Objective:To observe the influence of residual perfluorocarbon liquid in the anterior chamber after vitrectomy.Methods:This was a retrospective study. Total of 26 eyes of 26 cases with residual perfluorocarbon liquid in the anterior chamber after vitrectomy from Sep. 2008 to Dec. 2018 in Shenzhen Eye Hospital were examined with laser corneal confocal microscope. The morphological characteristics of cornea were analyzed.Results:The corneal endothelial cells were squeezed by residual perfluorocarbon liquid and showed "gold foil" changes under laser confocal microscope. The infiltration of residual perfluorocarbon liquid into the corneal endothelial cells boundary outlined the hexagonal structure of corneal endothelial cells clearly and straightly. In severe cases, perfluorocarbon liquid even entered the corneal stroma through the gap of corneal endothelial cells. The corneal endothelial cells far from the residual perfluorocarbon liquid were covered with large number of pigment particles.Conclusion:The direct and indirect damage of corneal endothelial cells induced residual perfluorocarbon liquid vesicles can be clearly observed with laser corneal confocal microscope.

Objective To explore the clinical therapeutic effect of modified corneal endothelium transplantation for bullous keratopathy.Methods Twenty patients with bullous keratopathy were collected in Shenzhen eye hospital during 2009-2012,randomly divided into two groups.There were 10 patients in each group.All the surgeries were performed by the same surgeon.Ten patients in experimental group were carried out the modified endothelium transplantation without endothelium delaceration.The other 10 patients in control group were underwent traditional penetrating keratoplasty (PKP).The visual acuity,intraocular pressure,slit lamp,corneal endothelial mirror,eye anterior segment OCT,corneal topography and corneal confocal microscopy were observed to all the patients at 1 month,3 months,6 months,1 year,and 2 years after operations.And the best corrected visual acuity,intraocular pressure,corneal thickness and endothelial cell number were recorded.The corneal transparency,complications,grafts adhesion,endothelial function and postoperative rejection were monitored.Results The best corrected visual acuity and corneal endothelial numbers of cases in experimental group were more than control group.Significant difference was observed between two groups (t =2.9103,P ＜0.05).There were seldom postoperative rejection in experimental group during postoperative follow-up.Conclusions The modified endothelium transplantation without endothelium delaceration could be an altered treatment for bullous keratopathy.

Objective To investigate the characteristics of corneal donors to Shenzhen Eye Bank during a 14-year period (2000-2014),to discuss some strategies about improving corneal donation rate at the present stage in china.Methods Retrospective analysis of Shenzhen Eye Bank records from February 2000 to February 2014.Results Among corneal donors,male (58％) was slightly more than female (42％) and the age span from 11 months to 95 years.The highest proportion being in 41-50 years age category and the most common cause of death was malignant tumor (54％).The donation corneas of Shenzhen local and other provinces has increased step by step then tends to stable situation.The main donation approach is based on the coordinators.Mean "death to enucleation time" and "preservation time" was 4.6 and 42.2 hours respectively.Using Optisol GS(R) media can significantly extend the preservation time.Conclusions In a 14 years-period,there is an increasing trend of donated corneas provided by Shenzhen Eye Bank.That is depended on the establishment of the organ donation coordinator and cooperating with the Shenzhen Red Cross,charities,and foreign exchanges.Therefore,Shenzhen corneal donation model follows:the legislation first,media coordination,multilateral cooperation,more channels opened and national mobilization.This also is the effective path to improve cornea donation rate and get more donor corneas in present stage of China.

Objective To observe the Langerhans' cells in the formation of superficial corneal macula by confocal microscopy.Analyze the role of LC in the superficial corneal macula formation.Methods To consecutively observe the 342 patients(342 eyes)with superficial corneal ulcers or keratitis,mild corneal trauma or chemical burn by confocal microscopy.The confocal microscope images of LC in the forming of the superficial corneal macula were summarized and analyzed.The role of the LC in the recovery time was studied.Results (1)In 342 cases(342 eyes),there were 317 cases(317 eyes)found Langerhans' cells migration from the limbal capillaries or neovascularization by confocal microscopy,accounted for 92.69％.(2)There were 287 cases(287 eyes)found Langerhans' cells migration in the corneal epithelium and Bowman's layer in the repair process,accounted for 83.92％.3.There were 231 cases(231 eyes)found Langerhans' cells continue to shift to the lesions in the peripheral corneal epithelial repair,and Langerhans' cells deformation,extending more synapses,began to participate in the repair process of superficial corneal macula,accounted for 67.54％.4.There were 322 cases(322 eyes)found Langerhans' cells migration accumulation to participate the repair process of superficial corneal macula,accounted for 94.15％.Conclusion Langerhans' cells have an important role in the superficial corneal macula formation.According to our study,the processes will be divided into three stages by confocal microscopy.The first stage leakage transitional period:Capillary or new blood vessels to dilate,Langerhans' cells migration from blood vessels.The second stage of repair corneal epithelium and Bowman's layer of the transitional period:Aggregation transitional Langerhans' cellss to the lesion,participate in the corneal epithelium and Bowman's layer repair repair process.The third stage of formation of shallow layer corneal macula:Langerhans' cells aggregation in the ulcer lesions,involved in the formation of shallow macula.

