目的：研究准分子激光原位角膜磨镶术(laser in situkeratomileusis，LASIK)前后角膜滞后量(corneal hysteresis，CH)和角膜阻力因子(corneal resistance factor，CRF)变化量，对其相关因素进行多元线性回归分析。方法：前瞻性研究。纳入行LASIK手术的近视眼及近视散光患者70眼(38例)，术前与术后6个月各项参数分别由眼反应分析仪(ocular response analyzer，ORA)、非接触眼压仪、超声角膜测厚仪及Pentacam眼前节分析仪测量。分析LASIK手术前后△CH，△CRF与术前、手术设计等参数的相关性，并对相关参数进行多元线性回归分析。结果：手术前后CH分别为(10.05±1.36)，(8.15±0.90) mmHg(1 mmHg=0.133 kPa)，CRF分别为(9.91±1.38)，(6.92±0.88) mmHg，差异均有统计学意义(P<0.01)；△CH与△CRF分别为(1.90±1.15)，(2.99±1.23) mmHg。△CH与术前CH，CRF，眼压(intraocular pressure，IOP)，预计切削深度(ablative depth，AD)以及AD/CCT呈正相关；△CRF与术前CH，CRF，IOP，AD，AD/CCT，术前等值球镜(spherical equivalent，SE)以及预计基质床厚度(residual stromal bed’s thickness，RSBT)有相关性。采用多元线性回归对LASIK手术前后△CH，△CRF与术前、手术设计等各相关参数进行分析，回归方程为：△CH=?6.182+0.658CH_术前+8.421AD/CCT (R2=0.639，P<0.01)，△CRF=?0.007+0.725CRF_术前?0.014RSBT (R2=0.689，P<0.01)。结论：LASIK术前后CH与预计AD和角膜厚度比值密切相关，CRF变化量与预计角膜RSBT密切相关，在设计手术时应慎重考虑预计AD与预计RSBT。

Objective: To discuss the change of corneal hysteresis and corneal resistance factor before and after laser in situkeratomileusis (LASIK), and to analyze their related factors by multivariate linear regression. Methods: In this prospective study, 70 eyes (38 patients) with myopia and myopic astigmatism undergoing LASIK were included. Related factors were measured preoperatively and at 6 months postoperatively by ocular response analyzer, noncontact tonometer (NCT), ultrasonic pachymeter, and Pentacam system. TTe correlation was analyzed between △CH, △CRF and preoperative and operative design’s parameters, and correlative factors analyze. △CH and △CRF were analyzed by the multiple linear regression. Results: CH before and after LASIK were (10.05±1.36) and (8.15±0.90) mmHg, and CRF before and affer LASIK were (9.91±1.38) and (6.92±0.88) mmHg. TTere was signiffcant difference between preoperative and postoperative CH and CRF (P<0.01). △CH and △CRF were (1.90±1.15) and (2.99±1.23) mmHg. Preoperative CH, CRF, intraocular pressure (IOP), ablative depth (AD) and AD/CCT were positive correlated with △CH. Preoperative CH, CRF, IOP, AD, AD/CCT, preoperative spherical equivalent (SE) and predicted residual stromal bed’s thickness (RSBT) were correlated with △CRF. TTe regression equation of △CH and △CRF and influencing factors were △CH =?6.182 + 0.658CH_preoperative + 8.421AD/CCT (R2 =0.639, P<0.01), △CRF =?0.007 + 0.725CRF_preoperative ? 0.014RSBT (R2 =0.689, P<0.01). Conclusion: The change of CH before and after LASIK is correlative with AD/CCT. The change of CRF before and after LASIK is correlative with predicted residual stromal bed’s thickness. Ablative depth and predicted residual stromal bed’s thickness should be considered carefully during the surgical design.

