去除上皮瓣的微型角膜刀法准分子激光角膜上皮瓣下磨镶术后早期兔角膜的修复方式研究  

The early post-operative wound healing mode study of the rabbit cornea after flap-flee epipolis laser in-situ keratomileusis

作　　者：刘玺[1] 杜之渝[1] 向一旻[1] 黄正[1] 

机构地区：[1]重庆医科大学附属第二医院眼科中心,400010

出　　处：《中华眼科杂志》2009年第10期919-925,共7页Chinese Journal of Ophthalmology

摘　　要：目的通过对兔微型角膜刀法准分子激光角膜上皮瓣下磨镶术（Epi—LASIK）和去除上皮瓣的（Flap-free）Epi．LASIK术后早期角膜组织的研究，探讨两种手术方式各自在角膜愈合方式方面的特点。方法实验研究。27只实验兔，24只按不同取材时间1、2、4、7d采用随机数字表法分为4组，每组6只兔，一只眼行Epi—LASIK，另一只眼行Flap—freeEpi—LASIK手术。另3只兔作为空白对照组。用VISX20／20准分子激光仪作-10．00D切削，另3只兔作为空白对照，通过观察术后1、2、4、7d角膜上皮愈合方式、检测角膜基质细胞数量、碱性成纤维细胞生长因子（bFGF）、角膜基质细胞凋亡的表达来探讨Flap-freeEpi-LASIK、Epi—LASIK两种术式术后早期角膜创伤愈合方式的差别。对Epi—LASIK和Flap—freeEpi—LASIK术后角膜基质bFGF表达、细胞数量变化和细胞凋亡情况的数据采用t检验进行统计学处理。结果通过光镜和透射电镜观察发现，Flap-free Epi-LASIK术后第1天有1层新生角膜上皮覆盖切削区域，以后逐层愈合。Epi—LASIK术后第1天角膜上皮基底膜与基质贴附较为紧密，但是在第2天可以看到有角膜上皮瓣水肿发生。术后4d Flap—freeEpi—LASIK角膜基质细胞数量分别为（33．85±3．39）个，多于Epi-LASIK组（t=-2．315，P〈0．05）。术后2d,4d组Flap—free Epi—LASIK角膜基质bFGF表达量分别为101．75±8．07和110．56±9．00，高于Epi—LASIK（t=-2．339，-2．396；P〈0．05）。术后2d、4d组Flap-free Epi—LASIK基质细胞凋亡数量也少于Epi—LASIK（t=3．332，2．989；P〈0．05）。结论由于Flap—free Epi-LASIK特定的上皮去除方式导致了特定的上皮愈合方式，有利于减少术后刺激症状及角膜组织的正常修复。Objective To evaluate the wound healing mode of rabbit corneal epithelium after Epi- LASIK（ epipolis laser in-situ keratomileusis） and Flap-free Epi-LASIK （Flap-free epipolis laser in-situ keratomileusis）. Methods Twenty-four New Zealand white rabbits （48 eyes） were randomly divided into four groups . There were six rabbits in every group,which were randomly treated with Epi-LASIK in one eye and Flap-free Epi-LASIK in the other by VISX20/20 excimer laser. Other three rabbits（6 eyes） without any treatment were used as control. The corneal epithelium wound healing mode was observed at 1,2,4,7 days after surgery by light microscope and electron microscope. The number of keratocytes ceils in the central anterior stroma were counted by hematoxylin-eosin-stained. The expression of basic fibroblast growth factor （bFGF） in corneal stroma were assessed by Immunohistochemistry staining. Cornea stromal cell apoptosis was evaluated by terminal deoxyribonucleotidyl transferase-mediated deoxynuridine triphosphate nick end labeling （TUNEL） assay. All the data was analysised by t-test to evaluate the different of wound healing mode after Epi-LASIK and Flap-flee Epi-LASIK. Results The findings of light microscope and electron mieroscope investigation demonstrated that, at the first day after surgery, there was one layer of neogenesis of the corneal epithelial cells covering the area of surgery in Flap-free Epi-LASIK specimens. It would increase gradually after 7 days. At the first day after the surgery, the base membrane of the corneal epithelium was tightly attached to the stroma in Epi-LASIK specimens. At the second day after the surgery, there was edema observed on the epithelium flap in the Epi-LASIK specimens. There were more keratocytes cells found at 4 days after surgery in Flap-free Epi-LASIK group（33.85 ±3.39） than that in Epi-LASIK group （t = -2.315, P 〈 0. 05 ）. The expression of bFGF in Flap-free Epi-LASIK group at 2,4 days after surgery were 101.75± 8.07 and 110.56 ± 9.00,wh

关 键 词：角膜切削术 上皮下 激光 创伤和损伤 伤口愈合 兔 

分 类 号：R686[医药卫生—骨科学]