能够更早提供最佳矫正视力,更早完成角膜重塑,因此在治疗角膜内皮失代偿疾病时,优先选择薄移植物来提高恢复时间。

A 5-year analysis of endothelial vs penetrating keratoplasty graft survival in Chinese patients

AIM:To determine if there is any difference in longterm graft survival between Descemet’s stripping endothelial keratoplasty(DSEK)and penetrating keratoplasty(PK).METHODS:A retrospective 5-year cases analysis of bullous keratopathy secondary to Fuchs’endothelial dystrophy or pseudophakic bullous keratopathy,receiving either DSEK or PK.A total of 42 DSEK cases and 25 PK cases were included in the analysis.RESULTS:In the 5-year analysis,graft survival rates were very similar in the two groups(DSEK 77.1%vs PK76.0%.P=0.918.95%CI:-6.3 to 33.4).Sub-analyses at 1y(DSEK 81%vs PK 95%.P=0.085.95%CI:-29 to 3.6)and 2y(DSEK 81%vs PK 88%.P=0.381.95%CI:-25.9 to 11.8)show a trend towards lower survival rates of DSEK vs PK,but the results were not statistically significant.CONCLUSION:Longterm 5-year graft survival is similar between the DSEK and PK methods of corneal transplant in Chinese patients with bullous keratopathy.

Simultaneous tectonic Descemet stripping endothelial keratoplasty and tectonic Bowman layer transplant for the management of corneal perforation

AIM:To report the outcomes of three cases of corneal perforation managed with simultaneous tectonic Descemet stripping endothelial keratoplasty(t-DSEK)and tectonic Bowman layer transplant(t-BLT)as an alternative to tectonic penetrating keratoplasty(t-PKP).METHODS:Three eyes of three patients receiving simultaneous t-DSEK and t-BLT for corneal perforation were included.The technique for DSEK was modified depending on individual requirements.The t-BLT technique was standardised using an 8 mm graft and fixated with a running suture.Success was measured by the ability of this procedure to close a corneal perforation.RESULTS:All three cases achieved tectonic eye globe restoration and remained stable during the minimum 3-month observation period.Reinterventions were relatively common:2 cases required amniotic membrane transplant for persistent epithelial defects.One case required DSEK rebubbling.One case developed angle closure glaucoma requiring surgical peripheral iridectomy.CONCLUSION:Simultaneous t-DSEK and t-BLT may be a useful strategy for the management of corneal perforation as an alternative management to t-PKP for selected cases.

Visual acuity and endothelial cell density with respect to the graft thickness in Descemet's stripping automated endothelial keratoplasty: one year results

AIM: To evaluate the visual acuity and endothelial cell density according to the thickness in Descemet’s stripping automated endothelial keratoplasty(DSAEK)one year after surgery.METHODS: DSAEK patients’ data were reviewed. Thirty seven eyes of 37 patients who underwent DSAEK for pseudophakic bullous keratopathy(PBK) were included in this study. Graft thickness was measured with optical coherence tomography(OCT) 12 mo after DSAEK. Eyes were divided into 3 groups based on the graft thickness:thick(】200 μm), medium-thick(150-200 μm) and thin(【150 μm). Best corrected visual acuity(BCVA),endothelial cells density(ECD) and complications were assessed and comparisons were done between groups.RESULTS: Median thickness of postoperative grafts was 188(range 73-317 μm). There was no significant difference in age, sex, preoperative BCVA, or follow-up period between DSAEK groups. At postoperative 12 mo,mean BCVA was 0.28±0.10 in thick graft group, 0.52±0.08 in medium-thick graft group, and 0.72 ±0.06 in thin graft group. Thin grafts showed better postoperative BCVA as compared with the medium-thick and thick grafts(P =0.001). Thick graft group had 1637.44 ±88.19-mm2,medium thick graft had 1764.50±34.28-mm2 and thin graft group had 1845.30 ±65.62-mm2. Thin graft group had better ECD at 12 mo after surgery(P =0.001).CONCLUSION: Thin grafts after DSAEK ensure better visual rehabilitation. Eyes with thin grafts had significantly lesser loss of ECD compared to eyes withmedium-thick and thick grafts one year after surgery.

