Objective： To assess the lower tear meniscus height（LTMH）, central tear film thickness（CTFT）, and central corneal epithelial thickness（CCET） after deep anterior lamellar keratoplasty（DALK）. Methods： This was...Objective： To assess the lower tear meniscus height（LTMH）, central tear film thickness（CTFT）, and central corneal epithelial thickness（CCET） after deep anterior lamellar keratoplasty（DALK）. Methods： This was a retrospective cross-sectional study of 20 patients who had DALK in one eye over a three-month period. LTMH, CTFT, and CCET of the operated eyes and the unoperated fellow eyes were measured using high-definition optical coherence tomography（HD-OCT）. Correlations between three OCT assessments and age, time following surgery, graft size, bed size, and the number of residual sutures were analyzed. Results： Compared to patients with keratoconus, patients with other corneal conditions had significantly higher CCET in the fellow eye（P=0.024）. For all patients, CCET in the operated eye was significantly negatively correlated with the number of residual sutures（R=-0.579, P=0.008）, and was significantly positively correlated with time following surgery（R=0.636, P=0.003）. In the fellow eye, a significant positive correlation was found between age and CCET（R=0.551, P=0.012）, and a significant negative correlation between age and CTFT（R=-0.491, P=0.028）. LTMH was found to be significantly correlated between operated and fellow eyes（R=0.554, P=0.011）. There was no significant correlation between LTMH and age, bed/graft size, time following surgery, or residual sutures（all possible correlations, P0.05）. Conclusions： Patients with keratoconus tend to have a thinner central corneal epithelium. Corneal epithelium keeps regenerating over time after DALK. DALK did not induce a significant change in tear volume compared with the fellow eye. Postoperative tear function might depend on an individual＇s general condition, rather than on age, gender, bed/graft size, time following surgery, or residual sutures.展开更多
Objective： To evaluate the clinical efficacy of peripheral deep anterior lamellar keratoplasty （DALK） using a cryopreserved donor cornea for Terrien＇s marginal degeneration （TMD）. Methods： Thirty-one eyes of 27...Objective： To evaluate the clinical efficacy of peripheral deep anterior lamellar keratoplasty （DALK） using a cryopreserved donor cornea for Terrien＇s marginal degeneration （TMD）. Methods： Thirty-one eyes of 27 patients with TMD underwent peripheral DALK using cryopreserved donor corneas, According to the distance between the inner edge of the lesion and the limbus, a ring-shaped or D-shaped DALK was performed. All grafts were stored at -20 ℃. Cryopreserved comeoscleral rims were prepared for ring-shaped grafts and cryopreserved whole eyeballs were prepared for D-shaped grafts. The general conditions, intraoperative performance, postoperative corneal reconstruc- tion, astigmatism, best corrected visual acuity （BCVA）, and various complications were analyzed. Results： Ring-shaped DALK was performed in 28 eyes and D-shaped DALK was performed in 3 eyes. Postoperative follow-up time was （28.4±24.8） months. There was evidence of inflammation before surgery in 12 eyes （38.7%） and intraoper- ative perforation occurred in 13 eyes （41.9%）. The corneal structures of all eyes were reconstructed. Postoperative astigmatism and BCVA showed improvement （both P=0.00） except for cases that underwent D-shaped DALK. Ten eyes （32.2%） developed transient ocular hypertension and one eye （3.2%） developed secondary glaucoma. No pri- mary disease recurrence or corneal allograft rejection was observed. Conclusions： Peripheral DALK for TMD using cryopreserved donor tissue is an effective technique that eliminates rejection and extends the use of donor eyes. Inflammatory history or intraoperative perforation has no adverse effect on graft recovery. However, D-shaped DALK did not achieve good visual outcomes.展开更多