目的：探讨飞秒激光辅助角膜内皮移植(endothelial keratoplasty，EK)患者的护理。方法：对40例 行飞秒激光辅助EK术的患者做好术前心理护理，完善术前检查及术前准备，术后重点做好体位护 理、病情观察及出院指导。结果：4例患者术后发生植片移位，经再次复位后贴合良好，1例术后第1天气泡到后房行前房成形术；13例患者术后出现眼压升高，经治疗眼压得到控制；40例患者全 部治愈出院。结论：对EK术患者应做好术前及术后的护理，及时发现并发症并采取相应的治疗与护理措施，以提高手术的成功率。

Objective: To explore the nursing care of patients with femtosecond laser assisted endothelial transplantation. Methods: Forty patients were involved in this study. Preoperative psychological nursing, ocular examination, and surgical preparation were taken, and the main nursing postoperation focused on patients’ position and the discharge guidance. Results: TTe graffs in 4 cases were displaced, and were all in place affer resetting. The bubble was observed in posterior chamber in 1 case, this case was taken anterior chamber forming operation. Intraocular pressure was high in 13 cases, and those cases were treated with topical medicines. Conclusion: Completing the preoperative nursing of patients with corneal endothelial transplantation, observing the complications and taking corresponding treatment and nursing measures help improve the success rate of the operation.  

目的：减轻行角膜移植术的患儿及家属的心理负担，提高患儿对手术的耐受性，减少术后并发症。方法：对45例将进行角膜移植的患儿进行围手术期护理。结果：所有患儿经过精心的治疗和护理后均恢复良好，视力均有提高。结论：术前做好充足的准备、术前心理护理，术后严密观察生命体征和眼部敷料的情况，做好相关的生活和饮食指导，遵医嘱及时有效用药，注意患儿异常的反应及眼部的情况，及时发现并处理并发症，给予细致的出院指导，有利于患儿早日康复。

Objective: To reduce the psychological burden of the children and families who are scheduled to the corneal transplantation, and to improve the patients’ tolerance and reduce postoperative complications. Methods: The perioperative care was given to 45 patients with corneal transplantation. Results: All children were treated well by careful treatment and care. Conclusion: Before operation, comprehensive preparation and psychological nursing care should be delivered. Affer operation, the physicians and nurses should guide the patients to live a healthy lifestyle, remind them to take the drugs timely, identify the abnormal symptoms and postoperative complications in children with abnormal responses, implement effective treatment timely to accelerate postoperative recovery.

目的：探讨飞秒激光辅助角膜内皮移植(endothelial keratoplasty, EK)手术的护理配合。方法：对19例(19只眼)飞秒激光辅助的EK手术进行术前访视，充分的术前准备，各种仪器调试及器械的准 备，术中熟悉手术过程，指导患者配合手术并密切配合医生，做好患者术中、术后的体位管理，仪器及器械的处理。结果：19例手术均顺利完成，术中无意外发生，患者积极配合，术后视力89.5%(17/19)明显提高，眼部刺激症状消失，植片角膜内皮细胞数丢失不多。结论：飞秒激光辅助EK作为一种全新的手术技术，完善的术前准备，密切的手术配合，特殊体位护理是保证手术成功的关键。

Objective: To investigate nursing and cooperation of femtosecond laser-assisted endothelial keratoplasty (EK). Methods: Preoperative visit and adequate preoperative preparation were proceeded in 19 patients (19 eyes) underwent femtosecond laser-assisted EK, instrument commissioning and equipment preparation were performed before the surgery. We mastered the surgical procedures, guided patients for cooperating the operation, and cooperated closely with surgeon during operation. Management of intraoperative and postoperative body position were accomplished, instruments and equipment were well processed aff er operation. Results: All of the 19 cases were successfully completed without intraoperative accident, all of the patients cooperated actively. Postoperative visual acuities in 89.5% (17/19) of the patients were improved significantly, ocular irritation symptoms were disappeared, and corneal endothelial cells of the grafts were decreased slightly. Conclusion: Femtosecond laserassisted EK is a brand new surgical technology, perfect preoperative preparation, intimate operative cooperation, and management of special body position are essential for a successful operation.

