目的：比较活体共聚焦显微镜和病理检查在角膜后部真菌感染的诊断阳性率，探讨两种检查方法在角膜后部真菌感染诊断中的价值。方法：回顾性病例对照研究。收集2009年11月至2020年12月在青岛眼科医院就诊并进行穿透性角膜移植手术治疗角膜后部真菌感染患者，术前均进行角膜刮片KOH涂片检查和活体共聚焦显微镜检查，术后病变角膜进行病理组织切片、过碘酸-Schiff法(PAS)染色和六亚甲基四胺银法(GMS)染色检查，比较不同检查方法诊断的阳性率。结果：18例角膜后部真菌感染患者角膜刮片KOH涂片均未检查到真菌菌丝，其中有16例患者经活体共聚焦显微镜检查到真菌菌丝(88.9%)，而2例患者在术前活体共聚焦显微镜检查中未查到病原体。术后病理检查PAS染色联合GMS染色，18例患者中18例均可检查到真菌菌丝，角膜后部真菌感染患者病理切片中可见角膜深基质层变性坏死，大量炎症细胞浸润，PAS染色和GMS染色可见典型真菌菌丝侵犯角膜基质深层，而角膜基质浅层及上皮层均未查见真菌菌丝。结论：活体共聚焦显微镜诊断角膜后部真菌感染具有一定的局限性，联合术后病理组织切片和特殊染色检查有助于提高角膜后部真菌感染的诊断率。
Objective: To compare the diagnostic rate between in vivo confocal microscopy and pathological examination in retrocorneal fungal infection. Methods: It is a retrospective study. A total of 18 patients with retrocorneal fungal infection and received PKP surgery in the Qingdao Eye Hospital from November 2009 to December 2020 were enrolled. KOH smear and in vivo confocal microscopy examination were performed before surgery, and pathological examination including periodic acid-schiff (PAS) stain and Grocott Methenamine Silver (GMS) stain were performed after surgery. Patients were diagnosed retrocorneal fungal infection based on in vivo confocal microscopy and pathological examination. The diagnostic rates of the two methods were compared. Results: None of the 18 patients with posterior corneal fungal infection were found to have fungal hyphae in the corneal smear.Sixteen patients (88.9%) were found fungal hyphae by in vivo confocal microscopy. Corneal stroma necrosis and a large number of inflammatory cells were shown by postoperative pathologic examination, and all patients were found fungal hyphae in posterior corneal stroma with PAS stain and GMS stain. Conclusion: Confocal microscopy has unique advantages such as non-invasive and rapid examination in the diagnosis of fungal keratitis.However, it needs to combine with pathological examination for diagnosing the retrocorneal fungal infection.
目的：探究球面塑形镜、环曲面塑形镜在矫治近视复合散光的有效性及安全性。方法：回顾分析宜昌市第一人民医院2016年3月至2018年3月角膜塑形镜治疗青少年近视94例(178眼)，按佩戴塑形镜类型分为球面塑形镜组(48例，90眼)与环曲面塑形镜组(46例，88眼)。记录配镜前、佩戴1年后、停戴1周后的视力、角膜散光、眼轴长、球镜屈光度、眼压、泪膜破裂时间及角膜着染率。结果：戴镜1年后，2组组内相比，散光、球镜度数、眼压、泪膜破裂时间均降低，但2组组间相比，仅散光度数差异有统计学意义(P<0.01)。戴镜1年后，两组视力较戴镜前显著提高，停戴后近视度数较佩戴前增加，但组间差异无统计学意义(P>0.05)；2种塑形镜角膜着染发生率差异无统计学意义(P>0.05)。结论：2种塑形镜均能够降低近视复合散光患者度数，有效提高患者视力，但并不能完全阻止近视的进展。虽然环曲面塑形镜在矫正散光方面有优势，但总有效性与安全性并不占优势。
Objective: To observe the effectiveness and safety of orthokeratology lens and toric design othokeratology treatment for compound myopic astigmatism. Methods: From March 2016 to March 2018, 94 teenagers(178 eyes) were selected as the subjects of study. They were divided into two groups according to the type of orthokeratology: the orthokeratology lens group (48 cases, 90 eyes) and the toric design othokeratology group(46 cases, 88 eyes). Visual acuity, corneal astigmatism, axial length, spherical lens refraction, intraocular pressure,tear film rupture time and corneal staining rate were recorded before, after 1 year and after 1 week. Results: After 1 year of wearing the lens, astigmatism, spherical lens degree, intraocular pressure and tear film rupture time were all decreased in the 2 groups compared with each other, but only astigmatism degree was statistically significant between the 2 groups compared with each other (P<0.01). After