目的: 比较新鲜羊膜和保存羊膜治疗睑球粘连的疗效差异, 分析影响疗效的因素。

方法: 共 51 例 55 只眼因陈旧性化学伤、热烧伤或 Stevens-Johnson 综合征而发生睑球粘连的临床连续病例接受睑球粘连分离联合新鲜羊膜移植(22 只眼) 或保存羊膜移植(33 只眼) 。其中男 30 例 32 只眼, 女 21 例 23 只眼。年龄 4～51 岁, 平均(34.2 ± 4.3) 岁。其中 11 只眼在烧伤后5～11个月, 平均(7.4 ± 1.6) 个月时接受手术, 40 只眼在烧伤后 1～8 年, 平均(2.0 ± 0.7) 年进行手术。

结果: 术后随访 12～32 个月, 平均(19.3 ± 4.1) 个月 。所有移植在结膜眼表面的羊膜(包括新鲜羊膜) 植片在术后早期均未见溃烂和溶解, 周边对合良好。31/55(56.4%) 只眼形成了足够深的穹窿部且恢复了眼球运动功能。9/55(16.4%) 只眼发生部分睑球粘连, 眼球运动轻度受限,但其面积远较术前为小。15 /55(27.3%) 眼术后发生中度以上的睑球粘连。新鲜羊膜和保存羊膜重建眼结膜表面的效果相似( X ² = 0.466, P = 0.797) ; 不同程度睑球粘连的患者其羊膜移植术后的效果不同(新鲜羊膜, X²=27.995, P=0.000; 保存羊膜, X²=33.610, P=0.000) ; 在眼表烧伤后1年内手术比 1 年以上进行羊膜移植的效果也不同(X ²= 4.243, P = 0.039) 。

结论: 新鲜羊膜和保存羊膜一样可以有效地用于重建睑球粘连解除后的结膜眼表。患眼术前睑球粘连程度以及烧伤后其眼表炎症是否处于安静状态等因素都会直接影响羊膜移植重建眼结膜表面的远期疗效。

Purpose: To compare the effect of fresh versus preserved amniotic membrane transplant-ation for conjunctival surface reconstruction after symblepharon lysis and analyze the associated factors.

Methods: Fifty-one consecutive cases (55 eyes) with symblepharon at different degree due to eye burns or Stevens-Johnson syndrome were accepted lysis of symblepharon and amniotic membrane transplantation. Twenty-two eyes of them were performed with fresh amnion grafts, the others (33 eyes) with preserved human amniotic membrane. Eleven eyes were performed within 1 year and forty eyes in 1 to 8 years (mean value, 2.0 ± 0.7 years) after eye burns.

Results: The follow-up time varied from 12 to 32 months (mean value, 19.3 ± 4.1 months) . Fifty-six point four percent (31/55) eyes got enough deep conjunctival fornix and resolution of eye movement restrict. Sixteen percent of them (9/55) recurred less symblepharon and remained slightly eye movement restrict. Fifteen- five eyes of them (27.3%) recurred moderate symblepharon. The effects of surgery were similar between fresh and preserved AMT (X ² = 0.466, P = 0.797) . The effects of AMT for those patients with symblepharon at different degree had significant difference statistically (fresh amnions, X ²= 27.995, P = 0.000; preserved amnions, X ² =33.610, P = 0.000) . The same results were observed between those patients who were performed in different time periods after eye burns ( X ² = 4.243, P = 0.039) .

Conclusion: Fresh amnion has the same effect as preserved one for conjunctival surface reconstruction. The degree of symblepharon and the surgical environment of the ocular surface in the affected eye before surgery will influence the results of amniotic membrane transplantation for conjunctival surface reconstruction.

目的: 探讨小梁切除术两种不同结膜瓣术后功能性滤过泡形成情况。

方法: 比较 372 例(372 只眼) 原发性青光眼不同结膜瓣小梁切除术术后功能性滤过泡形成情况, 其中以角巩缘为基底的结膜瓣 165 只眼, 以穹窿部为基底的结膜瓣 207 只眼。

结果: 术后 1 周对所有患者进行了观察, 3 个月时只有 127 只眼进行了随访。以角巩缘为基底的结膜瓣手术组术后 1 周滤过泡成功率为 83.03 %, 3 个月时为 78.69 %。以穹窿部为基底的结膜瓣手术组术后 1 周滤过泡成功率为 55.07 %, 3 个月时为 53.03 %。两组比较有明显差别。

结论: 本组研究发现, 传统的以角巩缘为基底的结膜瓣术后滤过泡成功率高于以穹窿部为基底的结膜瓣, 其术后降压效果相应亦较好。

Purpoes: To assess the success rate of the formation of functional filtration bleb in eyes undergoing different incision of conjunctiva flap after trabeculectomy.

