Preoperative evaluation and outcome of corneal transplantation for limbal dermoids：aten-yearfollow-up study

AIM： To summarize preoperative evaluation and outcome of corneal transplantation for limbal dermoids for ten years.METHODS： Eighty-five patients diagnosed with limbal dermoids and treated with corneal transplantation were analyzed retrospectively. All patients were further divided into two groups according to absence or presence of neovascularization surrounding the dermoids in the corneal stroma. Eighty-two eyes were treated with tumor excision combined with partial lamellar sclerokeratoplasty, and the other three eyes were performed by penetrating keratoplasty. The size and location of the tumor, the associated ocular and systemic anomalies, the depth of the corneal penetration of tumor tissues, the preoperative and postoperative best-corrected visual acuity （BCVA）, graft survival and cosmetic outcome, and surgical complications were recorded respectively.RESULTS： The average age at surgery was 5.3y （range, 3mo-36y）. The mean size of dermoids was 6.1±1.6 mm. The 43.5% of eyes （37/85） were present with hair at the surface of the dermoid and 72.9% of dermoids were located inferotemporal of the eye. Amplyopia was present in 34.1% of patients （29/85） and 9.4% of patients （8/85） had lipodermoids. Eighteen patients suffered from Goldenhar’s syndrome with an accessory ear. The 75% of patients in group 1 had involvement of the corneal deep stroma down to Descemet’s membrane without involving it, but 71.4% of patients had Descemet’s membrane involvement in group 2. Preoperative BCVA ranged from counting fingers to 20/20. Postoperatively 81.1% had a BCVA of 20/800 or better. There was no significant difference between the post-surgical BCVA of the two groups （t=1.584, P〉0.05）. The grafts of 70.5% patients were present as 1＋ opacity, 21.1% as 2＋ opacity, 8.2% as 3＋ opacity and none as 4＋ opacity. Surgical complications included graft rejection, microperforation, prolonged reepithelialization, steroid glaucoma, interface neovascularization, and interface hemorrhage.CONCLUSION： The dermoids with neovascularization surrounding them in the corneal stroma invaded deeper tissues in the cornea than those with no neovascularization surrounding them in the corneal stroma. Therefore, surgeons should take care to avoid corneal perforation during the corneal transplantation operation. The majority of patients markedly improved their cosmetic appearance after surgery.

A 60-Year-Male Post Corneal Transplantation with Acute Pneumonia

Pneumonia is a common complication in organ transplantation patients. Multiple respiratory pathogens such as bacteria, viruses and fungi are potentially coexisted. A 60-year-old male with left eye post corneal transplantation developed acute severe pneumonia caused by Pneumocystis jiroveci (PJP) coinfection with Nocardia spp. and Cytomegalovirus (CMV). He was hospitalized due to acute respiratory failure. Chest radiographs and chest Computed Tomography (CT) revealed extensive ground-glass opacities. PJP was diagnosed from Bronchoalveolar Lavage Fluid (BALF). The pneumonia was persistent despite of receiving intravenous cotrimoxazole. Tracheal aspirate showed faint gram-positive filamentous beaded branching organisms. Consequently Nocardia spp. was proven. Intravenous cotrimoxazole was continued and intravenous imipenem was added. After a course of dual antibiotics, pneumonia was gradually improved. A week after, he developed the worsened acute respiratory failure. The bronchoscopy was performed. The new pathogens were not detected from BALF microbiology. The BALF cytology was unremarkable. PJP was detected by Polymerase Chain Reaction (PCR) from BALF. CMV antigenemia was detected from BALF and blood. Intravenous ganciclovir was given. This report describes PJP coinfected with Nocardia spp. and CMV in post corneal transplantation patient suffering from severe pneumonia. Multiple respiratory pathogens are common among transplantation patients representing host immunosuppression and inadequate antimicorbial prophylaxis.