wearing the glasses for 1 year, the visual acuity of the two groups was significantly improved compared with that before wearing the glasses, and the myopia degree was increased after stopping wearing the glasses compared with that before wearing the glasses, but the difference between the two groups was not statistically significant (P>0.05). There was no statistical significance in the incidence of corneal staining between the two types of shaping lenses (P>0.05). Conclusion: Both of the two shaping lenses can reduce the degree of myopic patients with complex astigmatism and effectively improve the visual acuity of patients, but they can not completely prevent the progress of myopia. Although toroidal shaping mirror has advantages in correcting astigmatism, its overall effectiveness and safety are not.
目的：评估硅油填充术后眼压对角膜内皮细胞的影响及变化特点。方法：选取2019年1月1日至9月30日在佛山市第二人民医院眼科中心行玻璃体切除联合硅油注射的患者共131名，分为高眼压组(n=80)和正常眼压组(n=51)。高眼压组术后任意一次测眼压>21 mmHg，正常眼压组术后眼压均≤21 mmHg。比较填充硅油前与取硅油时的角膜内皮细胞参数测量值。结果：高眼压组的平均眼压为20.79 mmHg，正常眼压组的平均眼压为14.70 mmHg(P<0.001)。取硅油时，两组角膜内皮细胞密度(corneal endothelial cell density，ECD)均明显减少，平均内皮细胞面积均明显增大(P<0.05)，高眼压组内皮细胞大小变异系数(coefficient of variation of endothelial cell size，CV)明显变大(P<0.05)。高眼压组ECD丢失率(6.3%)高于正常眼压组(3.5%)；其中，高眼压组中术后1~6周内的眼压升高(7.1%)、眼压≥40 mmHg(7.3%)对角膜内皮细胞影响最大。ECD丢失与眼压变化有显著相关性(r=0.176，P=0.044)。结论：硅油填充后高眼压是角膜内皮细胞丢失的重要危险因素。
Objective: To evaluate the effect of intraocular pressure (IOP) on corneal endothelial cells after silicone oil tamponade. Methods: Patients (n=131) received vitrectomy with silicone oil injection in Ophthalmology Center in Second People’s Hospital of Foshan City from January 1st to September 30th 2019 were divided into the high IOP group (n=80) and normal IOP group (n=51). IOP was >21 mmHg at any time in the high IOP group and was ≤21mmHg in the normal IOP group after surgery. The values of corneal endothelial cells before filling with silicone oil and before removing silicone oil were compared.Results: The average IOP was 20.79 mmHg in the high IOP group, and 14.70 mmHg in the normal IOP group (P<0.001). The number of endothelial cells (ECD) was reduced, but the average endothelial cell area was increased (P<0.05) in both groups. The coefficient of variation of endothelial cell size in high IOP group was increased (P<0.05). ECD loss rate was 6.3% in the high IOP group and 3.5% in normal IOP group. Increased IOP within 1–6 weeks after surgery (7.1%) and IOP ≥40 mmHg (7.3%) had the greatest impact on ECD. ECD loss was correlated with IOP (r=0.176, P=0.044). Conclusion: High intraocular pressure after silicone oil filling is an important risk factor for the loss of corneal endothelial cells.Keywords intraocular pressure; corneal endothelium; silicone oil; vitrect
角膜病是眼科常见疾病，治疗主要以病因治疗为主。角膜疾病治疗不及时会发展为角膜云翳、角膜斑翳、角膜白斑甚至丧失视力。本例患者主要是一例因外伤形成角膜白斑致使视力低下，于三峡大学附属仁和医院行自体穿透性角膜移植(autologous penetrating keratoplasty，APK)的特殊病例。
Keratoconus is a common disease in ophthalmology and treatment is mainly based on etiology. Untreated corneal diseases can develop into corneal clouding, corneal macula, corneal leukoplakia or even loss of vision. This is a special case of a patient who underwent autologous penetrating keratoplasty (APK) in our hospital for low vision due to traumatic formation of corneal leukoplakia.