Objective To evaluate the biocompatibility and efficacy of chitosan keratoprosthesis implanted into the alkali-burned cornea of mini-pig.Methods Firstly 10 animal models of alkali-burned corneas of mini-pig were set up and left eyes were experimental eyes.Chitosan keratoprosthesis was implanted into these model corneas by two stages.At stage Ⅰ,the implant was implanted into intralamellar pocket.After 3 months,surgery of stage Ⅱ was performed to expose the optic area by removing the central lamella.The follow-up time was 6 months.The recepient corneas were clinically observed and evaluated.Results Ten keratoprosthesis remained in situ after stage Ⅰ procedure.Corneal perforation caused by infection occurred in 1 eye 2 months after stage Ⅰ.The posterior proliferative membrane was found in 4 eyes and the anterior proliferative membrane was seen in 3 operative eyes several weeks after stage Ⅱ.Other implants retained transparent.Fibroblasts migration into the skirt of the implants were found.The normal anatomical structure in implanted eyes was noted by anterior segment OCT.The specimens of anterior and posterior membrane were correlation with factor VEGF by immunohistochemical analysis.Conclusion Chitosan keratoprosthesis has good tissue biocompatibility,and its skirt is helpful for fibroblasts migration.The device has good therapeutic effects and potential application prospects.

Objective To evaluate the clinical efficacy of homologous sclera patch grafting combined with autogenous conjunctival flap covering for sterile scleral melting after ophthalmologic operation.Methods Ten eyes of 10 patients with sterile scleral melting after ophthalmologic operation who underwent homologous sclera patch grafting combined with autogenous conjunctival flap covering were retrospectively reviewed.The necrotic scleral tissue was smeared and cultured,and the serological examination was carried out.The 10 eyes were treated with FK506,rhEGF and artificial tears after the operation.Results Before the operations,no bacteria or fungi were found and there was no evidence of inflammation in the 10 cases.The rheumatoid factor was abnormally high expression in one case.8 patients presented dry eye.About at d 45,8 cases of the necrotic sclera has healed after operation.2 cases of the sclera graft began to melt at d 40 and d 48 after operation because of poor vascularization.Conclusion The immunoreaction caused by systemic immunity and operation may be the main causes of sterile scleral melting after the ophthalmologic operation.The homologous sclera patch grafting combined with autogenous conjunctival flap covering is helpful to treat the scleral melting which can preserve the eyeball integrity.

Objective To study the causes and treatment of dry eye syndrome caused by Meibomian gland dysfunction (MGD).Methods The clinical data of dry eye syndrome caused by (MGD)from 2011 to 2012 in Shenzhen Eye Hospital were retrospectively analyzed.The patients were comprehensively treated by eyelid rims cleaning,Meibomian gland massages,hot packing eyelid and topical drugs and lacrimal point plug.Results Of 60 patients,there were 38 patients cured,16 cases improved,and only 3 cases no response.The total effective rate was 95％.Conclusions Meibomian gland dysfunction is one of the main causes of dry eye.Therefore,the comprehensive treatment should be applied from the causes,So promoting Meibomian gland secretion,making Meibomian gland duct unblocked will be beneficial to the stabilization of tear film and remission of dry eye syndrome.

Objective To observe the interface fluid at an early stage after lamellar keratoplasty with the anterior segment optical coherence tomography (AS-OCT),and to observe the therapeutic effect of releasing interface fluid.Methods Eleven patients with onset of interface fluid were examined with AS-OCT after lamellar keratoplasty,to found the existence and determine the site and scope.The interface fluid was released and the effect was evaluated.Results The AS-OCT could observe interface fluid at an early stage after lamellar keratoplasty.Conclusions The patients with early graft edema after lamellar keratoplasty can be observed by the AS-OCT that contribute to the early discovery of postoperative interlaminar effusion.

