共聚焦显微镜在LASIK术后角膜检查中的应用  

The observation of post-LASIK cornea using confocal microscopy

作　　者：余晨颖[1] 李莹[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院眼科,100730

出　　处：《中华眼视光学与视觉科学杂志》2013年第5期271-275,共5页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的评估共聚焦显微镜在准分子激光原位角膜磨镶术（LASIK）术后角膜检查的应用价值。方法横断面研究。选择在北京协和医院行IASIK手术的患者27例（54眼），根据随访时间分为术后半年组和术后1年组。使用共聚焦显微镜观察其角膜神经的形态，并大致了解其角膜瓣的愈合情况以及各层细胞的结构变化。采用ACCMetrics软件对神经纤维的长度、密度，神经分支密度，神经纤维的弯曲度及反光度进行量化分析，并做组间对比。数据采用成组t检验。结果LASIK术后1年患者的角膜中央神经长度、密度，神经分支密度，神经弯曲度和反光度评分值均显著大于术后半年者（t=7．246、5．335、3．789、3．808、2．825，P〈0．01），飞秒激光制作的角膜瓣边缘更为齐整：术后视力未达1．0的2例患者，共聚焦显微镜提示其角膜微结构存在异常。结论共聚焦显微镜观察发现，LASIK术后1年内患者角膜中央神经处于再生状态，其数量与形态均会发生显著变化：此外，其还能在细胞水平对角膜微结构的改变作出评估，从而协助LASIK术后并发症的诊治。Objective To evaluate the role that confocal microscopy could play in post- laser in situ keratomileusis （LASIK） examinations. Methods Twenty-seven patients （54 eyes） who had LASIK surgery in Peking Union Medical College Hospital were included in this cross-sectional study. Patients were divided into 2 groups （6-month group and 1-year group） based on the post-LASIK follow-up. Confoeal microscopy was used to observe the regeneration of corneal nerves that could then be analyzed by ACCMetrics software using quantitative parameters （e.g., corneal nerve fiber length, density, nerve branch density, tortuosity and reflectivity of nerve fiber） before undergoing comparisons between the 2 groups. Confocal microscopy could also provide a general idea about the healing of the corneal flap and changes in keratocytes. The quantitative data of the 2 groups was compared using an independent samples t test. Results The values of corneal nerve fiber length, density, nerve branch density, and grading scores of nerve fiber tortuosity and refleetivity in patients from the 1-year group were all higher than those from the 6-month group （t=-7.246, 5.335, 3.789, 3.808, 2.825, P〈0.01）, and confoeal microscopy revealed a clear-cut corneal flap edge in patients who had FS-LASIK surgery. For the 2 patients whose post-LASIK visual acuity did not reach 1.0, confocal microscopy also help to identify some abnormalities in corneal structure that might have contributed to the condition. Conclusion The use of confocal microscopy revealed that central corneal nerves were in a regenerative state within 1 year post-LASIK, with their density and morphological features undergoing significant changes. Besides, confocal microscopy could also assess corneal micro-strnctural changes at a cellular level, thus promoting the diagnosis and treatment of post-LASIK complications.

关 键 词：显微镜检查 共焦 角膜磨镶术 激光原位 角膜神经 并发症 

分 类 号：R77[医药卫生—眼科]