(精品) 眼表疾病课件

Pathology of tear film
Aqueous tear deficiency
Mucus deficiency Lipid disorder
Definition
Dry eye is a disorder of the tear film due to tear deciency or excessive evaporation, which causes damage to the interpalpebral ocular surface and is associated with symptoms of ocular discomfort.
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
Dry eye syndrome
Environmental factors
Visual display termminal (VDT) Building disease syndrome (SBS) Office of the eye syndrome (OES)
work result in winking decreased environment cause over evaporation
A. 对照组 B. 实验组
2W
wk.baidu.com4W
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
眼表疾病
ocular surface diseases
Definition
Anatomy：mucous membrane lining the eyelids Histology：cornea, conjunctiva and tear film
Ocular surface
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.
by accessory lacrimal glands
Mucin layer by goblet cells
Neuronal feedback loop
Secretomotor impulse Lacrimal gland
Afford ocular surface tear
Nervous of ocular Surface excitation
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
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
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
Dry eye syndrome
Etiological classification： —Aqueous tear deficiency（ATD） —Mucin tear deficiency —Lipid tear deficiency —Tear dynamics disorder —Mixed type
SC
TAC
Reproductive activity infinite finite
Fissionability
low
high
Differentiation potency +
+
differentiated cells
PMC TDC
－－
—
－
++
+++
Characteristics of limbal stem cells
☆Non-Invasive, convenient, high specificity
Ophthalmic Physiol 1998： 471
The quality of tear
Tear fern-like crystal
normal
---- 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
CONJUNCTIVA LIMBUS
CORNEA
STEM CELL S
TRANSIEN T AMPLIFYIN
GCELLS
POSTMITOT IC
CELLS
TERMINALLY DIFFERENTIATE DCELLS
Limbal stem cells
Source of corneal epithelium
Triple-symptom complex： Conjunciva epithelial cells concentric movement, corneal vascularization, healing delay
Amnion application in ocular surface reconstrucion
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
Increased potential for proliferation, high capacity of self-renewal with a long cell cycle time and asymmetric cell division
Classification
proliferated cells
epithelium breathe Defense specificity and non-specificity
inflammatory
The structure of the tear-film
Lipid layer produced by meibomian glands
Aqueous layer
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
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
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)
Tear function examination
Schirmer test：5mm×35mm filter paper, measure the length of the moist part in 5min. Normal value:10~30mm。
BUT：Normal value:15~45s, <10s is tear film instability.
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
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