目的：观察羊膜移植手术对于减少碱烧伤后角膜新生血管的疗效。

方法：回顾性病例对照研究。2006－2010 年期间该院收治的 Ⅲ 度角膜碱烧伤的患者 19 例 23 眼，其中行羊膜移植术（治疗组）11 例 13 眼，未行羊膜移植术（对照组）8 例 10 眼。该两组的年龄和手术外的处理基本匹配。伤后 3 d 治疗组行羊膜移植术。分别在伤后 14、60 d 测量各组角膜新生血管面积。应用 SPSS 12.0 统计学软件将此两组的面积进行配对 t 检验，以 P < 0.05 作为差异有统计学意义。

结果：在烧伤后 14 d 治疗组新生血管面积（62.133 ± 8.571）mm²，明显低于对照组（89.561 ± 9.741）mm²，治疗组较对照组减低 30.6%，两组差异具有统计学意义（P < 0.05）。烧伤后 60 d 治疗组新生血管面积（112.019 ± 17.362）mm²，明显低于对照组（129.481 ± 13.534）mm²，治疗组较对照组减低 13.5%，两组差异具有统计学意义（P < 0.05）。

结论：羊膜移植术能明显抑制碱烧伤所致角膜新生血管的生长。

Purpose: To study the curative effect of amnion membrane transplantation on decreasing corneal neovascularization (CNV) induced by alkali burn.

Methods: It was a non-randomized retrospective case-control study. Among 19 cases (23 eyes) of third-degree alkali burns from 2006 to 2010, 11 cases (13 eyes) were performed with amnion membrane transplantation operation, and others were not. Amnion membrane transplantation was performed at the 3^rd day after burn in the treatment group. Ages and treatments beyond surgery of double groups were matched. Areas of CNV in double groups were measured at the 14^th day and 60^th day after burn.

Results: Area of CNV in the treatment group was (62.133 ± 8.571) mm² at the 14^th day after burn, and was 30.6% lower than that in the control group. Area of CNV in the treatment group was (112.019 ± 17.362) mm² at the 60^th day after burn, and was 13.5% lower than that in the control group. There was statistical significance (P < 0.05).

Conclusion: Amnion membrane transplantation operation can inhibit the growth of corneal neovascularization induced by alkali burn. 

      总结32例飞秒激光辅助角膜移植术患者的护理，认为做好心理护理、术前完善眼部检查和做好充分的准备，术后严密观察敷料、眼压和角膜植片的情况，做好特殊体位和角膜接触镜的护理，并做好出院指导是提高手术的成功率及预防并发症的关键。

This paper summarized the nursing care of 32 patients received femtosecond laser assisted corneal transplantation. The key points to increase the success rate of surgery and prevent complications were psychological nursing, preoperative examinations and fully prepared, postoperative observation of dressing, intraocular pressure and corneal glass, care of special position and corneal contact lens, and discharge guidance.

目的：观察 NIDEK EC5000 准分子激光治疗系统准分子激光原位角膜磨镶术(Laser in sitkeratomileusis, LASIK) 角膜切削深度的可预测性。
方法：采用 NIDEK EC5000 准分子激光系统对 79 例近视和(或)近视散光患者进行标准 LASIK 手术，术中使用超声角膜测厚仪分别测量制瓣后和激光切削后的剩余角膜床厚度，计算实际角膜切削深度，比较实际角膜切削深度同理论预测角膜切削深度的差异。
结果：LASIK 术中实际切削深度(92.32±29.86) μm，预测切削深度(74.16±25.95) μm，两者差值(18.16 ± 14.71) μm 有统计学意义(P < 0.001)。实际切削深度与预测切削深度具有较好的相关性，相关系数为0.87 (P < 0.001)，其直线回归方程为Y = 18.06 + 1.001X。按术前角膜 K 值、术前等效球镜绝对值及术前中央角膜厚度值分组的实际切削深度与预测切削深度的差值均有统计学意义。实际切削深度与术前等效球镜有关，与术前中央角膜厚度和 K 值无关。实际切削深度与预测切削深度差值同 K 值、等效球镜，术前中央角膜厚度均无关。
结论：NIDEK EC5000 准分子激光系统 LASIK 术中实际角膜切削深度比预测角膜切削深度高 (18.16±14.71) μm，在手术设计时要考虑实际切削与机器标示值存在偏差，应尽可能多的预留剩余角膜基质床厚度，以提高手术安全性。