In Vivo Confocal Microscopic Observation of Lamellar Corneal Transplantation in the Rabbit Using Xenogenic Acellular Corneal Scaffolds as a Substitute

Background： The limiting factor to corneal transplantation is the availability of donors. Research has suggested that xenogenic acellular corneal scaffolds （XACS） may be a possible alternative to transplantation. This study aimed to investigate the viability of performing lamellar corneal transplantation （LCT） in rabbits using canine XACS. Methods： Fresh dog corneas were decellularized by serial digestion, and LCT was performed on rabbit eyes using xenogeneic decellularized corneal matrix. Cellular and morphological changes were observed by slit-lamp, light, and scanning electron microscopy at 7, 30 and 90 days postoperatively, lmmunocytochemical staining for specific markers such as keratin 3, vimentin and MUC5AC, was used to identify cells in the graft. Results： Decellularized xenogenic corneal matrix remained transparent for about l-month after LCT. The recipient cells were able to survive and proliferate into the grafts. Three months after transplantation, grafts had merged with host tissue, and graft epithelialization and vascularization had occurred. Corneal nerve fibers were able to grow into the graft in rabbits transplanted with XACS. Conclusions： Xenogenic acellular corneal scaffolds can maintain the transparency of corneal grafts about 1-month and permit growth of cells and nerve fibers, and is, therefore, a potential substitute or carrier for a replacement cornea.

The lived experiences of patients undergoing acellular porcine corneal stroma transplantation

To explore the lived experiences of patients undergoing acellular porcine corneal stroma（APCS）transplantation,a descriptive,qualitative design was performed.A purposive sample of 13 patients who underwent APCS transplantation to treat progressive infectious keratitis were enrolled in the semi-structured,open-ended interviews.The taped and transcribed interviews were analyzed using a thematic analysis approach.Alterations in the transparency of APCS grafts were accompanied by a gradual improved visual acuity（before surgery：1.38±0.91 logMAR;3mo postoperatively ：0.40±0.24 logMAR, respectively）.Accordingly,in terms of lived experiences,the patients generally reported＂negative＂experiences before the operation and during the early postoperative period,but this was greatly improved 3mo after surgery.Four main themes were derived：anxiety and fear,stigma,lifestyle change,and gratitude and insights. Conclusively,health care professionals should provide holistic care for patients,proactively promoting patients’physical and mental health.

Corneal transplantation outcomes after the extrusion of an intrastromal keratoprosthesis:a pilot study

This short report includes 5 eyes of 5 patients(mean age 63.2±12 years)who underwent a tectonic keratoplasty[deep anterior lamellar keratoplasty(DALK)or penetrating keratoplasty(PK)]in order to rehabilitate the eye after the extrusion of the non-perforating keratoprosthesis(Kpro)KeraKlear(KeraMed,USA).The non-perforating Kpro was extruded after a mean period of 21.4±21.8 months due to melting.In two cases,the keratoplasty was performed the same day of the non-perforating Kpro removal due to a severe melting,while in the other three cases it was performed one to 3 months later.Two eyes received a DALK,but in 3 eyes a macroscopic Descemet membrane perforation forced the conversion into a PK.The mean follow-up period after the keratoplasty was 16.8±6.6 months.No cases of rejection were recorded.All the 5 eyes achieved“anatomical success”(transparent graft,with no signs of infection or inflammation).Two eyes showed limited“functional success”because the achievement of the best visual potential was prevented by the development of glaucomatous optic atrophy during the follow-up period.In conclusion,this short report presents an unexpected success of a keratoplasty performed with a tectonic purpose after the extrusion of the non-perforating Kpro because the corneal graft remained transparent,without neovascularization or scarring during the follow-up period.This initial evidence shows some encouraging results regarding graft survival rate and the achievement of a useful visual rehabilitation with keratoplasty after a nonperforating Kpro failure instead of repeating the Kpro implantation.

Effect of amnion membrane transplantation on corneal neovascularization in 10 patients with alkali burn

By observing clinical cases, we studied the curative effect of amnion membrane transplantation on decreasing corneal neovascularization (CNV). It was a non-randomized retrospective case-control study. Among 17 cases (21 eyes) of third-degree alkali burns from 2007 to 2010, 10 cases (12 eyes) were performed with amnion membrane transplantation operation, and others were not. Amnion membrane transplantation was performed at the 3rd day after burn in the treatment group. Areas of CNV in double groups were measured at the 14th day and 60th day after burn. Area of CNV in the treatment group was (66.207±7.251)mm2 at the 14th day after burn, and was 18.27% lower than that in the control group. Area of CNV in the treatment group was (120.046±13.812)mm2 at the 60th day after burn, and was 11.35% lower than that in the control group. There was both statistical significance (P<0.05). Amnion membrane transplantation operation can inhibit the growth of corneal neovascularization induced by alkali burn.

