LASIK与LASEK术后兔角膜神经损伤和修复的实验研究  

Corneal nerve injury and recovery after LASIK and LASEK in rabbits

作　　者：刘畅[1] 张一川[2] 乔诗凝[1] 贺美[1] 丁清[1] 屈淑娥[1] 

机构地区：[1]北京大学深圳医院准分子激光中心,广东深圳518036 [2]吉林大学

出　　处：《眼科》2011年第6期391-396,共6页Ophthalmology in China

基　　金：深圳市科技局计划资助项目(200802018)

摘　　要：目的比较准分子激光原位角膜磨镶术(laser in situ keratomileus,LASIK)与准分子激光上皮下角膜磨镶术(lasersubepithelial keratomileusis,LASEK)两种准分子激光手术后兔角膜中神经生长因子(NGF)mRNA表达的差异及手术后兔角膜神经损伤和再生修复情况。设计动物实验。研究对象新西兰白兔60只。方法将60只新西兰白兔随机分为6组,每组10只,1组为正常对照组,其余依术后取角膜时间不同分为5个实验组。实验组白兔一眼行LASIK手术,另一眼行LASEK手术。术后第1、7天、1、3、6个月取兔角膜,通过氯化金染色的方法观察兔角膜神经损伤及再生修复,用半定量RT-PCR的方法检测兔角膜中NGF mRNA的表达。主要指标光镜下角膜神经损伤和再生修复的变化,角膜中NGF mRNA的表达量。结果光镜下观察,LASEK手术后1天深层基质神经保留,术后7天切削区内的神经断端开始再生,术后6个月切削区前基质神经丛重构基本完成,形态与正常接近;而LASIK术后1天可见基质层神经纤维断端,术后7天深层基质神经无明显再生的神经纤维,术后1个月角膜瓣边缘神经断端再生神经增多,术后6个月角膜瓣内的前基质神经丛开始恢复,部分神经断端无神经再生,形成盲端。LASEK组在术后早期(1、7天)角膜中NGF mRNA表达增高(0.650±0.101、0.580±0.109),而LASIK组术后1个月才开始增高(0.661±0.032),随着手术后角膜神经再生修复时间的延长,两组角膜中NGF mRNA表达的差异越来越小(t=0.687,0.277,0.107;P=0.530,0.796,0.920)。结论与LASIK相比,LASEK术后兔角膜神经损伤轻,修复快。Objective To observe and compare the nerve growth factor（NGF） mRNA expression and the corneal nerve injury and recovery in the rabbit cornea after LASIK and after LASEK.Design Animal experiment.Participants Sixty New Zealand white rabbits.Methods The 60 rabbits were randomly divided into six groups randomly,ten rabbits each group,one group was the normal control group,the remaining five groups was the experimental group.In experimental group,LASIK was performed on one eye of each rabbit,and LASEK was performed on the contrast eye.The rabbits were sacrificed at the 1st,7th day,1st,3rd,and 6th month after surgery,and NGF mRNA expression in cornea was detected by Reverse transcription（RT）-polymerizes chain reaction（PCR）.Corneal nerves were stained with the gold chloride staining method.The changes in corneal nerve injury and recovery after LASIK and LASEK were observed with microscope.Main Outcome Measures The changes in corneal nerve injury and recovery under microscope,the expression of NGF mRNA in rabbits＇ cornea after LASIK and LASEK.Results By microscopy observation,at the first day after LASEK,deep matrix nerve was preserved.The neural cutting ends began to regenerate at the seventh day.And at the sixth months,shallow matrix plexus reconstruction completed in the cutting zone,morphology closing to normal;while at the first day after LASIK,nerve fiber cutting ends was visible in the stromal layer.At the seventh day,deep matrix neural plexus had no obvious regeneration.At a month after LASIK the regenerated nerve of neural cutting ends increased in the corneal flap edge,and after six months,shallow matrix plexus of corneal flap began to recover,part of the neural cutting ends had no nerve regeneration,formed the blinds.NGF mRNA expression increased at early period（1,7 days） after LASEK（0.650±0.101、0.580±0.109）,while at one month after LASIK（0.661±0.032）.The difference of NGF mRNA expression between two groups was smaller with the time of corneal nerve recovery prolonged after surge

关 键 词：兔 准分子激光原位角膜磨镶术 准分子激光上皮下角膜磨镶术 神经再生 氯化金 神经生长因子 

分 类 号：R779.63[医药卫生—眼科]