Szemészet, 2010 (147. évfolyam, 1-4. szám)
2010-12-01 / 3-4. szám
10 Szemészet Supplementum I migration on a surface coated with intact fibronectin. therefore the possibility of fibronectin fragments competing with intact fibronectin molecules can prevent re-epithelisation of the corneal surface seems to be quite plausible. It has been shown in other systems that the proper orientation of fibronectin molecules is important for the migration of cells (keratocytes or epithelial cells) in the process of wound healing. Frozen sections of alkali burned and scraped corneas showed uPA activity at the leading edge of the healing epithelium. and tPA activity along the surface of the regenerated epithelium. Plasminogen activator activity was completely inhibited by amyloride. a selective inhibitor of uPA. while the lysis around the surrounding epithelium was unaffected. Anti-tPA antibodies on the contrary inhibited the lysis around the epithelium and left the leading edge activity unaffected. On the basis of these data the process of corneal re-epithelisation in simple cases of epithelial defects could be accomplished in five steps: 1. the removal of fibrous exudate consisting of fibrin, fragmented and/or randomly positioned fibronectin molecules, plasma proteins, released intracellular proteins and fragments of injured epithelial cells. This, besides the mechanical effect of blinking and washing effect of tears, on a molecular level could be effected by the proteolytic action of free plasmin generated by uPA secreted by the leading edge of the growing epithelium. This could be followed by a 2. step, the production of a layer of intact fibronectin molecules kept in the right position by appropriate attachment to the basal membrane and by the presence of fibrin molecules helping the fibronectin molecules to stay in an upright position keeping their cell binding domain ready to bind to the cell membrane receptors of the approaching epithelial cells. The 3. step would be the migration of the epithelial cell. This may be followed by the selective resoption of fibrin from under the regenerated epithelium effected by fibrin-bound plasmin generated by tPA produced by the epithelial cells (4. step). The last phase of epithelial wound healing involves the reformation of anchoring hemidesmosomes (5. step). Szürkehályog-műtét szűk pupilla esetén Bíró Zsolt PTE KK, Szemészeti Klinika Szürkehályog-műtét esetén az intraoperativ műtéti komplikációk leggyakoribb oka a szűk pupilla. Szűk pupilla oka lehet glaucoma (miotikum használata), pseudoexfoliatio, diabetes, korábbi szemészeti műtét, és szűk pupillával találkozhatunk kongenitális cataracta esetén is. A synechiák miatt letapadt, szabálytalan alakú pupilla szemészeti gyulladások, illetve sérülések után szintén nehezíti a műtétet. Az előadásban áttekintjük az intraoperativ pupillatágítás különböző lehetőségeit. Saját módszereinket videofilmekkel demonstráljuk, és áttekintjük azokat a műtéti lépéseket (capsulorhexis, phacoemulsificatio, mülencse-beültetés). melyek különösen nehezek lehetnek szűk pupilla esetén. Cataract surgery on patients with small pupil Zsolt Bíró Medical University of Pécs, Department of Ophthalmology The most common cause of intraoperative surgical complications during cataract surgery is the small pupil. Small pupil can be found in glaucomatous patients (due to miotics), in pseudoexfoliation syndrome, in diabetic patients, after previous eye surgery and in new-borns with congenital cataract. Irregular pupil may render the surgery more difficult in cases after intraocular inflammations and trauma because of synechia formation. The different intraoperative possibilities to dilate the pupil during surgery, and those for keeping it dilated, will be discussed in the lecture. Video films will be shown to demonstrate our own experiences in such eyes. The most dif-Előadáskivonatok / Abstracts