Methods: To study the formation of functional filtration bleb after trabeculectomy, the result of trabeculectomy with the limbus based conjunctival flap in 165 eyes and the fornix based conjunctival flap in 207 eyes (372 eyes in 372 cases with primary glaucoma in total) was compared.

Results: All patients were observed after trabeculectomy in 1 week, but only 127 eyes were followed up in 3 months. In patients with trabeculectomy using the limbus based conjunctival flap, the success rate of the formation of the filtration bleb was 83.03 % in 1 week and 78.69 % in three months postoperatively, while in those using the fornix based conjunctival flap, the success rate was 55.07 % in 1 week and 53.03 % in 3 months. There was significant difference between the two groups in terms of the success rate of the formation of the filtration bleb.

Conclusions: The result showed that limbus based conjunctival flap was especially effective and had better postoperative intraocular pressure decline.

目的：评价海藻糖滴眼液对摘除眶内眶外泪腺的实验性大鼠干眼的疗效。方法：SD大鼠30只，随机分成正常组、对照组、实验组，每组10只(20只眼)。正常组不给予处置，实验组和对照组通过摘除大鼠主泪腺制作干眼动物模型。对照组和实验组于造模完成术后1周后分别给予生理盐水、海藻糖滴眼液点双眼，每天4次，治疗共4周。分别于造模术前和造模术后1，2，3，5周进行基础泪液分泌试验(Shirmer I test)，角膜上皮荧光染色评分检测；造模5周后将大鼠处死，采用免疫组织化学方法对结膜上皮细胞中Bcl-2和Bax凋亡基因蛋白表达进行检测，观察干眼动物模型结膜上皮细胞凋亡与眼表干眼病变及组织损伤的关系。结果：基础泪液分泌试验结果显示，对照组和实验组除术后第5周比较差异有统计学意义外(P<0.05)，其余时间点差异无统计学意义(P>0.05)，术后各时间点与正常组比较差异均有统计学意义(P<0.05)。造模术后第1周，对照组和实验组角膜荧光色染色评分明显高于正常组；术后第2周后，对照组和实验组评分差异无统计学意义(P>0.05)，随着时间的延长，术后第3周和第5周，两组评分差异均有统计学意义(P<0.05)，且实验组评分小于对照组。结膜上皮细胞免疫组织化学检测结果显示：正常组结膜上皮细胞Bax蛋白阳性表达的细胞数较对照组和实验组少，与对照组比较，差异有统计学意义(P<0.05)，与实验组比较差异无统计学意义(P>0.05)；正常组可见大量Bcl-2蛋白阳性表达，且多于实验组，差异无统计学意义(P>0.05)，多于对照组，差异有统计学意义(P<0.05)；对照组结膜上皮细胞中可见大量Bax蛋白阳性表达于细胞质，呈棕黄色颗粒，实验组中Bax蛋白阳性表达相对于对照组明显较少，两者差异有统计学意义(P<0.05)；实验组结膜上皮细胞中可见大量Bcl-2蛋白阳性表达，对照组Bcl-2蛋白表达相对于实验组明显减少，差异有统计学意义(P<0.05)。结论：海藻糖滴眼液可以减少角膜表层上皮脱落，对结膜上皮细胞有一定的保护作用，可以拮抗结膜上皮细胞的凋亡，从而增强角结膜上皮屏障功能，改善由干燥引起的眼表上皮的损伤。海藻糖溶液可用于眼表上皮疾病的潜在临床应用，为治疗眼表疾病如干眼症提供治疗选择。