冰盖表面消融是气候变化和全球变暖的敏感指示剂。冰雪消融会降低地表反照率进而影响全球能量平衡,表面融水会加剧裂隙的传播,降低冰架稳定性进而影响冰盖物质平衡。当前,高时空分辨率消融区分布数据的缺乏限制了南极冰盖消融发生机理...冰盖表面消融是气候变化和全球变暖的敏感指示剂。冰雪消融会降低地表反照率进而影响全球能量平衡,表面融水会加剧裂隙的传播,降低冰架稳定性进而影响冰盖物质平衡。当前,高时空分辨率消融区分布数据的缺乏限制了南极冰盖消融发生机理和时空特征的深入探索。围绕南极冰盖大范围消融区(蓝冰、湿雪和融水)的提取研究,提出了一种基于改进的冰雪归一化消融指数(Modified Normalized Difference Water Index Adapted for Ice,MNDWIice)的消融区自动提取方法,采用2016年9月—2017年4月18景30 m分辨率的Landsat-8数据,获取了消融区自动提取的MNDWIice阈值,并以东南极达尔克冰川为例,实现了高空间分辨率的季节性消融信息提取和分析。结果表明:在云和地形阴影干扰较小的情况下,基于Landsat-8反射率数据计算的MNDWIice采用单一阈值(0.136)对消融区的提取精度在67.7%—94.2%之间,平均精度为81.5%;达尔克冰川消融面积、消融区MNDWIice均值表现出明显的季节性时空变化特征;消融发生的时间不晚于Landsat-8数据观测的最早时间(9月7日);消融最早出现和主要分布区在地形下降剧烈的东部接地线处。展开更多
Deep anterior lamellar keratoplasty(DALK)is preferred over conventional penetrating keratoplasty(PKP)for the treatment of anterior corneal opacities or ectasias due to decreased risk of endothelial rejection.However,D...Deep anterior lamellar keratoplasty(DALK)is preferred over conventional penetrating keratoplasty(PKP)for the treatment of anterior corneal opacities or ectasias due to decreased risk of endothelial rejection.However,DALK remains surgically challenging,largely due to challenges associated with achieving consistent pneumo-dissection of posterior stroma from the underlying pre-Descemet’s or Descemet’s membrane(DM).Air must be injected at sufficient depth in the corneal stroma in order to achieve successful pneumo-dissection,but advancing a needle too deep into the cornea can lead to perforation of DM.We describe here a novel technique using a handheld slit lamp(Eidolon model 510L,Eidolon Optical LLC,Natick,MA,USA)to assist in creation of the big-bubble in DALK surgery.Use of a handheld slit beam intraoperatively is a safe,relatively inexpensive,and effective technique for increasing the success of big-bubble formation in DALK procedures.展开更多
基金Project supported by the Zhejiang Provincial Natural Science Foundation of China(No.LQ16H120002)
文摘Objective： To assess the lower tear meniscus height（LTMH）, central tear film thickness（CTFT）, and central corneal epithelial thickness（CCET） after deep anterior lamellar keratoplasty（DALK）. Methods： This was a retrospective cross-sectional study of 20 patients who had DALK in one eye over a three-month period. LTMH, CTFT, and CCET of the operated eyes and the unoperated fellow eyes were measured using high-definition optical coherence tomography（HD-OCT）. Correlations between three OCT assessments and age, time following surgery, graft size, bed size, and the number of residual sutures were analyzed. Results： Compared to patients with keratoconus, patients with other corneal conditions had significantly higher CCET in the fellow eye（P=0.024）. For all patients, CCET in the operated eye was significantly negatively correlated with the number of residual sutures（R=-0.579, P=0.008）, and was significantly positively correlated with time following surgery（R=0.636, P=0.003）. In the fellow eye, a significant positive correlation was found between age and CCET（R=0.551, P=0.012）, and a significant negative correlation between age and CTFT（R=-0.491, P=0.028）. LTMH was found to be significantly correlated between operated and fellow eyes（R=0.554, P=0.011）. There was no significant correlation between LTMH and age, bed/graft size, time following surgery, or residual sutures（all possible correlations, P0.05）. Conclusions： Patients with keratoconus tend to have a thinner central corneal epithelium. Corneal epithelium keeps regenerating over time after DALK. DALK did not induce a significant change in tear volume compared with the fellow eye. Postoperative tear function might depend on an individual＇s general condition, rather than on age, gender, bed/graft size, time following surgery, or residual sutures.
