不同切削深度对兔PRK和去瓣Epi—LASIK术后早期角膜愈合反应的观察  

Early cornea healing response of PRK and free-flap Epi-LASIK under different cutting depth in rabbit

作　　者：苏杰[1] 袁满红[1] 

机构地区：[1]南华大学附属第二医院眼科,衡阳421001

出　　处：《中华实验眼科杂志》2011年第4期336-340,共5页Chinese Journal Of Experimental Ophthalmology

摘　　要：背景去瓣准分子激光角膜上皮瓣下磨镶术（Epi—LASIK）术后上皮愈合快，创伤反应轻，受到眼科医师的关注。但去瓣Epi～LASIK术后上皮愈合的机制一直是目前研究的热点。目的研究兔准分子激光角膜切削术（PRK）和去瓣Epi—LASIK对不同屈光度眼切削术后早期角膜基质中炎性细胞、碱性成纤维细胞生长因子（bFGF）、核转录因子（NF—KB）的表达，探讨两种手术方式在不同切削深度时角膜创伤愈合反应的机制。方法将16只新西兰大白兔按随机数字表法分为高度切削组（-10．00D）6只、低度切削组（-3．00D）6只和空白对照组2只。实验组取一侧眼行PRK，对侧眼行去瓣Epi—LASIK，术后每日裂隙灯下观察活体兔角膜愈合情况。术后7d空气栓塞法处死兔，角膜组织用苏木精一伊红染色和免疫组织化学法检测早期角膜上皮及基质中炎性细胞、bFGF和NF—κB的表达。结果裂隙灯检查表明，去瓣Epi-LASIK手术眼术后炎症反应轻于PRK眼。在低度切削组，2种术式间术后角膜炎性细胞的数量以及NF—κB和bFGF在角膜组织中表达的差异均无统计学意义（P〉0．05），而在高度切削组，PRK手术眼角膜中炎性细胞数量为（12．25±1．22）个／400倍视野，明显高于去瓣Epi—LASIK手术眼的（6．67±0．31）个／400倍视野，差异有统计学意义（t=-8．87，P〈0．01）。角膜中PRK手术眼NF—KB的表达量（A）分别为6．11±1．36、41．82±8．71，较去瓣Epi—LASIK手术眼的3．01±0．81、11．59±4．55明显增加，而角膜中PRK手术眼bFGF的表达量（A）分别为33．59±6．98、123．68±18．81，较去瓣Epi—LASIK手术眼的69．20±8．85、123．68±18．81降低，差异均有统计学意义（P〈0．05）。去瓣Epi-LASIK上皮愈合速度快于PRK组，而随着切削深度的增加，愈合速度减慢。结论在低度切削时，去瓣Epi—LASIK手术眼角膜上皮的愈合速�Background Free-flap Epi-LASIK surgery show a fast epithelial healing and mild trauma responses. Its mechanism is notable. Objective The aim of this study was to compare the corneal epithelial healing response following photorefractive keratectomy （PRK） and flap-free Epi-LASIK surgery. Methods Twelve experimental rabbits were randomly assigned to high cutting group （- 10.00 D） and low cutting group （-3.00 D） , and 2 normal matched rabbits were used as controls. PRK was performed in lateral eyes and flap-free epipolis laser in situ- keratomileusis（Epi-LASIK） surgery was curried out in the fellow eyes. The corneal wound healing response in early stage of post-operation was examined under the slim lamp, and the inflammatory cells infiltration in cornea, basic fibroblast growth factor（bFGF） and nuclear transcription factor（NF-KB） expressions in corneal stroma were detected by hematine-eosin staining and immunohistochemstry in the seventh day after operation. Results The inflammatory reaction was milder in the eyes with Epi-LASIK than ones of PRK under the slim lamp. No significant differences were found in numbers of inflammatory cells in cornea, expressions of bFGF and NF-KB in corneal stroma between two types of surgeries in low cutting group（P〉0.05 ）. In high cutting group, the numbers of inflammatory ceils were （ 12.25±1.22）/400 field in PRK eyes, and those of free-flap Epi-LASIK eyes were （6.67±0.31）/400 field, showing obviousdifference between them（t =-8. 87 ,P〈0. 01 ）. Expressions of NF-KB（A value） in cornea were 6. ll-＋1.36 and 41.82＋ 8.71 in PRK eyes of low cutting group and high cutting group, and those in free-flap Epi-LASIK were 3. O1-＋0. 81 and 11.59-＋4. 55,indicating a drastically increase in PRK eyes（P〈O. 05 ）. The expressions of bFGF（A value） in corneal stroma were 33.59-＋6. 98 and 123.68-＋ 18.81 in PRK eyes and those in free-flap Epi-LASIK eyes were 69. 20＋-8.85 and 123.68 ＋-18.81 in low cutting group and high cutting group,

关 键 词：准分子激光角膜上皮瓣下磨镶术 准分子激光角膜切削术 角膜 创伤愈合 碱性成纤维 细胞生长因子 核转录因子 屈光度 

分 类 号：R779.63[医药卫生—眼科]