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目的 观察角膜缘移植的治疗效果 ,明确角膜表面重建的上皮来源 ,研究兔模型角膜缘移植排斥反应的免疫机制。方法 2 0只健康白兔随机分为 3组 ,分别行角膜缘切除 +角膜上皮剥离术、自体角膜缘移植术 (供体为对侧眼 )、异体角膜缘移植术 (供体为灰兔眼 )。术后以 1%荧光素钠染色观察角膜表面的上皮化 ,移植排斥反应通过移植眼的临床表现和病理检查加以评估。结果 单纯角膜缘切除 +角膜上皮剥离眼术后角膜水肿、混浊 ,最终表面结膜上皮化、新生血管生成。自体角膜缘移植眼术后 11～ 14天 (平均 12 5天 ) ,角膜表面全部上皮化 ,角膜表面光滑、透明、规则 ,新生血管少。异体角膜缘移植组术后早期也可见角膜表面上皮化 ,术后 10～ 14天(平均 11 8天 )发生角膜上皮炎症反应 ,炎症反应分为 4个时期 :初发期、急性期、排斥期和慢性期 ;最后角膜上皮细胞被破坏、角膜混浊、新生血管生成。结论 对角膜缘组织和角膜上皮细胞完全被切除的眼表 ,通过角膜缘移植能重建角膜表面 ,而重建的角膜表面不仅能维持角膜组织的完整 ,还能减轻角膜的炎症 ,促进角膜基质新生血管的回退 ;可使临床更容易、准确地判断角膜缘移植排斥反应的发生及其强度。
Objective To observe the therapeutic effect of corneal limbal transplantation, clarify the epithelial origin of corneal surface reconstruction and study the immune mechanism of limbal graft rejection in rabbits. Methods Twenty healthy rabbits were randomly divided into three groups: limbal excision + corneal epithelial dissection, limbal autograft transplantation (donor contralateral eye), limbal allograft transplantation ). The epithelialization of corneal surface was observed with 1% sodium fluorescein staining. The rejection after transplantation was evaluated by the clinical manifestations and pathological examination of the implanted eyes. Results Corneal limbal resection + corneal epithelial stripping surgery corneal edema, opacity, the final surface conjunctival epithelial, angiogenesis. Autologous corneal limbal transplantation 11 to 14 days after surgery (an average of 12 5 days), all of the corneal surface epithelialization, corneal surface smooth, transparent, regular, less angiogenesis. Corneal epithelialization could also be seen early after operation in allogeneic limbal transplantation group. Corneal epithelial inflammation occurred 10 ~ 14 days after operation (average 11 days). Inflammatory reaction was divided into four stages: initial stage, acute stage and rejection stage And chronic phase; finally corneal epithelial cells are destroyed, corneal opacity, angiogenesis. Conclusion Corneal limbal tissue and corneal epithelial cells were completely resected ocular surface, corneal surface reconstruction by corneal limbal reconstruction, and reconstruction of the corneal surface can not only maintain the integrity of the cornea, but also reduce corneal inflammation and promote corneal stromal neovascularization Of the retreat; can make clinical more easily and accurately determine the incidence of limbal graft rejection and its intensity.