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 aft...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.展开更多
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 ey...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.展开更多
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 transpl...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.展开更多
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 te...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.展开更多
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 transplant...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. Postoperatively81.1% 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.展开更多
BACKGROUND Streptococcus mitis(S.mitis)is an opportunistic pathogen that can lead to severe ocular infections.In previous reports,penetrating keratoplasty(PK)was usually adopted for the treatment of persistent corneal...BACKGROUND Streptococcus mitis(S.mitis)is an opportunistic pathogen that can lead to severe ocular infections.In previous reports,penetrating keratoplasty(PK)was usually adopted for the treatment of persistent corneal ulcers.This report describes an unusual case of nonhealing descemetocele caused by S.mitis treated by antibiotics plus amniotic membrane transplantation(AMT).CASE SUMMARY A 63-year-old woman presented with a right persistent corneal ulcer that she had suffered from for the past 9 mo.The culture of a corneal scraping yielded S.mitis.The right eye descemetocele decreased in diameter from 3 to 0.8 mm after the continuous administration of topical vancomycin and ceftriaxone for 2 wk.Due to the slow healing,AMT was performed.Her corneal erosion healed and gradually became clear.Her visual acuity recovered from initially counting fingers to 100/200 at the last follow-up,67 mo after AMT.CONCLUSION Antibiotics plus AMT may be an effective alternative treatment other than PK to promote epithelializationand to reduce inflammation in the corneas complicated by S. mitis keratitis.展开更多
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 transpl...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 <em>Pneumocystis jiroveci</em> (PJP) coinfection with <em>Nocardia spp</em>. and <em>Cytomegalovirus</em> (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 <em>Nocardia spp</em>. 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 <em>Nocardia spp</em>. 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.展开更多
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...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 Tübingen. 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.展开更多
目的了解角膜内皮移植(EK)近年的文献分布规律和研究热点。方法以Web of Science核心合集中的科学引文扩展索引和社会科学引文索引为数据源,提取2011—2021年以EK为主题的文献,对以EK为主题、文献类型为论著的年文献量、文献发表量前10...目的了解角膜内皮移植(EK)近年的文献分布规律和研究热点。方法以Web of Science核心合集中的科学引文扩展索引和社会科学引文索引为数据源,提取2011—2021年以EK为主题的文献,对以EK为主题、文献类型为论著的年文献量、文献发表量前10的作者和期刊、引用频次前10位的论文及其主要观点进行统计,并将文献数据导入VOSviewer软件,对EK相关领域文献的核心作者及关键词进行可视化分析。结果共检索出文献1454篇。2011—2021年,文献发表量的逐年累积量呈线性增长,美国是发表EK相关文献最多的国家,Melles GRJ的论文发表量和论文被引数均占据第1位,文献发表总量排名第1的期刊为Cornea。目前,EK的研究方向主要集中于多种术式术后效果的比较和相关并发症的处理。关键词分析显示,其被分为5个聚类,其中聚类1是关于EK术后视觉质量的评价;聚类2是术后并发症和移植失败高风险因素的分析;聚类3是以角膜后弹力层内皮移植(DMEK)为中心的适应证和手术技巧的研究;聚类4是植片相关问题,如植片制备、内皮细胞损失、术后植片脱位的处理等;聚类5主要是角膜移植术式的变化趋势。出现频次最多的关键词是DMEK,共559次,说明目前DMEK是EK相关研究领域的重点。2017年以来,"DMEK"、"previous trabeculectomy"、"graft preparation"、"stability"、"safety"、"air"等关键词出现频次增加,可见有青光眼手术史的病例处理、手术的安全性和稳定性、大气泡法制备植片是近几年来的研究热点。结论植片制备技巧、复杂病例处理、角膜内皮疾病患者青光眼的治疗方法、大气泡法制备植片的长期术后效果评估可能成为今后EK研究发展的方向。展开更多
目的通过文献计量方法分析Web of Science数据库中巩膜镜的研究现状。方法检索2013年1月至2022年12月Web of Science核心合集数据库收录的巩膜镜相关文献,采用CiteSpace工具对文献进行可视化分析,对文献发文量、国家及机构分布、核心作...目的通过文献计量方法分析Web of Science数据库中巩膜镜的研究现状。方法检索2013年1月至2022年12月Web of Science核心合集数据库收录的巩膜镜相关文献,采用CiteSpace工具对文献进行可视化分析,对文献发文量、国家及机构分布、核心作者信息、刊文期刊分布及关键词聚类等方面进行综合分析。结果共检索到340篇文献,相关文献分别刊载在54种期刊,平均每种期刊约6.3篇,涉及301位作者;该研究领域覆盖35个国家或地区,共256个研究机构;学科发展主要集中在美国、印度、西班牙、澳大利亚,主要研究领域为巩膜镜(巩膜接触镜)、眼表疾病、角膜水肿、小型巩膜接触镜等方面。近10年来,巩膜镜的研究热点变化趋势为从最初的巩膜接触镜与眼表疾病相结合的研究,到后续的眼表人工置换研究,再到角膜间隙及形状方面的研究。2013—2021年主要关注的主题为眼表疾病、巩膜接触镜及角膜水肿,而在2021年后,眼表疾病和角膜移植术的相关研究有衰落趋势。2013年1月至2022年12月巩膜镜相关的突现词主要包括:第1阶段为巩膜接触镜、移植、抗宿主病、假体装置等研究;第2阶段为眼表生态系统人工置换、不规则角膜等研究;第3阶段为角膜间隙、特有形状等研究。光学相干断层扫描和角膜地形图是巩膜镜研究和验配的常用检查。结论目前巩膜镜主要应用于干眼、角膜扩张、角膜炎、角膜移植(特别是穿透角膜移植术后)和屈光不正;眼表人工置换、角膜间隙及形状是近年的研究热点。展开更多
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...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.展开更多
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...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.展开更多
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 challeng...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.展开更多
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...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.展开更多
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) i...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.展开更多
文摘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.