Short-term Results of Using Lamellar Corneo-scleral Patch Graft for the Ahmed Glaucoma Valve Implant Surgery

Background: Human donor sclera is commonly used in glaucoma implant surgery to cover the external portion of the silicone tube and prevent its erosion through the overlying conjunctiva. Corneo-scleral graft is used in this study as an alternative material for its desirable properties of being transparent, higher in tensile strength, cheap and more readily available. Methods: Eighteen consecutive cases were implanted with the Ahmed glaucoma valve im-plant. The limbal portion of the silicone tube was covered by a comeo-scleral graft obtained from the corneo-scleral rim left over following corneal transplant operation. The effectiveness in protecting the tube from erosion or migration, the transparency of the patch graft and complications encountered after surgery were assessed.Results: At a mean follow-up of 6 months, all tubes were well protected and no complications related to the patch graft were encountered during intra and postoperative period. All comeo-scleral grafts remained transparent and

角膜绷带镜对生物工程角膜移植术后的临床治疗作用

目的观察角膜绷带镜对生物工程角膜移植术后的临床治疗作用。方法收集我院2017年1月至2018年6月住院并使用生物工程角膜进行板层角膜移植手术治疗的感染性角膜溃疡患者30例30眼的临床资料,随机分为A、B两组,各15例。A组角膜上皮愈合后给予戴角膜绷带镜联合滴眼液点眼治疗,2周更换1次,术后3个月拆线后停用。B组患者不戴角膜绷带镜,药物治疗同A组。观察生物工程角膜移植术后角膜植片上皮化时间,比较术后第1、2、3、4周两组角膜植片水肿程度,比较术后第1、2、3个月两组角膜植片上皮完整性和泪膜破裂时间(breakup time of tear film,BUT),比较两组角膜植片水肿消退时间和术后3个月两组角膜植片存活率。结果术后3~5 d角膜植片上皮化,2~4周植片水肿消退。A组患者术后第2~3周角膜植片水肿消退,B组患者第3~4周角膜植片水肿消退,时间长于A组(P <0.001),术后第2~3周A组角膜植片水肿程度明显轻于B组(第2周P=0.002,第3周P <0.001)。术后第1、2、3个月时A组患者角膜荧光素染色评分均低于B组(均P <0.001),BUT时长高于B组(P=0.009、0.002、0.33)。A组患者中1例未按时复诊戴角膜绷带镜近5周,继发细菌感染,退出研究,术后3个月A组植片存活率93.3%(14/15);B组患者有2例1个月后出现角膜上皮无菌性缺损,另有1例术后2个月出现角膜溶解,3例均退出研究,术后3个月B组植片存活率80.0%(12/15),与A组相比差异无统计学意义(P=0.283)。结论生物工程角膜上皮化后戴角膜绷带镜可加速角膜植片水肿消退,保护角膜上皮完整性,维持眼表泪液稳定,有利于维护眼表微环境健康,对生物工程角膜术后角膜植片修复有明显促进作用。