基金Project supported by the Major Program for Science and Technology Research of Zhejiang Province(No.2011C13029-2)the Medical Scientific Research Foundation of Zhejiang Province(Nos2012ZDA026 and 2013ZDA012),China
文摘Objective： To evaluate the clinical efficacy of peripheral deep anterior lamellar keratoplasty （DALK） using a cryopreserved donor cornea for Terrien＇s marginal degeneration （TMD）. Methods： Thirty-one eyes of 27 patients with TMD underwent peripheral DALK using cryopreserved donor corneas, According to the distance between the inner edge of the lesion and the limbus, a ring-shaped or D-shaped DALK was performed. All grafts were stored at -20 ℃. Cryopreserved comeoscleral rims were prepared for ring-shaped grafts and cryopreserved whole eyeballs were prepared for D-shaped grafts. The general conditions, intraoperative performance, postoperative corneal reconstruc- tion, astigmatism, best corrected visual acuity （BCVA）, and various complications were analyzed. Results： Ring-shaped DALK was performed in 28 eyes and D-shaped DALK was performed in 3 eyes. Postoperative follow-up time was （28.4±24.8） months. There was evidence of inflammation before surgery in 12 eyes （38.7%） and intraoper- ative perforation occurred in 13 eyes （41.9%）. The corneal structures of all eyes were reconstructed. Postoperative astigmatism and BCVA showed improvement （both P=0.00） except for cases that underwent D-shaped DALK. Ten eyes （32.2%） developed transient ocular hypertension and one eye （3.2%） developed secondary glaucoma. No pri- mary disease recurrence or corneal allograft rejection was observed. Conclusions： Peripheral DALK for TMD using cryopreserved donor tissue is an effective technique that eliminates rejection and extends the use of donor eyes. Inflammatory history or intraoperative perforation has no adverse effect on graft recovery. However, D-shaped DALK did not achieve good visual outcomes.
文摘冰盖表面消融是气候变化和全球变暖的敏感指示剂。冰雪消融会降低地表反照率进而影响全球能量平衡,表面融水会加剧裂隙的传播,降低冰架稳定性进而影响冰盖物质平衡。当前,高时空分辨率消融区分布数据的缺乏限制了南极冰盖消融发生机理和时空特征的深入探索。围绕南极冰盖大范围消融区(蓝冰、湿雪和融水)的提取研究,提出了一种基于改进的冰雪归一化消融指数(Modified Normalized Difference Water Index Adapted for Ice,MNDWIice)的消融区自动提取方法,采用2016年9月—2017年4月18景30 m分辨率的Landsat-8数据,获取了消融区自动提取的MNDWIice阈值,并以东南极达尔克冰川为例,实现了高空间分辨率的季节性消融信息提取和分析。结果表明:在云和地形阴影干扰较小的情况下,基于Landsat-8反射率数据计算的MNDWIice采用单一阈值(0.136)对消融区的提取精度在67.7%—94.2%之间,平均精度为81.5%;达尔克冰川消融面积、消融区MNDWIice均值表现出明显的季节性时空变化特征;消融发生的时间不晚于Landsat-8数据观测的最早时间(9月7日);消融最早出现和主要分布区在地形下降剧烈的东部接地线处。
文摘全球气候变暖严重影响冰川的稳定性,南极多条冰川表面发生塌陷。由于缺少高空间和高时间分辨率的南极地表高程模型DEM(Digital Elevation Model),目前单支冰川表面时空变化的研究不充分。利用2011年—2016年11期南极参考高程模型REMA(The Reference Elevation Model of Antarctica)数据,开展东南极达尔克冰川表面塌陷区域的高程变化监测,并利用Landsat 7/8和Worldview-2光学影像等数据分析塌陷过程和原因。结果表明,达尔克冰川在2013年发生了一起严重的塌陷事件,塌陷深度最大约45.29 m,造成了约26.29×10^(6)m^(3)的水体损失;塌陷发生后,该区表面高程不断增加,于2016年恢复至塌陷前的高程。塌陷区具有明显的整体性沉降特征,并存在融水聚集,推测塌陷和达尔克冰川冰下湖的排水过程存在密切的联系。本研究证明达尔克冰川存在较大的不稳定性,同时验证了REMA数据监测冰川表面塌陷的可行性,为未来精细化监测南极冰盖/冰架响应气候变化提供技术参考。
文摘Deep anterior lamellar keratoplasty(DALK)is preferred over conventional penetrating keratoplasty(PKP)for the treatment of anterior corneal opacities or ectasias due to decreased risk of endothelial rejection.However,DALK remains surgically challenging,largely due to challenges associated with achieving consistent pneumo-dissection of posterior stroma from the underlying pre-Descemet’s or Descemet’s membrane(DM).Air must be injected at sufficient depth in the corneal stroma in order to achieve successful pneumo-dissection,but advancing a needle too deep into the cornea can lead to perforation of DM.We describe here a novel technique using a handheld slit lamp(Eidolon model 510L,Eidolon Optical LLC,Natick,MA,USA)to assist in creation of the big-bubble in DALK surgery.Use of a handheld slit beam intraoperatively is a safe,relatively inexpensive,and effective technique for increasing the success of big-bubble formation in DALK procedures.