文摘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.
基金Supported by National Natural Science Foundation of China(No.81670826No.81400423)the Science and Technology Planning Project of Guangdong Province(No.20160215)
文摘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.
文摘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.
文摘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. Postoperatively81.1% 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.
文摘BACKGROUND Streptococcus mitis(S.mitis)is an opportunistic pathogen that can lead to severe ocular infections.In previous reports,penetrating keratoplasty(PK)was usually adopted for the treatment of persistent corneal ulcers.This report describes an unusual case of nonhealing descemetocele caused by S.mitis treated by antibiotics plus amniotic membrane transplantation(AMT).CASE SUMMARY A 63-year-old woman presented with a right persistent corneal ulcer that she had suffered from for the past 9 mo.The culture of a corneal scraping yielded S.mitis.The right eye descemetocele decreased in diameter from 3 to 0.8 mm after the continuous administration of topical vancomycin and ceftriaxone for 2 wk.Due to the slow healing,AMT was performed.Her corneal erosion healed and gradually became clear.Her visual acuity recovered from initially counting fingers to 100/200 at the last follow-up,67 mo after AMT.CONCLUSION Antibiotics plus AMT may be an effective alternative treatment other than PK to promote epithelializationand to reduce inflammation in the corneas complicated by S. mitis keratitis.
文摘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 <em>Pneumocystis jiroveci</em> (PJP) coinfection with <em>Nocardia spp</em>. and <em>Cytomegalovirus</em> (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 <em>Nocardia spp</em>. 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 <em>Nocardia spp</em>. 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.
文摘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 Tübingen. 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.
文摘目的通过文献计量方法分析Web of Science数据库中巩膜镜的研究现状。方法检索2013年1月至2022年12月Web of Science核心合集数据库收录的巩膜镜相关文献,采用CiteSpace工具对文献进行可视化分析,对文献发文量、国家及机构分布、核心作者信息、刊文期刊分布及关键词聚类等方面进行综合分析。结果共检索到340篇文献,相关文献分别刊载在54种期刊,平均每种期刊约6.3篇,涉及301位作者;该研究领域覆盖35个国家或地区,共256个研究机构;学科发展主要集中在美国、印度、西班牙、澳大利亚,主要研究领域为巩膜镜(巩膜接触镜)、眼表疾病、角膜水肿、小型巩膜接触镜等方面。近10年来,巩膜镜的研究热点变化趋势为从最初的巩膜接触镜与眼表疾病相结合的研究,到后续的眼表人工置换研究,再到角膜间隙及形状方面的研究。2013—2021年主要关注的主题为眼表疾病、巩膜接触镜及角膜水肿,而在2021年后,眼表疾病和角膜移植术的相关研究有衰落趋势。2013年1月至2022年12月巩膜镜相关的突现词主要包括:第1阶段为巩膜接触镜、移植、抗宿主病、假体装置等研究;第2阶段为眼表生态系统人工置换、不规则角膜等研究;第3阶段为角膜间隙、特有形状等研究。光学相干断层扫描和角膜地形图是巩膜镜研究和验配的常用检查。结论目前巩膜镜主要应用于干眼、角膜扩张、角膜炎、角膜移植(特别是穿透角膜移植术后)和屈光不正;眼表人工置换、角膜间隙及形状是近年的研究热点。
基金Supported by Science and Technology Planning Project of Guangdong Province (No.2017A020211005)Science and Technology Programme of Guangzhou, China 2016 (No.201607010386)
文摘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.
文摘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.
文摘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.
文摘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.
基金supported by China Natural Science Foundation(81070711)Guangdong Provincial Science and Technology Projects(2012B031800456)+1 种基金Doctoral Program of the Ministry of Education(20110171120104)the Young Teachers Training Program of Sun Yat-sen University(11ykpy42)
文摘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.