Mesenchymal stem cells: Potential role in corneal wound repair and transplantation

Corneal diseases are a major cause of blindness in the world. Although great progress has been achieved in the treatment of corneal diseases, wound healing after severe corneal damage and immunosuppressive therapy after corneal transplantation remain prob-lematic. Mesenchymal stem cells(MSCs) derived from bone marrow or other adult tissues can differentiate into various types of mesenchymal lineages, such as osteocytes, adipocytes, and chondrocytes, both in vivo and in vitro. These cells can further differentiate into specific cell types under specific conditions. MSCs migrate to injury sites and promote wound healing by secreting anti-inflammatory and growth factors. In ad-dition, MSCs interact with innate and acquired immune cells and modulate the immune response through their powerful paracrine function. Over the last decade, MSCs have drawn considerable attention because of their beneficial properties and promising therapeutic prospective. Furthermore, MSCs have been applied to various studies related to wound healing, autoim-mune diseases, and organ transplantation. This review discusses the potential functions of MSCs in protecting corneal tissue and their possible mechanisms in corneal wound healing and corneal transplantation.

Organ transplantation scandal influencing corneal donation rate

~ In the majority of countries, there is a shortage of donor corneas for corneal transplantations. This study investigated the impact of organ transplantation scandals on corneal donation rate at the University Hospital T/ibingen. Each deceased patient was considered as a potential corneal donor. An ophthalmic resident handled with stable methods of procedures the corneal donor procurement from 2009 to 2015. The rates of corneal donation were examined and analyzed. Among the 5712 hospital deaths, consent for corneal donation was obtained in 711 cases. The mean annual corneal donation rate was 12.4%. Since 2009, the donation rate per year could be increased with exception of 2013 and 2015. In the end of 2012 and 2014 two huge organ donation scandals were known in Germany. In the following years 2013 and 2015 corneal donation rate decreased significantly （P=0.0181 and P=0.0006）. We concluded that transplantation scandals have a significant impact on corneal donation rate. Improving professional＇s performance through full transparency and honesty is very important to earn trust of potential donors and their families.

Tocilizumab promotes corneal allograft survival in rats by modulating Treg-Th17 balance

AIM: To examine the therapeutic effects of tocilizumab on experimental corneal transplantation and its effect on Treg/Th17 balance. METHODS: Allograft corneal graft was performed between host Sprague Dawley and Wistar donor rats.The rats were randomly divided into four groups: normal,autograft, allograft, and allograft treated with tocilizumab.Kaplan-Meier was performed to draw the survival curve.The protein levels of interleukin-17A(IL-17A), vascular endothelial growth factor(VEGF), and forkhead box protein3(Foxp3) were measured by immunohistochemistry.The mRNA levels of IL-17A, VEGF, retinoid-related orphan receptor gammat(RORγt), interleukin-6(IL-6) and Foxp3 were detected by reverse transcription real-time polymerase chain reaction(RT-PCR). The Treg and Th17 cells were investigated by flow cytometry. RESULTS: The survival time of tocilizumab group was(24±1.27 d) longer than that of allograft group(10±0.55 d).Moreover, immunohistochemical examination revealed that IL-17A and VEGF protein levels in the allograft group were significantly higher than that of tocilizumab group(P<0.01),while Foxp3 levels in the allograft group was significantly lower than that of the tocilizumab treated group(P<0.001).Flow cytometry showed that the number of Th17 cellsin allograft group was significantly higher than that in tocilizumab group(P<0.001). Meanwhile, the number of Tregs was significantly lower than in tocilizumab group(P<0.001). Simultaneously, Foxp3 m RNA expression level in corneal tissues of tocilizumab treated group was significantly higher than other groups(P<0.001). CONCLUSION: These findings suggest that tocilizumab may promote corneal allograft survival, possibly by modulating Treg-Th17 balance.

Ipsilateral Lymphadenectomy to Inhibit Corneal Allograft Rejection in Rats

In order to investigate the ipsilateral lymphadenectomy for inhibiting rejection in rat corneal transplantation, corneal allogenic transplantation models were established in rats. Eighteen female Wister rats were used as donors, and 36 Sprague Dawley rats as recipients. After penetrating corneal transplantation, recipients were randomly divided into 3 groups: group A (control group); group B, the ipsilateral lymphadenectomy group; group C, the bilateral lymphadenectomy group. Among 12 rats in each group, the corneas of 2 rats in each group were used for pathological study at day 14 after the transplantation, and the remaining 10 rats were used for studying corneal rejection by a slit lamp. The time points when allograft rejection occurred were recorded and mean survival time (MST) was compared. The results showed that MST in groups B and C was 46 30±9 464 days and 44 43±7 604 days, respectively, which was significantly prolonged as compared with that in group A (10 71±1 567 days, P<0.01). There was no significant difference in MST between groups B and C (P>0.05). It was concluded that both bilateral and ipsilateral lymphadenectomy therapies could effectively inhibit the corneal allograft rejection. Ipsilateral lymphadenectomy is a less complex surgical procedure and is just as effective in preventing rejection.

