丝状角膜炎角膜丝状物构成分析

背景丝状角膜炎患者临床症状较重,易复发,病因复杂,治疗十分棘手。目前,其发病机制仍不明确,对丝状物构成方面的研究较少,结果不一。目的应用影像学检查结合组织病理学方法检测丝状角膜炎患者丝状物的组成结构,分析角膜丝状物的形成机制。方法收集山东省眼科医院2008年1月至2011年1月收治的丝状角膜炎患者82例88眼,详细记录患者的病史等临床资料,并根据病因进行分类。采用高清光学相干断层扫描（HD-OCT）检查角膜丝状物附着处的角膜结构,激光扫描共焦显微镜（LSCM）检查角膜丝状物的组成结构,然后取丝状物铺片行Giemsa染色及Masson三色染色,分析丝状物的成分。结果穿透角膜移植术后发生丝状角膜炎者40例;白内障手术、准分子激光角膜切削术（PRK）等术后发生者18例;眼部功能失调,如干眼、神经营养不良性角膜病者14例;急性结膜炎患者10例。HD—OCT显示丝状物病变可累及前弹力层。LSCM检查显示,丝状物由上皮细胞、炎性细胞、黏液、高反光螺旋状条索形核心构成,核心中含有上皮细胞、炎性细胞及纤维状组织。Giemsa染色结果显示,角膜丝状物含有角膜上皮细胞、炎性细胞和黏液,丝状物中央有螺旋状深蓝染的条状核心,核心中含有炎性细胞、上皮细胞、纤维状细胞。Masson三色染色表明,条状核心呈红色纤维组织,周围黏液为蓝色。结论角膜炎丝状物的主要成分有条状核心、炎性细胞、上皮细胞和黏液,病变较深,可达前弹力层。     

Long-term results of treatment with diquafosol ophthalmic solution for aqueous-deficient dry eye

Purpose

To evaluate the preliminary long-term efficacy of diquafosol ophthalmic solution for aqueous-deficient dry eye.

Methods

Fifteen patients with mild-to-moderate aqueous-deficient dry eye were enrolled. After a washout period, the patients were treated with 3 % diquafosol ophthalmic solution for 6 months. We assessed 12 subjective dry eye symptoms, corneal and conjunctival staining with fluorescein, tear film break-up time (BUT), lower tear meniscus height measured with anterior-segment optical coherence tomography, Schirmer’s testing, and adverse reactions at baseline and 1, 3, and 6 months after the start of treatment.

Results

Treatment with diquafosol ophthalmic solution significantly improved dry eye symptoms, corneal staining, BUT, and tear meniscus height at 1 month and maintained the effectiveness for 6 months. Conjunctival staining significantly improved 3 and 6 months after treatment. No significant adverse reactions developed.

Conclusions

Prolonged use of diquafosol ophthalmic solution for 6 months produced significant improvement both subjectively (dry eye symptom score) and objectively (ocular staining score and tear function tests) for aqueous-deficient dry eye.     

The treatment of aqueous-deficient dry eye with removable punctal plugs. A clinical and impression-cytologic study

Punctal plugs were placed in 18 dry eye patients of the aqueous-deficiency type who were on maximally tolerable medical therapy and who had Schirmer testing with topical anesthetic measuring less than 6 mm. Pretreatment and posttreatment evaluations included rose Bengal and fluorescein staining, Schirmer testing, and conjunctival impression cytology. Six weeks after plug placement, 11 of 18 patients had subjective improvement and were able to decrease dependency on tear supplements; all of these patients have successfully worn plugs for at least 8 months. Although these 11 patients improved clinically, impression cytologic abnormalities persisted 6 weeks after plug placement. Three patients did not improve clinically after punctal plug therapy, and four patients improved subjectively but extruded plugs within 2 weeks of placement. Three of the patients who extruded plugs had marked lid laxity and dilated puncta before placement. Reversible punctal occlusion by plugs may significantly decrease dependency on tear supplements in selected patients.     