Objective To evaluate the effect of subconjunctival bevacizumab on experimental corneal neovascularization (NV) in rabbits at different time points.Methods The right eyes of 54 white New Zealand rabbits were chemically burned with 1mol/L NaOH and randomly divided into three groups.Eighteen eyes (group A) received subconjunctival injection of bevacizumab (2.5 mg,0.1 mL) immediately after burn.Eighteen eyes (group B) received subconjunctival injection of bevacizumab (2.5 mg,0.1 mL) 3 days after burn with subconjunctival injection of normal saline.Group C was the control group.The angiogenesis and inhibition of corneal neovascularization were detected respectively by measuring the length and area of NV under slit lamp microscopy everyday.Corneal confocal microscope was used to detect the cornea at 7 days,14 days and 28 days after corneal burn.Results The occurrence time of corneal NV was (5.9± 0.8) d,(3.5 ± 0.6) d and (3.4 ± 1.1) d in group A,B and C.Compared with the group C,the corneal NV occurrence was significantly delayed in group A and B.No significant difference in the occurrence time of corneal NV was found between group B and group C (P =0.068).The corneal NV areas of group A and group B were smaller than the group C at different time points,and the difference has statistical significance (P ＜ 0.05).The degrees of fibrous structures and scars in corneal stroma of treatment groups were slightly less than the group C.Conclusion Subconjunctival injection of bevacizumab can sufficiently decrease the number of inflammatory cells in the cornea after chemical burn,improve the microenvironment of injured corneal stroma and accelerate the cornea wound healing,which eventually inhibit the growth of corneal NV.The anti-neovascular effect of bevacizumab is better if the injection is performed at the early stage of corneal angiogenesis.

Objective To evaluate the clinical efficacy of rotational autokeratoplasty combined with double-lamellar autokeratoplasty in the treatment of cornea perforation.Methods Eight patients (8 eyes) with cornea perforation who underwent rotational autokeratoplasty combined with double-lamellar autokeratoplasty from June 2010 to December 2012 were retrospectively reviewed.8 cases (8 eyes) with cornea perforation included 5 cases of fungal corneal ulcers with perforation,1 case of pseudomonas ulcer with perforation,1 case of advanced Mooren' s ulcer with perforation,and 1 case of acute perforation of keratoconus.All cases underwent rotational autokeratoplasty combined double-lamellar autokeratoplasty.Results After operation,all patients not only preserved their eyeballs,but also retained the best-corrected visual acuity at 1 month after surgery:hand move in 3 eyes,0.04 in 2 eyes,0.05 in 1 eye,0.08 in 1 eye,0.1 in 1 eye.In two weeks after operation,the grafts epithelium was integrity in 8 eyes.No other postoperative complications developed in all patients.Conclusion Rotational autokeratoplasty combined with double-lamellar autokeratoplasty is an effective method to save eyeballs under the situation of deficiency of cornea donor in the treatment of cornea perforation.

Objective To study the occult perforation in Terrien Marginal Degeneration by anterior segment optical coherence tomography (AS-OCT),and provide the basis for clinical diagnosis and treatment.Methods Defined the inner lesions of Terrien Marginal Degeneration as the occult perforation by AS-OCT,and measured the perforated inner diameter.Results The occult perforation rate of Terrien Marginal Degeneration were 22.2％ (4/18),the minimum inner diameter of occult perforation was 1.5mm,the maximum inner diameter of that was 4.3mm,average of that was 3.1 ± 1.3mm.Conclusions It is helping to identify occult perforation of Terrien Marginal Degeneration by AS-OCT,and has an important role for the assessment of the patient's prognosis and surgery program design.

Objective To study the occult perforation in corneal ulcer with piston by anterior segment OCT,and provide the basis for clinical diagnosis and treatment.Methods Eleven cases (12 eyes) diagnosed as the occult perforation in corneal ulcer with piston valve in Shenzhen Eye Hospital of Jinan University from June 2005 to June 2013,were observed by Anterior segment OCT.Piston valve size was measured.When the piston valve was open and there was aqueous leakage from the inside hole of corneal ulcer,it was defined as fluorescein streams test positive.When the piston valve was closed and the inside hole of corneal ulcer was closed,it was negative as fluorescein streams test positive.Results Anterior segment OCT panoramic corneal ulcer perforation occurred occult piston valve,The minimum of 0.69mm,the maximum of 1.52mm,average of that was 1.05 ± 0.27mm.Conclusions It is helpful to identify occult perforation in corneal ulcer with piston by anterior segment OCT,and have an important role for the assessment of the patient's prognosis and surgery program design.