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。

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.

Effects of CTLA4-Ig Gene-modified Dendritic Cells on the Corneal Allografts

In order to investigate the effects of mouse CTLA4Ig gene-modified dendritic cells （DCs） on the survival of the corneal allografts in rats, the plasmid PG／CTLA4Ig was transfected into DCs of F344 rats mediated by Lipofectamine^TM 2000. The expression of CTLA4Ig was detected by immunofluorescent microscopy. The effects of donor DCs on the proliferation of T cells in Lewis rats （recipients） were tested by by CCK8. Corneal transplantation was performed from F344 rats to Lewis rats. The DCs modified with CTLA4Ig gene were injected into the Lewis rats on the day 0 and 3 after transplantation. The movement of the DCs after modification in vivo was observed by immunofluorescent microscopy, and the survival of corneal allografts was evaluated by Holland criterion. The results showed that the CTLA4Ig-modified DCs could restrain the proliferation of allogenetic T cells. The CTLA4Ig-modified DCs prolonged survival of corneal allografts. （P〈0.01）. It was suggested that the injection of CTLA4Ig gene-modified DCs could obviously inhabit the allograft rejection and prolong the survival of corneal allografts.

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.·

An Association between Corneal Inflammation and Corneal Lymphangiogenesis after Keratoplasty

Purpose:.To examine the relationship between corneal inflammation and corneal lymphangiogenesis after keratoplasty.Methods:.Rat corneal lymphangiogenesis was examined by lymphatic vessel endothelial receptor(LYVE-1) immunohistochemistry and whole mount immunofluorescence at 1, 3, 7,10, and 14 days after corneal transplantation. Corneal inflammation was evaluated by inflammation index(IF) grading and NF-κB immunohistochemistry at the same time points. The association between lymphatic vessel counting(LVC) and the IF scores was then examined.Results:.LYVE-1 positive lymphatic vessels occurred in the corneal stroma on day 3,.developed throughout days 7 and10,.and peaked in number at day 14 after keratoplasty.Corneal inflammation was strong on day 3, and then resolved gradually,.but increased again from days 7 to 14 after the transplantation..LVC was strongly and positively correlated with IF after keratoplasty(r=0.41;P<0.05). However, changes in IF scores and LVC were not parallel.Conclusion:.A close,.but not parallel,.relationship was found between corneal lymphangiogenesis and corneal inflammation after corneal transplantation.

Observation of Long-term Efficacy of Corneal Limbal Conjunctival Autografts in Microscopy Treatments of Pterygium

Purpose: To compare the long-term efficacy of a corneal limbal conjunctival autograft combined with pterygium excision in the treatment of primary pterygium. Methods: This random control study included 63 patients (63 eyes) with primary pterygium. These were randomly divided into a group with corneal limbal conjunctival autograft combined with pterygium excision (group A) and a group with pterygium excision with exposed sclera (group B) and subjected to long-term follow up. The surgical outcomes were classified and evaluated (grade Ⅰ-Ⅳ). Several indexes were analyzed, including ocular surface irritation symptom,tear film stability, surgical complication, and recurrence rate. Results: The follow up ranged from 24 to 38 months, (26.9± 3.4) months on average. No recurrence was noted at 6 weeks postoperatively. At 6 months postoperatively, the recurrence rate of pterygium was 5.2% in group A and 8.0% in group B. At 1 year postoperatively, the recurrence rate in group A was 10.5% and 20.0% in group B. At the end of follow up, the recurrence rates were 13.1% in group A and 24.0% in group B. No statistical significance was found between two groups regarding the recurrence rates at each time point (P>0.05). After the follow up. (> 2 years),the severity of ocular surface conditions was significantly milder in patients in group A than in group B (P <0.01).No statistically significant differences were noted between the two groups at 6 weeks,6 months, and 1 year after surgery. No statistically significant differences were observed between the two groups regarding postoperative tear film break-up time. Fewer postoperative complications and milder ocular surface irritation symptoms occurred in patients in group A. Conclusion: Corneal limbal conjunctival autograft combined with pterygium excision yields sound long-term efficacy and a low recurrence rate and induces only mild damage on the ocular surface when used as a treatment for pterygium.