A review of filamentary keratitis

Filamentary keratitis (FK) is characterized by the presence of filaments on the corneal surface that are often associated with symptoms of foreign body sensation, irritation, and eye pain. FK is associated with a variety of ocular and systemic conditions, most notably dry eye disease. These filaments are composed primarily of epithelium, mucus, and cellular debris; however, their pathogenesis remains an area of debate. Aggravating factors for FK include desiccation, inflammatory mediators, as well as eyelid mechanical forces. Management consists of addressing associated conditions, especially dry eye disease, and providing medical and procedural treatments to alleviate symptoms and restore the ocular surface. Mainstay treatments include filament removal, increased lubrication with artificial tears and punctal occlusion, hypertonic saline, antiinflammatory and mucolytic medications, and autologous serum eye drops, as well as bandage contact lenses. A stepwise approach is required to manage patients with acute or chronic FK. Prolonged therapy is often necessary to prevent recurrence of this bothersome condition.     

丝状角膜炎的临床治疗观察

目的观察丝状角膜炎的临床处理方法。方法123例丝状角膜炎患者,根据病因（干眼症、术后继发、角结膜炎、暴露性角膜炎、Sjogren综合征等）,采用不同的治疗方案（人工泪、高渗盐、甾体或非甾体滴眼液、环孢霉素、自体血清、泪小点栓子、角膜接触镜等）。结果所有的病例在用药一周后,症状明显改善,一月内丝状物完全消失。结论丝状角膜炎较易复发,且疗程较长。但是只要选择合适的治疗方案,经过系统的治疗,均可以得到较好的控制。     

丝状角膜炎的个体化治疗

目的应用激光共聚焦显微镜（LSCM）联合高清光学相干断层扫描（HD-OCT）检测丝状角膜炎丝状物的组成结构,指导丝状角膜炎的个体化治疗。方法前瞻性病例研究。2009年1月至2011年1月山东省眼科医院确诊的丝状角膜炎患者70例（76眼）。根据病因进行分类,详细记录患者治疗过程。治疗前应用LSCM检测角膜丝状物组成,进行炎症细胞计数,HD-OCT检查丝状物累及角膜的深度。针对病因治疗前提下,根据LSCM检查结果,个体化应用抗炎药物、抑制增殖药物、黏液溶解剂;根据HD-OCT确定去除角膜病灶的深度。结果通过LSCM观察到角膜丝状物由不同直径高反光的核心、上皮细胞、炎症细胞组成。炎症细胞的密度在不同的患者之间存在个体差异,平均炎症细胞计数<5/视野12眼,10/视野＞炎症细胞计数≥5/视野26眼;炎症细胞计数≥10/视野38眼。HD-OCT可以观察到角膜丝状物病变深者达到前弹力层。个体化治疗后,患者的治愈率达到了100%,随诊1年未见复发,治愈后HD-OCT检查发现病变处未遗留瘢痕。结论LSCM结合HD-OCT检测角膜丝状物结构,可以个体化地指导丝状角膜炎的治疗,并取得了良好的治疗效果。     

Smart Plug泪小管塞治疗水液缺乏型干眼症临床初步观察

目的：探讨Smart Plug泪小管塞治疗水液缺乏型干眼症临床疗效。
　　方法：选取2012-05/2013-04期间我院收治的48例水液缺乏型干眼症患者为研究对象,进行Smart Plug泪小管塞治疗,观察术后临床疗效、基础泪液分泌试验( Schirmer Ⅰtest,SⅠt)、泪膜破裂时间( tear break up time,BUT)、角膜荧光素染色( fluoreseein staining,FL)变化。
　　结果：本组48例患者,显效31例(65%),有效14例(29%),无效3例(6%),总有效率为94%。治疗前,患者SⅠt,BUT,FL分别为3.49±1.24mm/5min,3.15±1.07s,2.52±0.11分。治疗后,患者SⅠt,BUT,FL均明显改善,与治疗前比较,差异具有统计学意义( P<0.05)。1例患者术后有异物感,8 h后栓子脱落;1例患者于术后8 mo出现肉芽组织,泪小管塞脱落。其余病例无下泪小管感染或肉芽肿。
　　结论：Smart Plug泪小管塞治疗水液缺乏型干眼症疗效确切,能够有效缓解临床症状,值得临床推广。     

A case report and review of filamentary keratitis.