暴露性角膜炎是角膜失去眼睑保护而暴露在空气中，引起角膜干燥、上皮细胞脱落进而继发感染的角膜炎症，多见于眼睑缺损、眼球突出、睑外翻、面神经麻痹、手术麻醉等。泪液的缺失、眼睑闭合不全、眼表暴露等因素皆会影响角膜健康，使其处于炎症、溃疡及穿孔的危险中。暴露性角膜炎治疗目的是去除暴露因素、保护角膜上皮和维持眼表湿润，目前常用的治疗手段有手术治疗与药物治疗，有些是暂时性的，有些是永久性的。
Exposure keratitis is an inflammation of the cornea that occurs when the cornea loses the protection of the eyelid and is exposed to air, resulting in dryness, epithelial exfoliation, and secondary infection. Most of them are found in eyelid defect, protopsis, eyelid ectropion, facial palsy, and anesthesia. Loss of tears, lagophthalmos and exposed ocular surface all affect the health of the cornea, putting it at risk of inflammation, ulceration, and perforation. The purpose of treatment is to remove exposure factors, protect the corneal epithelium and keep ocular surface moist.Currently, the commonly used treatments are surgical treatment and medical treatment, and some of them are temporary while others are permanent.
角膜神经性疼痛(neuropathic corneal pain，NCP)的患者具有眼部及躯体症状，但临床体征不典型，治疗效果不理想。随着干眼诊治的规范化程度不断提升，NCP的患者日益增多。NCP与全身慢性疼痛综合征相互交织。角膜共聚焦显微镜及活体印迹细胞检测可以发现特征性神经形态及相关蛋白改变。NCP的治疗应基于个体化、多学科联合的原则。本文综述近年来，NCP的病因学、病理生理学、综合治疗等取得新的进展以指导临床及转化医学研究。
Patients with neuropathic corneal pain (NCP) have local and physical symptoms, but the clinical signs are atypical,and the treatment is not effect. With the improvement of standardization of diagnosis and treatment of dry eye, the number of patients with NCP has been increasing. The NCP is intertwined with systemic chronic pain syndrome.Corneal confocal microscope and in vivo blot cytology can find the signs of morphology and associated proteins variation. The treatments of NCP should be based on the principle of individualized, multidisciplinary treatment (MDT). This article reviews recent advances in the etiology, pathogenesis, and comprehensive treatment of NCP to guide clinical translational medicine research.