Purpose: To assess the predictability of corneal ablation depth in LASIK using NIDEK EC5000 excimer laser.
Method: Standard LASlK surgery was performed in 79 myopic patients with or without astigmatism with the NDEK EC5000 excimer laser system. Ultrasonic cornealpachymetry was performed immediately after flap creation and after laser ablation during LASIK procedure, by which the actual corneal ablation depth was calculated.The values of actual and predicted ablation depth were compared.
Results: The actual ablation depth was (92.32+29.86) μm, the predicted ablationdepth was (74.16+25.95) μm. The differences between them (18.16+14.71) μm were statistically significance (P < 0.001 ). Linear regression suggested that the actual ablation depth correlated closely with the predicted ablation depth (r = 0.87 , P < 0.001 ). The regression model was Y = 18.06+1.001X. The differences remained statistically significant and were independent of the levels of preoperative corneal keratometry, absolute preoperative spherical equivalent and the preoperative central cornea thickness.
Conclusion: The actual ablation depth was about (18.16+14.71) μm thicker than thepredicted ablation depth in the NlDEK EC5000 excimer laser system. We may have totake into account this deviation in order to ensure sufficient thickness of residualstromal bed.

角膜是基因治疗的理想靶器官。角膜碱烧伤、角膜新生血管、角膜移植术后排斥反应因其病理机制复杂，所牵涉的致病因素众多而治疗困难，疗效不佳。本文就基因治疗在上述疾病中的应用加以综述，以了解基因治疗应用于角膜病变的新进展 。

Cornea is an ideal target organ for gene therapy. Corneal alkali burn, cornealneovascularization and corneal graft rejection tend to be with poor treatment elicacydue to its complex pathogenesis. This article aims to update the recent progress of genetherapy on corneal diseases.

神经营养性角膜病变是一种与角膜神经退行性改变有关的疾病，角膜神经的知觉和营养功能受损，导致角膜上皮缺损、角膜溃疡甚至角膜穿孔。目前人工泪液、治疗性角膜绷带镜、泪点栓塞、羊膜移植，睑缘缝合等治疗措施仍是治疗神经营养性角膜病变的主要治疗方式，对于轻中度病变患者，具有较好的治疗效果，而对于重度病变患者，药物治疗及简单的手术干预治疗效果不佳，病情反复发作。由于重度神经营养性角膜病变患者的角膜神经完全消失，丧失角膜感觉，对未恢复角膜神经营养功能的角膜白斑或溃疡患者行角膜移植术，可能导致角膜移植术后上皮持续不愈合，因此恢复角膜神经营养功能是复明的重要保障手段。角膜神经移植术是重度神经营养性角膜病变患者恢复角膜神经营养功能，提高角膜知觉，改善角膜透明度的重要和有效的治疗方法。角膜神经移植术通过将具有正常功能的供体神经移植到麻痹眼角膜缘周围，使神经末梢重新长入角膜基质，恢复角膜知觉功能。随着角膜神经移植术的术式的不断改进，其良好的术后效果和优点已经渐渐突显。角膜神经移植术包括直接角膜神经移植和间接角膜神经移植，促使角膜神经重新生长，重建角膜神经的营养和知觉功能。角膜神经移植手术已有40年历史，1981年Samii等首次报告了角膜神经移植术，2009年Terzis等成功地实施了第1例直接角膜神经移植术，2014年Elbaz等进行了第1例以腓肠神经作为间置移植物的间接角膜神经移植。封面展示了神经营养性角膜病变患者未接受治疗前的和接受角膜神经移植术后的眼表角膜图像。由于角膜神经退行性改变，角膜失去神经支配，继而出现角膜上皮缺损，角膜缘新生血管形成，经角膜神经移植后，角膜上皮愈合，角膜透明度改善，同时角膜缘新生血管消退。

