摘要
目的探讨微型角膜刀法准分子激光上皮下角膜磨镶术(Epi-LASIK)术后角膜的愈合规律,并与准分子激光屈光性角膜切削术(PRK)比较。方法建立兔近视性Epi-LASIK及近视性改良PRK动物模型,用锥虫蓝-茜素红活性染色法观察Epi-LASIK术后角膜上皮细胞活性,裂隙灯显微镜下观察角膜瓣变化、上皮修复过程和上皮下雾状混浊(haze)形成情况,通过角膜组织病理学观察角膜上皮及基质的愈合反应。结果 Epi-LASIK术后角膜上皮愈合时间为(4.67±0.41)d,而PRK术后为(2.75±0.27)d,差异有统计学意义(t=9.550,P=0.000)。PRK术后即刻和3d、5d角膜上皮瓣细胞活性率分别为(85.83±2.07)%、(48.67±3.41)%、(91.33±3.10)%,差异有统计学意义(F=215.060,P=0.000)。Epi-LASIK术后角膜瓣逐渐融解并被新生上皮取代,上皮愈合过程较改良PRK缓慢。PRK术后haze分级高于Epi-LASIK,差异有统计学意义(Z=2.27,P=0.02)。角膜组织病理学检查显示,术后1个月时2组上皮均明显增厚,3个月时上皮细胞排列仍不规则,6个月时上皮细胞形态基本恢复正常,术后3～6个月时Epi-LASIK组角膜上皮厚度已基本接近正常,与PRK组比较差异有统计学意义(P<0.05)。术后3～6个月时Epi-LASIK组角膜前基质细胞数明显低于PRK组(P<0.05)。结论 Epi-LASIK术后上皮瓣活性随时间的推移而降低,上皮修复较慢。与改良PRK比较,Epi-LASIK术后上皮细胞形态变化和上皮增厚程度较轻,角膜基质细胞恢复快,haze程度明显减轻。
Background The cornea healing process after epipolis laser in situ keratomileusis （Epi-LASIK） was unknown.There is no convincing support in histopathology after Epi-LASIK.Objective This study was to observe the cornea healing process after Epi-LASIK.Methods Myopia Epi-LASIK animal models were established in lateral eyes of 57 rabbit eyes,and photorefractive keratectomy （PRK） was performed in fellow eyes.Other 6 eyes of 3 normal rabbits were used as normal control group.The epithelial flap specimens were obtained during the surgery and stained with trypan blue and alizarin red to evaluate corneal epithelial cell viability under the light microscopy.Corneal epithelial thickness was measured and the anterior keratocytes were calculated by hemotoxylin and eosin staining.Haze was observed with slit-lamp examination and graded on the Hanna criteria.Results The healing time of corneal epithelium was （4.67±0.41） days after Epi-LASIK and （2.75±0.27） days after PRK,showing a significant difference （t=9.550,P=0.000）.The epithelial cell viability ratio immediately after surgery was （85.83±2.07）% and that in 3 days and 5 days was （48.67±3.41）% and （91.33±3.10）% respectively,showing a significant increase （F=215.060,P=0.000）.The score of corneal haze after PRK was higher than that of Epi-LASIK （Z=2.27,P=0.02）.The corneal epithelial thickness value was highest in 1 month after Epi-LASIK and gradually declined in 3 months and then closed to normal value till 6 months postoperatively.After PRK,the epithelial thickness increased from 1 month through 6 months postoperatively.Statistically significant differences were found in corneal epithelial thickness between these two operative fashions from 1 month through 6 months （q=6.14,q=5.74,q=14.052,q=6.08,P〈0.05）.The anterior keratocyte density was highest after Epi-LASIK in 1 month and declined in 3 months and returned to normal till 6 months postoperatively,showing considerably differences in comparison with PRK （q=56.00,q=83.50,q=5
出处
《眼科研究》
CSCD
北大核心
2010年第8期766-770,共5页
Chinese Ophthalmic Research