Objective: To observe the efficacy of trehalose eye drops on experimental dry eye rat with removal of inside and outside lacrimal glands. Methods: A total of 30 SD rats were randomly divided into a normal group, a control group, and an experimental group, with 10 rats for each group (20 eyes). The normal group was not treated, and the experimental group and the control group were made into a dry eye animal model by removing the main lacrimal gland of the rat. The control group and the experimental group were given with normal saline and trehalose eye drops once a week after the completion of modeling, 4 times a day for 4 weeks. Shirmer I test and fluorescence staining test were carded before and 1, 2, 3, and 5 weeks after modeling. After 5 weeks of modeling, the rats were sacrificed and the expression of Bcl-2 and Bax apoptosis protein in conjunctival epithelial cells was detected by immunohistochemistry in order to observe the relationship between apoptosis of conjunctival epithelial cells and dry eye lesions and tissue damage in dry eye animal models. Results: Schirme I test results showed that there was no significant difference between the control group and the experimental group (P>0.05) except for the 5th week after operation (P<0.05). There was a statistical difference between the two groups and the normal group at each time point after surgery (P<0.05). At the first week after modeling, the corneal fluorescence staining scores of the control group and the experimental group were significantly higher than those of the normal group. After the second week after surgery, there was no significant difference between the control group and the experimental group (P>0.05). The prolongation of time, the 3 week and the 5th week after surgery, the difference between the two groups was statistically significant (P<0.05), and the score of the experimental group was smaller than the control group. The immunohistochemical results of conjunctival epithelial cells showed that the number of Bax protein positive cells in the normal conjunctival epithelial cells was less than that in the control group and the experimental group. The difference between the normal group and the control group was statistically significant(P<0.05). There was no significant difference between the two groups (P>0.05). There was a large amount of Bcl- 2 protein in the normal group, which was more than the experimental group. The difference was not statistically significant (P>0.05), which was more than the control group. The difference was statistically significant (P<0.05); a large amount of Bax protein was positively expressed in the cytoplasm and brownish-yellow particles in the conjunctival epithelial cells of the control group. The positive expression of Bax protein in the experimental group was significantly less than that in the control group, and the difference was statistically significant (P<0.05). A large amount of Bcl-2 protein was positively expressed in the conjunctival epithelial cells of the experimental group, and the expression of Bcl-2 protein in the control group was significantly decreased compared with the experimental group (P<0.05).Conclusion: Trehalose eye drops can reduce epithelial detachment of the cornea and have a protective effect on conjunctival epithelial cells, which can antagonize the apoptosis of conjunctival epithelial cells,thereby enhancing the keratoconjunctival barrier function and improving the ocular surface epithelium caused by dryness. The potential clinical application of trehalose solution for ocular surface epithelial diseases and provide treatment options for ocular surface diseases, such as dry eye.

术前有效杀灭或减少眼表微生物的数量是降低术后眼内炎的重要措施。聚维酮碘消毒液和妥布霉素均能有效的降低眼科手术术后眼内炎发生率。笔者通过文献报道，综合分析聚维酮碘消毒液及妥布霉素滴眼液及注射液对眼科手术结膜囊微生物的控制能力，为眼科手术术前准备提供理论依据。

Effectively killing or reducing the number of ocular microbes before surgery is an important measure to reduce postoperative endophthalmitis. Both povidone-iodine disinfectant and tobramycin can effectively reduce the incidence of endophthalmitis after ophthalmic surgery. Through literature reports, the author comprehensively analyzes the control ability of povidone-iodine disinfectant and tobramycin eye drops and injection on the microscopy of conjunctival sac in ophthalmic surgery, and provides theoretical basis for preoperative preparation of ophthalmic surgery

目的：探讨睑结膜乳头切除联合自体游离结膜瓣移植术治疗春季角结膜炎的临床效果。方法：在显微镜下对11例(22眼)春季角结膜炎患者行睑结膜乳头切除联合自体游离结膜瓣移植术，观察治疗效果。结果：术后随访36~48个月，11例(22眼)春季角结膜炎患者中，治愈19眼(86.36%)，有效2眼(9.09%)，无效1眼(4.55%)，总有效率95.45%。结论：睑结膜乳头切除联合自体游离结膜瓣移植术是治疗春季角结膜炎安全、有效的方法。

Objective: To evaluate the efficacy and safety of surgical resection of conjunctival papillae combined with autologous conjunctival graft in the treatment of vernal keratoconjunctivitis (VKC). Methods: All 11 cases (22 eyes) with VKC were treated with surgical resection of conjunctival papillae in combination with autologous conjunctival graft. Clinical efficacy and safety were evaluated. Results: After 36 to 48 months of follow-up, 19 eyes were cured (86.36%), 2 eyes were improved (9.09%), and 1 eye was ineffective (4.55%). The total effective rate

was 95.45%. Conclusion: Surgical resection of conjunctival papillae combined with autologous conjunctival graft is efficacious and safe in the treatment of VKC.