FK506胶原药膜抑制兔角膜移植的免疫排斥反应

目的 探讨FK5 0 6胶原药膜治疗和预防兔高危角膜移植术后免疫排斥反应的有效性和可行性。方法 2 4只新西兰大白兔建立严重的碱烧伤的高危角膜移植动物模型 ,然后施行穿透性角膜移植术 ,将全部大白兔的右眼定为实验组、左眼定为对照组 ,术后右眼用缓释胶原药膜载FK5 0 6给药 ,左眼局部滴FK5 0 6眼液 ,用酶联免疫吸附 (ELISA)方法测定术后 1、2、4、8、2 4、72h的角膜、结膜、房水的药物浓度和持续时间 ;观察植片不同时期的角膜移植排斥反应发生率 ,平均随访 3个月。结果 实验组 1h角膜浓度 (84 .1±2 0 .6 )ng·g-1、结膜浓度 (2 9.2± 10 .3)ng·g-1、房水浓度 (2 5 .6± 6 .8)ng·L-1,4h后分别为 (2 30 .2± 2 6 .6 )、(15 4 .5± 19.4 )、(15 .3± 5 .7)ng·L-1;72h后分别为 (2 3.5± 11.2 )、(13.8± 9.3)、(11.2± 2 .4 )ng·L-1,而对照组的 1h角膜、结膜、房水的药物浓度分别为(4 1.2± 11.6 )、(30 .5± 10 .5 )、(8.2± 2 .1)ng·L-1,4h后分别为 (17 8± 6 .5 )、(18.5±6 3)、(6 .7± 1.2 )ng·L-1;8h以后检测到药物浓度非常低 ,不能达到有效药物浓度。在实验期间 ,实验组的植片排斥反应的发生率及上皮愈合质量 2个指标均明显优于对照组。结论 FK5 0

TGFβ2-DC对小鼠同种异体角膜移植排斥反应的抑制作用

目的:观察自体TGFβ2-DC对于同种异体角膜移植术后免疫排斥反应的调节作用。方法:PBS或已摄取供体抗原的自体TGFβ2-DC经小鼠尾静脉注射7d后,建立小鼠同种异体角膜移植模型,临床观察两组植片混浊程度等情况,比较植片存活时间。结果:TGFβ2-DC注射后,植片发生移植排斥反应的时间延迟,植片存活时间明显延长,PBS组及TGFβ2-DC尾静脉组植片的存活时间分别为17.8±3.01d和37.6±1.65d(P<0.01)。结论:摄取供体抗原的不成熟自体DC可以诱导受体获得供体抗原的特异性免疫耐受,使小鼠同种异体角膜移植的免疫排斥反应延迟,植片存活时间明显延长。

雷帕霉素微乳滴眼剂的制备及其在大鼠角膜移植排斥反应的应用

目的制备雷帕霉素微乳滴眼剂,评价其抑制大鼠角膜移植排斥反应的疗效。方法采用微乳制备方法,研制雷帕霉素微乳滴眼剂;通过大鼠双眼滴加药液进行粘膜刺激性试验和对大鼠角膜移植排斥反应的作用,评价雷帕霉素微乳滴眼液治疗大鼠角膜移植的效果。结果雷帕霉素微乳滴眼剂为透明或半透明的淡蓝色均一溶液,其平均粒径129.5nm,对粘膜刺激性小;有效减少角膜移植排斥反应的发生,显著延长角膜植片的存活时间。结论雷帕霉素微乳滴眼剂能够用于治疗大鼠角膜移植手术后的排斥反应。

角膜移植显微外科自动缝合器的设计

首先论述了角膜移植手术中缝合技术的发展现状.在分析医生手工缝合动作和手术要求的基础上,提出了间断缝合机构的设计方案,并开发了相关的控制系统.通过在猪眼球上进行的角膜缝合实验证实了设计的可行性.

重度化学性眼灼伤早期手术治疗的探讨

目的观察重度化学性眼灼伤早期（伤后３周内）行结膜与角膜移植手术治疗的临床疗效。方法对１８例（２１眼）重度化学性眼灼伤早期行坏死结膜、角膜板层组织切除联合结膜及板层角膜移植，术后随访１ａ以上。结果１５只眼手术成功，维系相对正常的球表结构，为尔后行增视性角膜移植创造了条件。结论重度化学性眼灼伤早期行结膜及角膜板层移植手术是可行及有效的，比保守治疗主动。可在相当程度上扼制灼伤后持续的炎症反应过程。手术适应证。