(精品) 眼表疾病课件

A. 对照组 B. 实验组
2W
4W
Stem cells of corneal limbus cultivation and transplantation
a
b
眼类天疱疮 术前（a、b）
眼表重建 术后（c、d）
c
d
Shimazaki J et al：Ophthalmology 109：1285，2002
Dry eye syndrome
Etiological classification： —Aqueous tear deficiency（ATD） —Mucin tear deficiency —Lipid tear deficiency —Tear dynamics disorder —Mixed type
Stem cells of corneal limbus cultivation and transplantation
a
b
c
口腔黏膜上皮
羊膜
d
a 正常人角膜 b 正常人口腔黏膜 c 培养的角膜上皮 d 培养的口腔黏膜上皮（与前者具有相似的复层上皮结构）
Rama P et al：Transplantation 72：1478，2001
NI-BUT
Tear function examination
Corneal fluorescein staining: observe corneal epithelium defect
Tear function examination
Tear function examination Rose bengal
Tear film function
Improve optical properties of cornea Clean and dilute foreign bodies and toxin Moisten and lubricate ocular surface to
protect epithelium Intermediary agent where corneal
Location: the basement of corneal limbus Epithelium repair when limbus defected
Corneal epithelial cells concentric movement Conjunctiva to corneal-like epithelium “Conjunctivalization" of the cornea with vascularization
Neurotrophy disorder
SchirmerII and ＢＵＴ decrease, osmotic pressure of tear increase, and all will recover in 6~9 months.
Physiological functions degeneration with years
CONJUNCTIVA LIMBUS
CORNEA
STEM CELL S
TRANSIEN T AMPLIFYIN
GCELLS
POSTMITOT IC
CELLS
TERMINALLY DIFFERENTIATE DCELLS
Limbal stem cells
Source of corneal epithelium
----1995 NEI Report on Dry Eye
Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface.
epithelium breathe Defense specificity and non-specificity
inflammatory
The structure of the tear-film
Lipid layer produced by meibomian glands
Aqueous layer
Tear function examination
Lise-green dye
Tear meniscus
Patel
Tears of the River Bend area of the
radius of curvature
☆正常（R1）＞干眼症（R2）
正常为＞0.5～1.0mm ☆ 0.35 mm是诊断为干眼
眼表疾病
ocular surface diseases
Definition
Anatomy：mucous membrane lining the eyelids Histology：cornea, conjunctiva and tear film
Ocular surface
Epithelium
Corneal epithelium: the stem cells reside at the corneoscleral limbus
Conjunctival epithelium: the conjunctival fornix or the junction between the posterior eyelid and the eyeball
Working face the screen
Visual function burden increased
The eyes is hard to defense due to lifestyles change
About 50% female who is 35-50 years old in U.S.A. suffering from the dry eye symptoms
SC
TAC
Reproductive activity infinite finite
Fissionability
low
high
Differentiation potency +
+
differentiated cells
PMC TDC
－－
—
－
++
+++
Characteristics of limbal stem cells
Marine life
Amphibia
Terrestrial animal
Human being
Human “civilization” break the balance of the evolution
Shanxi
Lanzhou
Beijing
Zhejiang
The eye “working environment” and visual function burden
---- 2007 Report of the Dry Eye WorkShop
病理学机制----假说
The earth is suffering from “dry eye”
virgin forest
desert and gobi
The influence of organic evolution and human modern civilization
Stem cells of corneal limbus cultivation and transplantation
眼类天疱疮术前（视力：0.01）
术后14个月（视力：0.6）
Hayashida Y et al：Invest Ophthalmol Vis Sci 46：1632，2005
Keratoconjunctivitis sicca (KCS)
Triple-symptom complex： Conjunciva epithelial cells concentric movement, corneal vascularization, healing delay
Amnion application in ocular surface reconstrucion
Dry eye syndrome
Environmenty termminal (VDT) Building disease syndrome (SBS) Office of the eye syndrome (OES)
work result in winking decreased environment cause over evaporation
Limbal Stem Cell Deficiency
Pathogenesis: lumbus epithelium defected
Pathology: corneal epithelium occupied and replaced by conjunctival epithelium
Manifest: conjunctivalization, vascularization, chronic inflammation, persistent uncle, basilar membrane failure, fibrocyte invasion
羊膜的作用机制
促进上皮化
抑制炎症反应
抗纤维化