Corneal stem cells and tissue engineering: Current advances and future perspectives

Major advances are currently being made in regenerative medicine for cornea. Stem cell-based therapies represent a novel strategy that may substitute conventional corneal transplantation, albeit there aremany challenges ahead given the singularities of each cellular layer of the cornea. This review recapitulates the current data on corneal epithelial stem cells, corneal stromal stem cells and corneal endothelial cell progenitors. Corneal limbal autografts containing epithelial stem cells have been transplanted in humans for more than 20 years with great successful rates, and researchers now focus on ex vivo cultures and other cell lineages to transplant to the ocular surface. A small population of cells in the corneal endothelium was recently reported to have self-renewal capacity, although they do not proliferate in vivo. Two main obstacles have hindered endothelial cell transplantation to date: culture protocols and cell delivery methods to the posterior cornea in vivo. Human corneal stromal stem cells have been identified shortly after the recognition of precursors of endothelial cells. Stromal stem cells may have the potential to provide a direct cell-based therapeutic approach when injected to corneal scars. Furthermore, they exhibit the ability to deposit organized connective tissue in vitro and may be useful in corneal stroma engineering in the future. Recent advances and future perspectives in the field are discussed.

真菌性角膜炎角膜移植术后真菌感染的临床特征及预后

目的总结真菌性角膜炎手术治疗后真菌感染的临床特征,分析临床表现与预后的关系。方法对河南省立眼科医院2009年1月至2019年12月收治的真菌性角膜炎行角膜手术治疗后真菌感染患者的临床诊治资料进行回顾性分析。结果共12例(12眼),其中男9例,女3例,年龄30~77岁,平均54.83岁。12例患者中8例(66.7%)行眼内容摘除术,4例(33.3%)患者行穿透性角膜移植术,随访12~75个月,3例无复发,1例失访。临床表现中度至重度混合充血,其中角膜移植片水肿混浊5例,角膜全层水肿混浊3例,植床混浊2例,结膜瓣血供丰富,无明显溃疡2例;3例角膜见新生血管长入。12例患者的角膜过碘酸-雪夫染色(PAS)和六胺银染色(GMS)染色中均可见到真菌菌丝结构,其中4例患者苏木精-伊红染色(HE)可见真菌菌丝结构。8例行眼内容摘除患者的角膜基质层纤维均呈化脓性炎症的病理改变,基质层纤维坏死,大量中性粒细胞浸润,其中3例角膜植床和植片组织中可见大量真菌菌丝结构,1例真菌位于角膜植床基质深层,达后弹力层,4例患者无法识别植床和植片结构,基质层纤维可见真菌菌丝结构。结论真菌性角膜炎患者行治疗性角膜手术,可以赢得治疗时间,角膜植床中是否存在真菌菌丝以及菌丝的多少是真菌性角膜炎治疗成败的重要因素,应给予重视,改善患者的预后。

Boston type I keratoprosthesis

Successful corneal solid tissue transplantation,beginning with penetrating keratoplasty(PKP),and evolving to include contemporary lamellar and endothelial keratoplasty,has been a tremendous advancement in the struggle to combat corneal blindness.However,there remain patients with high-risk features predictive of transplant failure,for whom donor keratoplasty is not a viable option.Prosthetic corneas have therefore been developed in order to meet the needs of these patients.The Boston type I keratoprosthesis(BKPro)is the most widely used prosthetic cornea in the treatment of corneal blindness.In the years since the BKPro’s introduction,refinement of surgical technique and clinical management as well as improvements in prosthetic design have contributed to promising patient outcomes,particularly in the short term.As such,patients with keratoprosthesis implants continue to grow in number,and the indications for the BKPro have commensurately increased.However,risks of permanently blinding complications after implantation persist over all stages of follow-up.For the foreseeable future,the success of keratoprosthesis(KPro)implantation will continue to depend on refined patient selection,preoperative optimization,and incisive postoperative management.Here we explore indications,surgical technique and postoperative outcomes as well as several core tenants in the management of BKPro patients:limiting glaucomatous progression,controlling inflammation,and optimizing the ocular surface.The exquisite sensitivity of the BKPro-implanted eye to perturbations in any one of these areas showcases the intimate relationship between the prosthetic device and its surrounding environment.