神经营养性角膜病变是一种与角膜神经退行性改变有关的疾病，角膜神经的知觉和营养功能受损，导致角膜上皮缺损、角膜溃疡甚至角膜穿孔。目前人工泪液、治疗性角膜绷带镜、泪点栓塞、羊膜移植，睑缘缝合等治疗措施仍是治疗神经营养性角膜病变的主要治疗方式，对于轻中度病变患者，具有较好的治疗效果，而对于重度病变患者，药物治疗及简单的手术干预治疗效果不佳，病情反复发作。由于重度神经营养性角膜病变患者的角膜神经完全消失，丧失角膜感觉，对未恢复角膜神经营养功能的角膜白斑或溃疡患者行角膜移植术，可能导致角膜移植术后上皮持续不愈合，因此恢复角膜神经营养功能是复明的重要保障手段。角膜神经移植术是重度神经营养性角膜病变患者恢复角膜神经营养功能，提高角膜知觉，改善角膜透明度的重要和有效的治疗方法。角膜神经移植术通过将具有正常功能的供体神经移植到麻痹眼角膜缘周围，使神经末梢重新长入角膜基质，恢复角膜知觉功能。随着角膜神经移植术的术式的不断改进，其良好的术后效果和优点已经渐渐突显。角膜神经移植术包括直接角膜神经移植和间接角膜神经移植，促使角膜神经重新生长，重建角膜神经的营养和知觉功能。角膜神经移植手术已有40年历史，1981年Samii等首次报告了角膜神经移植术，2009年Terzis等成功地实施了第1例直接角膜神经移植术，2014年Elbaz等进行了第1例以腓肠神经作为间置移植物的间接角膜神经移植。封面展示了神经营养性角膜病变患者未接受治疗前的和接受角膜神经移植术后的眼表角膜图像。由于角膜神经退行性改变，角膜失去神经支配，继而出现角膜上皮缺损，角膜缘新生血管形成，经角膜神经移植后，角膜上皮愈合，角膜透明度改善，同时角膜缘新生血管消退。

目的:通过观察对金黄色葡萄球菌性角膜溃疡的疗效,筛选克拉霉案眼用凝胶的合适浓度。

方法:角膜实质层接种法建立40只家兔右眼金黄色葡萄球菌性角膜溃疡模型,将模型随机分成5组,每组8只免(8只眼),各组分别给予空白基质、0.1%克拉素眼用凝胶、0.25%克拉霉素眼用凝胶、左氧氟沙星凝胶、0.25%克拉霉素眼用凝胶联合重组牛碱性成纤维细胞生长因子(Recombinant bovine basic fibroblast growth factor, Rb-bFGF)，每天4次，每次2滴，分别在第1、3、5、7、10、14 天观察角膜病变情况及溃疡面积大小。

结果:在相同的给药方法下，0.1%克拉霉素眼用凝胶、0.25%克拉素眼用凝胶、左氧沙星凝胶、0.25%克拉霉素眼用凝胶联合Rb-bFCF均能使金黄色葡萄球菌性角膜溃疡面积缩小角膜病变好转，与空白基质组相比有统计学差异(P < 0.05)：0.25%克拉素眼用凝胶组疗效明显优于0.1%克拉荐素眼用凝胶组(P < 0.05)。

结论:制备的 0.25%克拉霉素眼用凝胶对金黄色葡萄球菌性角膜溃疡疗效肯定，可以进一步开发应用于临床。

Purpose:To screen proper concentration of clarithromycin ophthalmic gel by observingthe efficacy of different concertrations of clarithromycin ophthalmic gel for treatingstaphylococcal corneal ulcers.
Methods:Corneal ulcer was induced in the right eye of 40 rabbits, 3.0 x 10°CFU/mlstaphylococcus aureus suspension was injected midstromally into the central cornel.These rabbits were divided randomly into $ groups ,each group received respectivelytopical blank matrix, clarithromycin ophthalmic gel 0.1%, clarithromycin ophthalmicgel 0.25%,levofloxacin ophthalmic gel, clarithromycin ophthalmic gel 0.25% andrecombinant bovine basic fibroblast growth factor (Rb-bFGF), 4 times every day, 2drops each time. The eyes were examined respectively with the slit lamp beforetreatment(day0), on day3, day5, day7, day 10, day 14 to observe theprogression of corneal ulceration. including the area of the corneal ulcer and mark of keratitis.

Resuls:Under the same way of giving medicine, experimental coreal ulcer studiesshowed a statistically significant decrease in all tratement groups on measurements ofthe area of the comeal ulcer and mark of keratitis(P<0.05), and clarithromycinophthalmic gel 0.25% had a better action than clarithromycin ophthalmic gel 0.1%against staphylococcus aureus corneal ulcer.
Conclusion:Clarithromycin ophthalmic gel 0,25% was proved to be an effective ocularmedication for the therapy of gram-positive bacterial corneal ulcer.