准分子激光屈光性角膜切削术后角膜雾状混浊发生机制的研究  

STUDIES ON THE MECHANISM OF HAZE FORMATION AFTER PHOTOREFRACTIVE KERATECTOMY

作　　者：齐虹[1] 朱秀安[1] 

机构地区：[1]北京医科大学第三临床医学院眼科,北京100083

出　　处：《解剖学报》2002年第1期78-83,共6页Acta Anatomica Sinica

基　　金：国家教委博士点科研基金教技管中心资助项目(1991 19)

摘　　要：目的　研究准分子激光屈光性角膜切削术 (PRK)后 ,角膜雾状混浊 (haze)发生机制。　方法　选用 2 4只新西兰大耳白兔 ,随机分为 8组 ,每组 3只。在同样条件下 ,同时对 8组兔角膜按照 - 10 0 0D高度近视设计切削 ,右眼行PRK ,左眼行准分子激光原位角膜磨镶术 (LASIK)。分别于术后即刻 ,2 4h ,1、2周 ,1、3、6及 12月用裂隙灯显微镜检查角膜haze,并分期分批取角膜组织用光镜及电镜观察角膜组织形态学改变 ;用免疫组织化学及RT PCR方法检测细胞外基质成分改变 ,对比各组双眼结果。　结果　PRK术后haze的发生率为 10 0 % ;LASIK术后没有haze发生。与haze发生有关的角膜组织变化为 :角膜上皮的基底膜不完整 ;基质浅层成纤维细胞数量增多且被激活 ,胶原纤维排列紊乱 ,Ⅰ、Ⅲ、Ⅵ型胶原纤维及糖蛋白FN、TN、LN沉积。　结论　PRK术后haze的形成及消失是角膜细胞外基质成分与成纤维细胞之间相互作用的结果。Objective To study the mechanism of haze formation after photorefractive keratectomy (PRK). Methods 27 adult New Zealand white rabbits were employed in this study.24 of them received PRK in the right eye and laser in situ keratomileusis (LASIK) in the left eye at the same time and under the same condition for -10\^00D ablation at once,24hour,1 week,2 week,1month,3 month,6 month and 12 month after surgery,the corneas were examined periodically by slip\|lamp microscopy for haze formation,and the both eyes of 3 rabbits were enucleated,the corneas were studies with light microscopy;transmission electron microscopy;immunohistochemical evaluation for extracellular matrix,including collagen type Ⅰ,type Ⅲ,type Ⅵ,cellular fibronection,tenascin and laminin;RT\|PCR detection for mRAN of collagen type Ⅰ. Results The incidence of haze was 100% after PRK.No haze formation after LASIK.Haze was located at the anterior stroma immediately adjacent to the ablated areas.The change of structure and composition which correlated with haze formation was due to a combination of the following factors:the basement membrane of corneal epithelium was discontinuous;A new layer of subepithelium tissue was synthesized;fibroblast was increased in number and activated;the collagen fibrils were disorganized.The diameter of fibrils and the space between the fibrils were irregular in the anterior stroma;The newly synthesized extracellular matrix inculding collagen type Ⅰ,type Ⅲ,type Ⅵ,cellular fibronection,tenascin and laminin were deposited in the anterior corneal stroma.Conclusion\ The formation and disappearing of haze was the result of interreaction between fibroblast and extracellular matrix.The destruction of basement membrane of corneal epithelium and Bowmen's member after PRK is initializing factor during haze formation.\;[

关 键 词：准分子激光角膜切削术 角膜磨镶术 雾状混浊 细胞外基质 

分 类 号：R779.63[医药卫生—眼科] R779.2[医药卫生—临床医学]