Objective To observe the occult Descemet membrane detachment with the anterior segment optical coherence tomography (OCT) after cataract operation,to provide the basis for clinical diagnosis and treatment.Methods Twenty-two patients were examined with Anterior segment OCT after cataract operation,whose eyes were with refractory corneal edema to find where the existence of Descemet membrane detachment and determine the site and scope in Shenzhen Eye hospital during December 2011 to September 2012.Results Eight cases were found with different degrees of Descemet membrane detachment,which occurred near the incisions in 7 cases.Conclusions The examination of Anterior segment OCT to the patients whose eyes are with refractory corneal edema after cataract operation is helpful to find different levels of occult Descemet membrane detachment.

Objective To evaluate the biocompatibility of β-TCP/PVA keratoprosthesis and its therapeutic effects on the alkali-burned cornea in rabbit.Methods Firstly the models of alkali-burned cornea were induced by putting the filter paper dipped in 1 mol/L NaOH solution on whole cornea of left eyes in 10 New Zealand white rabbits.β-TCP/PVA keratoprosthesis was implanted into these model cornea by two stages.At stage Ⅰ,a superior half-thickness dissection was made from sclera,1.5 mm posterior to the limbus,extended into the cornea and formed an intralamellar pocket,the superior flap was retracted inferiorly and then a 3 mm central opening was created.The device was implanted into the pocket,centering the optic over the posterior opening.After 3 months,stage Ⅱ surgery was performed to expose the optic by removing the central lamella.The recepient cornea and anterior segment findings were clinically observed and evaluated.The dissected corneal tissues were examined pathologically.Results All the keratoprosthesis remained in situ after stage Ⅰ procedure.Comeal perforation caused by inflammatory occurred in No.4 rabbit 4 weeks after stage Ⅰ.The diffuse white posterior membrane was found in No.2 eye and the anterior membrane was seen in No.7 operative eye several weeks after stage Ⅱ surgery.No.9 rabbit died from a diarrhea.Others,implants had been retained,with no severe complications,such as extrusion,stromal malting or aqueous leakage.The intraocular pressure of all eyes was just in normal range.Fibroblasts migration into the skirt of the implants was found.The normal anatomical structure in implanted eyes was noted by anterior segment OCT.Conclusion β-TCP/PVA keratoprosthesis has good tissue biocompatibility,its skirt is helpful to fibroblasts migration.It is predicted that the device will has potential application prospects on the solution for corneal blindness in the future.

Objective To evaluate the clinical value of the corneal laser confocal microscope for judge the position,size and material quality of the foreign body with serious comea edema,small,deep,and difficult to inspect the situation of the foreign body.Methods Seventeen cases were treated in the Shenzhen eye hospital during October 2011 to December 2012,patients whose cornea were injured by foreign body that were difficult to find by slit lamp with the closed wounds,serious edema,small and deep positions,while B ultrasonic,X-ray and CT examination pointed out the existence of the foreign body,17 eyes were examined by corneal laser confocal microscopy,then the characteristics of the image were analyzed,and the performance of the deep corneal foreign body in vivo corneal confocal microscope were summarized.Results The results suggested that the varying degrees of high echo image of the foreign body in deep stroma and endothelium,the contour was clear,internal echo was uniform and the shape was club-shaped or nubby,associated with peripheral corneal stroma cells and endothelial cells were edema obviously.Conclusions Laser corneal confocal microscopy can assist in determining the existence,position,size and rough texture of corneal foreign bodies in vivo and in three-dimensional space,provide the image evidence of value in the diagnosis and operation.

Objective To research the effect of human fibrin glue on the conjunctival flap graft of pterygium excision.Methods The patients with pterygium were operated with pterygium excision and conjunctival flap transplantation.Group A were transplanted with conjunctival flap adhesive application of human fibrin glue,group B were sutured conjunctival flap directly.After 7 days of taking out stitches,the conjunctival flap graft were observed and measured by anterior segment OCT (AS-OCT).The data were tested statistically.Results The average thickness of conjunctival flap of group A were 437.80±38.70□ m,conjunctival hemorrhage rate was 5％; that of group B were 631.95± 44.97um and 55％ (P ＜0.05),with statistical significance.Conclusions The conjunctival flaps of autologous transplantation are fixed by using human fibrin glue instead of sutures in pterygium surgery partially.It can shorten operation time,reduce edema and bleeding under conjunctival flap postoperatively.AS-OCT can directly measure the thickness of conjunctival flap after operation; thereby indirectly know the degree of the conjunctival edema.