为满足眼部化学伤患者高效急救的需要，发明一种眼部化学伤结膜囊冲洗器，包括进液管道，冲洗管道，手动加压球，流量调节器和结膜囊冲洗头，避免反复更换冲洗液，减少操作时间，同时有利于冲洗液快速大量聚集，为严重眼部化学伤的患者缩短急救等待时间；手动加压球的设置，实现了冲洗液重力基础上的加压冲洗，为患者眼部急救治疗效果提供了可靠保证。

A new conjunctiva sac irrigation device which includs a liquid inlet pipe, flush pipe, and a manual pressure device,a flow regulator and a flush filter was invented to meet needs of efficient first aid for ocular chemical injuries. It is worth noting to avoid changing fushing fliud frequently and shorten time of operation, which is beneficial to gather a lot of flushing fluid in a short time and shorten the first aid waiting time for patients with severe ocular chemical injuries. For this device, the design of manual pressure ball realizes presure flush based on the gravity of flushing fliud, which confirms a reliable effect on the acute treatment to patients' eyes.

目的：通过球结膜下注射基质金属蛋白酶(metalloproteinase,MMP)-1、3构建结膜松弛症的动物模型。方法：20只新西兰大白兔随机分为4组：对照组无干预措施；伪造模组球结膜下注射生理盐水；MMP-1组球结膜下注射MMP-1；MMP-3组球结膜下注射MMP-3。8周后观察眼前节照相和眼前节光学相干检查、泪液蕨类试验及结膜组织光镜检查结果。结果：对照组和伪造模组未见结膜皱褶形成，泪液羊齿状结晶样结构完整，光镜下未见胶原和弹力纤维破坏；MMP-1组可见结膜皱褶形成，泪液羊齿状结晶样结构破坏，光镜下见胶原和弹力纤维破坏；MMP-3组未见结膜皱褶形成，泪液羊齿状结晶样结构部分破坏，光镜下见胶原和弹力纤维部分破坏。结论：球结膜下注射MMP-1可构建结膜松弛症1~2级的动物模型。

Objective:To establish an animal model of conjunctivochalasis by subconjunctival injection of matrix metalloproteinase 1 and 3. Methods:New Zealand white rabbits were randomly divided into four groups, the control group had no intervention measures; Pseudo model group was injected susbconjunctival with normal saline; MMP-1 group was injected subconjunctival with matrix metalloproteinase 1; MMP-3 group was injected subconjunctival with matrix metalloproteinase 3. Afer 8 weeks, the results of anterior segment photography and optical coherence test, tear fern test and conjunctival tissue light microscopy were observed. Results:No conjunctival folds were observed in the control group and Pseudo model group, the lacrimal fern-shaped crystalline structures were intact, and no destruction of collagen and elastic fbers was found under the light microscope. In MMP-1 group, conjunctival folds were formed, lacrimal ferns crystalline structures were damaged, and collagen and elastic fbers were damaged under light microscope. No conjunctival folds were found in MMP-3 group, and the lacrimal ferns crystalline structure was partially destroyed, while the collagen and elastic fibers were partially destroyed under light microscope. Conclusion:Subconjunctival injection of matrix metalloproteinase-1 can construct the animal model of conjunctivochalasis of 1-2 grades.

过敏性结膜炎经典的发病机制包括了IgE介导的I型超敏反应以及T淋巴细胞介导的IV型超敏反应，其中肥大细胞、肥大细胞脱颗粒释放的组胺、嗜酸性粒细胞等在过敏性结膜炎病理发展中发挥了重要作用。然而，临床发现针对上述机制的治疗药物临床疗效欠佳，有相当数量的过敏性结膜炎患者无法获得较好的生存质量，因此研究和阐明过敏性结膜炎的新机制，寻找新的治疗手段和药物靶点具有重要的临床意义。目前研究发现Th17细胞等多种炎性细胞和IL-17等细胞因子、过敏原介导神经调节机制、菌群失调机制、脂质介质作用方面可能与过敏性结膜炎发病相关，这对过敏性结膜炎新机制的研究有着重大的临床意义。本文将对过敏性结膜炎发病机制的新进展进行综述，以期为过敏性结膜炎的治疗提供新思路。

The classic pathogeneses of allergic conjunctivitis include type I hypersensitivity and type IV hypersensitivity, in which mast cells, eosinophils and some active substances such as histamine play important role. However, sincethe therapeutic drugs have not achieved satisfactory efficacy in clinical practices, a significant number of patients fail to achieve a good quality of life. The pathogenesis of allergic conjunctivitis remains to be further studied.Current studies have identified a variety of inflammatory cells such as Th17 cell and cytokines such as IL-17, the mechanisms of neuromodulation, flora dysregulation mechanisms, and lipid mediators that may be involved in the pathogenesis of allergic conjunctivitis, which has significant clinical implications for the study of mechanisms of allergic conjunctivitis. In this article, we will review the recent research progress of the pathogenesis of allergic conjunctivitis in order to provide new ideas for the treatment of allergic conjunctivitis.