眼表疾病课件
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眼表疾病
ocular surface diseases
Definition
Anatomy：mucous membrane lining the eyelids Histology：cornea, conjunctiva and tear film
Ocular surface
Epithelium
epithelium breathe Defense specificity and non-specificity
inflammatory
The structure of the tear-film
Lipid layer produced by meibomian glands
Aqueous layer
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
Increased potential for proliferation, high capacity of self-renewal with a long cell cycle time and asymmetric cell division
Classification
proliferated cells
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
Triple-symptom complex： Conjunciva epithelial cells concentric movement, corneal vascularization, healing delay
Amnion application in ocular surface reconstrucion
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)
by accessory lacrimal glands
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
羊膜的作用机制
促进上皮化
抑制炎症反应
抗纤维化
羊膜
抗新生血管形成
缓解疼痛
角膜缘干细胞体 外培养的龛环境
Stem cells of corneal limbus cultivation and transplantation
○
冷冻干燥保存羊膜
将角膜缘处的上皮或口腔黏膜上皮放到冷冻干燥保存的羊膜上 进行培养、扩增，并移植到眼表衰竭（角膜缘缺陷）的患眼上
A. 对照组 B. 实验组
Leabharlann Baidu
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
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
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
CONJUNCTIVA LIMBUS
CORNEA
STEM CELL S
TRANSIEN T AMPLIFYIN
GCELLS
POSTMITOT IC
CELLS
TERMINALLY DIFFERENTIATE DCELLS
Limbal stem cells
Source of corneal epithelium
SC
TAC
Reproductive activity infinite finite
Fissionability
low
high
Differentiation potency +
+
differentiated cells
PMC TDC
－－
—
－
++
+++
Characteristics of limbal stem cells
ocular surface diseases
Definition
Anatomy：mucous membrane lining the eyelids Histology：cornea, conjunctiva and tear film
Ocular surface
Epithelium
epithelium breathe Defense specificity and non-specificity
inflammatory
The structure of the tear-film
Lipid layer produced by meibomian glands
Aqueous layer
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
Increased potential for proliferation, high capacity of self-renewal with a long cell cycle time and asymmetric cell division
Classification
proliferated cells
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
Triple-symptom complex： Conjunciva epithelial cells concentric movement, corneal vascularization, healing delay
Amnion application in ocular surface reconstrucion
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)
by accessory lacrimal glands
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
羊膜的作用机制
促进上皮化
抑制炎症反应
抗纤维化
羊膜
抗新生血管形成
缓解疼痛
角膜缘干细胞体 外培养的龛环境
Stem cells of corneal limbus cultivation and transplantation
○
冷冻干燥保存羊膜
将角膜缘处的上皮或口腔黏膜上皮放到冷冻干燥保存的羊膜上 进行培养、扩增，并移植到眼表衰竭（角膜缘缺陷）的患眼上
A. 对照组 B. 实验组
Leabharlann Baidu
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
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
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
CONJUNCTIVA LIMBUS
CORNEA
STEM CELL S
TRANSIEN T AMPLIFYIN
GCELLS
POSTMITOT IC
CELLS
TERMINALLY DIFFERENTIATE DCELLS
Limbal stem cells
Source of corneal epithelium
SC
TAC
Reproductive activity infinite finite
Fissionability
low
high
Differentiation potency +
+
differentiated cells
PMC TDC
－－
—
－
++
+++
Characteristics of limbal stem cells