Objective To study the significance of the distances from ICL to lens and iris tension in complicated cataract of ICL.Methods Based on the position changes of ICL in the posterior chamber with complicated cataract patients and with no complicated cataract patients with anterior segment and full-field optical coherence tomography,the data of the two group were analysed with the Independent-samples T Test.Results Under mydriasis,the average minimum distance between ICL peripheral part and the front surface of lens (D3 value) in study group was (77.75 ± 8.70)μm,ranged from 69.05 to 86.45μm,and (145.68 ±28.88)μm,ranged from 116.8 to 174.56μm in control group.The Independent-samples T Test showed the highly significant difference statistically between them (P =0.03＜0.05); The iris tension differential (D2-D1value) was respectively (321 ±21.31) μm(range 299.69 to 342.315μm) and (286.32±60.46)μm (range 225.86 to 346.78μm) in study group and control group.A statistical comparison between the two groups is significant with regard to iris tension (P =0.03＜0.05).Conclusions The minimum distance between the peripheral part of ICL and the front surface of lens (D3 value) and the iris tension (D2-D1 value) is of great significance in the etiology of complicated cataract after ICL implant.D3 value of more than 116.8μm is relatively safe and not easy to cause lens opacity.But D3 value less than 86.45μm and D2-D1 value more than 299.69μm would increase the chance of contact between the ICL and the lens and then the occurrence of post-operative cataract.

Objective To observe the fungal corneal ulcer by comeal confocal microscopy and identify the fungal hyphae and other organizational structure under confocal microscope.Methods One hundred and twenty-two cases (122 eyes) of fungal corneal ulcer in patients were examined by laser confocal microscopy.The characters of fungal hyphae images on the confocal microscopy were summarizes,and identified with the similar structure.Results The fungal hyphae were identified with the six intracorneal structures (nerve fibers,the mesh structure of Bowman's layer disintegrating,neovascular,corneal suture,dendritic cells,drug crystal structure) by the confocal microscopy and were identified.There were characteristics of six intracorneal structures respectively.Conclusions It is not difficult to identifying the fungal hyphae with the six intracorneal structures in the familiar with corneal layers of normal structure and observation on the relationship between fungal hyphae and surrounding tissue structure by confocal microscopy and dynamic.

ObJective To study the characteristics of soft contact lens wearing by laser confocal microscopy in vivo.Methods The central and peripheral parts of soft contact lens wearing were examined by laser confocal microscopy respectively.The image features of two parts were studied.Results The central parts of soft contact lens were corrugated reflective structure in laser confocal microscopy.Each wave was composed of a high reflective structure and low reflective structures,arranged in curved and gradually expand,and no cell structure.The central parts of soft contact lens were the center of a circle,around a circle and gradually expand in concentric circles arranged like.The white wave was composed of dark reflective structure,which was the soft contact lens material.The peripheral part of that were unpaired concentric circles arranged like and the arrangement could be relatively disordered.The rate of impurities attaching to the soft contact lens wearing was 70.6％.The rate of scratches on the soft contact lens wearing was 47.1％.Conclusions Confocal microscopy with high expansion check for soft contact lens wearing,the study of soft contact lens into the era of in vivo and micron level,as well as that to provide an objective basis to guide the rational contact lens wear.Wear contact lens should pay attention to aseptic technique,even if the naked eye contact lens free of impurities,it can not be taken lightly.Small scratches on the soft contact lens on the corneal potential damage prompted us to wear contact lenses should be promptly replaced to avoid damage to the cornea.

Objective To study the occult perforation in Mooren's ulcer by anterior segment OCT,and provide the basis for clinical diagnosis and treatment.Methods Defined the inner lesions of Mooren's ulcer as the occult perforation by anterior segment OCT,and measured the perforated inner diameter.Results The occult perforation rate of Mooren's ulcer were 8.3％,the minimum inner diameter of occult perforation was 1.8mm,the maximum inner diameter of that was 4.5mm,average of that was 3.1 ± 0.97mm.Conclusions It's helping to identify occult perforation of Mooren' s ulcer by anterior segment OCT,and has an important role for the assessment of the patient's prognosis and surgery program design.