BACKGROUND: Filamentary keratitis is most often a chronic corneal condition, characterized by filaments attached at one or both ends to the cornea. Patients often experience foreign body sensation, grittiness, discomfort, photophobia, blepharospasm, and increased blinking. Filamentary keratitis is commonly the result of aqueous deficient dry eye syndrome. Management options include lubrication, punctal occlusion, removal of filaments, hypertonic saline, mucolytic agents, anti-inflammatory agents, and therapeutic contact lenses. CASE REPORT: A 58-year-old man came to us with acute symptoms of pain, photophobia, and redness x 2 days 0.S. The diagnosis of filamentary keratitis was made based on the clinical findings of positively staining mucus strands attached to the superior cornea. The patient was also found to have dry eye, blepharitis, and floppy eyelid syndrome. Numerous treatment regimens were implemented, including lubrication with non-preserved artificial tears, lubricating ointment, and topical steroids. The patient's condition was finally best managed with silicone plug punctal occlusion and therapeutic contact lenses. CONCLUSION: Filamentary keratitis can be a recurrent and incapacitating condition that may prove difficult to manage.     

Study of filamentary keratitis by replica technique

Summary Histopathological study of filamentary keratitis was done by using the replica technique in five patients. The filaments are produced by sliding of the epithelial cells around small areas of focal degeneration of the superficial epithelium. In comparison to the filaments in other conditions, the filaments in KCS are smaller and thicker and do not show the torsional segment. The filaments contain degenerated epithelial cells and alcian blue-PAS positive mucoid material. Making a corneal replica may result in healing of filamentary keratitis.     

Endocrine disrupting chemicals associated with dry eye syndrome

BackgroundDry eye syndrome (DES) is a multifactorial disease that causes changes in the tear film and occurs more frequently in women. Sex hormones (SHs) influence tear production, and SHs imbalance is associated with DES. Endocrine-disrupting chemicals (EDCs) are compounds that can bind to SHs receptors, changing the SHs action in several organs and tissues.MethodsThe levels of 21 EDCs were measured in the urine of DES patients and healthy controls. All individuals were submitted to eye exams for DES and responded to the questionnaire “Ocular Surface Disease Index (OSDI)”. DES was considered present when the OSDI score was >20 and one of the DES tests surpassed the established thresholds.ResultsMethyl-protocatechuic acid (OHMeP), had higher urine levels in DES individuals than in control individuals (p = 0.0189). On the other hand, triclocarban (TCC) exhibited lower urine levels in DES individuals than in control individuals (p = 0.0081). Statistically significant positive associations were found between Methyl Paraben (MeP), EtP (ethyl paraben) and OHMeP with fluorescein staining test; between TCC and Tear breakup time test and between OHMeP and OSDI score. Significant negative associations were found between EtP and OHMeP and schirmer test; between OHMeP and Tear breakup time test; between TCC and the OSDI score and fluorescein and lissamine staining test.The quadratic discriminant function classified 94.4% of individuals in their groups based on the urine levels of EDCs.ConclusionThe following EDCs, MeP, EtP, and OHMeP, were associated with signs and symptoms of DES. TCC had a paradoxical protective effect against DES. These findings suggest that EDCs are associated with DES and the exposure should be included in the investigation of causes and risk factors for DES.     