在热带和亚热带国家，真菌性角膜炎是角膜盲的一个重要原因。随着现代医学的进展，早期真菌性角膜炎通过药物或者手术治疗后治愈率有了显著改善，但是很多真菌性角膜炎患者由于缺乏及时合理的治疗，病情变得迁延难治，预后较差。随着无数学者的努力，近年来在难治性真菌性角膜炎领域在抗真菌药物、给药方式及其他治疗方式上有了一些新的进展，目前可选的难治性真菌性角膜炎治疗方式各有特点及优劣之处。了解目前可用的抗真菌治疗方式、其适应证及不良反应等，是处理难治性真菌性角膜炎病例的必要条件。
Fungal keratitis is a significant cause of corneal blindness in tropical and subtropical countries. With the development of modern medicine, the cure rate of early fungal keratitis has been significantly improved after medical or surgical treatment. However, due to the lack of timely and reasonable treatment for many patients with fungal keratitis, the disease has become difficult to treat and the prognosis is poor. With the efforts of numerous scholars, some new advances have been made in the treatment of recalcitrant fungal keratitis in recent years, such as antifungal drugs and administration methods. At present, the treatment methods of recalcitrant fungal keratitis have their own characteristics, advantages and disadvantages. It is necessary to understand the available antifungal therapies, their indications and side effects for the treatment of recalcitrant fungal keratitis.
报告1例因电路短路产生电弧光烧伤患者双眼角膜的病例。专科检查:双眼角膜缘颞侧球结膜缺血区小于1/3，角膜上皮呈白色混浊，上皮部分脱落。入院给予清除角膜表面白色坏死组织、抗炎、扩瞳对症治疗，2周后角膜恢复透明，随访3个月患者晶状体及眼底未见明显异常；探讨电弧光在眼球不同部位的致病机制。
A case of corneal burn caused by arc light due to electrical short is reported. Specialist examination: ischemic areas of the temporal limbus bulbar conjunctiva in both eyes were less than 1/3, the corneal epithelium was white and cloudy, and the epithelium was partially peeled. The corneas became transparent after 2 weeks’ treatment of removing the white necrotic tissue, anti-inflammatory and dilating pupil. During the follow-up within 3 months, the patient’s lens and fundus showed no obvious abnormalities. The injury mechanism of arc light caused by electrical short to the eyeball is discussed.
随着白内障手术由复明性向屈光性转变，对角膜的散光矫正显得越来越重要。而角膜散光不仅仅应该关注角膜前表面的散光数据，更应该考虑角膜后表面的散光，否则对散光人工晶状体植入矫正角膜散光可能出现不同程度的术后屈光误差。角膜后表面散光均值约为0.37 D，且多数情况下会产生逆规散光的效果，因此在进行散光型人工晶状体计算时应考虑到这一特点，进一步防止术后欠矫或过矫的发生。
With the cataract surgery evolving from visual restoration surgery to refractive surgery, surgical correction of corneal astigmatism becomes more and more important. For Toric intraocular lens implantation, the surgeon should not only pay attention to the values in surface of anterior corneal astigmatism but also that in posterior corneal astigmatism. Otherwise,unwanted postoperative refractive errors may occur. The mean value of posterior corneal astigmatism was around 0.37 D.In most cases, the posterior corneal astigmatism produces against-the-rule effect. Therefore, the above-mentioned feature of posterior corneal astigmatism should be noticed to prevent the under-correction or over-correction effect of toric lens.
目前对于成人圆锥角膜(keratoconus，KC)的研究已经很广泛，而对于儿童KC的研究则较少，其诊断和治疗常常基于成人KC的研究基础。与成人KC相比，儿童KC的发展更迅速、造成的后果更严重，其导致的儿童视觉障碍会追随其一生，对其生活质量以及教育发展产生严重的负面影响。为了对儿童KC的治疗有较全面的认识和理解，本文针对近几年儿童KC的治疗进展，对不同治疗方法的安全性、有效性和治疗时机等方面进行综述。
At present, the research on adult keratoconus has been extensive, while the research on pediatric keratoconus is few. The diagnosis and treatment of pediatric keratoconus are often based on the study of keratoconus in adults. Pediatric keratoconus is more aggressive than adult keratoconus, resulting in visual impairment that can follow throughout their lives and have a serious negative impact on their quality of life and educational development. In this paper, according to the treatment progress of pediatric keratoconus in recent years, the safety, effectiveness, and treatment timing of different treatment methods were summarized, in order to have a more comprehensive understanding of the treatment of pediatric keratoconus.