水液缺乏型干眼和混合型干眼患者睑板腺形态及功能差异

目的 探讨水液缺乏型干眼和混合型干眼患者睑板腺形态及功能差异.方法 选取四川大学华西医院2018年9月至12月眼科门诊收治的干眼患者67例(67眼),其中水液缺乏型干眼患者32例32眼(水液缺乏型组),混合型干眼患者35例35眼(混合型组).分别统计两组患者眼表疾病指数问卷调查表得分,采用LipiViewⅡ眼表面干涉仪...     

干眼的治疗现状

干眼是一种临床常见的慢性眼表疾病,发病率逐年增加。我们综述了应用人工泪液、皮质类固醇、环孢霉素A、泪小管填塞术、颌下腺移植术和中医药等方面治疗干眼的现状。     

Optical aberrations and visual disturbances associated with dry eye

Optical aberrations and visual disturbances are associated with dry eye, although visual impairment is often not detected by conventional visual acuity testing. The newly developed functional visual acuity (FVA) device allows continuous dynamic evaluation of distance visual acuity and assessment of the effect of natural tear film status on dynamic visual function. Similarly, to detect corneal surface irregularities during sustained eye opening in dry eye subjects, a new tear stability analysis system (TSAS) has been developed. Both FVA and TSAS measurement systems seem to be effective tools in the assessment of dynamic visual acuity changes in dry eye and normal subjects. Both methods were also found to be helpful in the evaluation of the outcome of management of dry eye disease. FVA testing has been suggested to be an important indication of an individual's performance in relation to certain daily activities, such as driving, reading and working at a video display terminal. This review provides illustrations of results obtained from FVA and TSAS systems.     

Different conjunctival adaptive response in patients with aqueous-deficient and with mucous-deficient dry eyes

PURPOSE: To describe the different cellular adaptive patterns found in the conjunctival epithelium from patients with aqueous-deficient and mucous-deficient dry eyes. METHODS: The authors studied different conjunctival areas, by impression cytology and by biopsy, 50 eyes with facial nerve paralysis (FNP), 50 eyes with ocular cicatricial pemphigoid (OCP), and 50 eyes from patients with primarily Sj?gren syndrome (1SS). RESULTS: Eyes with FNP from the first clinical grade showed a progressive alteration of the nonsecretory cells, with a significant decrease in density goblet cells, generally with a PAS-positive staining. Eyes with OCP, during clinical grades 1 and 2, showed a slow deterioration of the nonsecretory cells; but from clinical grade 3, there was a significant increase of the cellular size and the thickness of the conjunctiva. Goblet cells showed a significant decrease in density from clinical grade 1, generally with a PAS-negative staining. Eyes with 1SS during clinical grades 1 and 2 showed a progressive alteration of the nonsecretory cells, with a significant decrease in density goblet cells, and a PAS-positive staining. From clinical grade 3 appeared a significant increase of nonsecretory cellular size and thickness of conjunctiva, with a significant decrease in goblet cell counts, and a PAS-negative staining. CONCLUSIONS: Patients with FNP (a primarily aqueous-deficient alteration) follow completely the squamous metaplasia process. Patients with OCP (a primarily mucous-deficient syndrome) have a hypertrophy and hyperplasia process along the ocular surface. Patients with 1SS (a primarily aqueous-deficient and mucin-deficient alteration) have a squamous metaplasia process, but from clinical grade 3 also appears a hypertrophy and hyperplasia process.     

Acanthamoeba keratitis associated with fungal keratitis

PURPOSE: To report fungal infection complicating Acanthamoeba keratitis. METHODS: Case report. A 45-year-old woman with contact lens-related bilateral Acanthamoeba keratitis developed corneal ulcer, corneal perforation, and mature cataract in the left eye, which was managed by penetrating keratoplasty, lensectomy, and vitrectomy. RESULTS: Histopathologic examination of the keratoplasty specimen from the left eye revealed extensive lamellar stromal necrosis with the coexistence of both empty cysts and branching hyphae. Cultures from the keratoplasty specimen grew Scedosporium apiospermum. CONCLUSION: Keratomycosis caused by S. apiospermum may complicate protracted Acanthamoeba keratitis.