激光扫描共焦显微镜对飞秒激光小切口基质透镜取出术后角膜帽神经修复的动态观察  

Dynamic observation of corneal reinnervation after small incision lenticule extraction at cap by confocal microscope

作　　者：葛庆曼 崔传波 孔德言 宋丽 

机构地区：[1]山东医学高等专科学校附属眼科医院屈光手术科,临沂276002 [2]山东医学高等专科学校眼科教研室,临沂276000

出　　处：《中华实验眼科杂志》2017年第2期151-155,共5页Chinese Journal Of Experimental Ophthalmology

摘　　要：背景飞秒激光小切口基质透镜取出术（SMILE）术后角膜中央部上皮基底膜下神经纤维丛存在再生的过程，但术后不同时间点角膜上皮基底膜下神经纤维的生长方式及角膜帽缘神经修复的动态变化鲜见报道。 目的探讨SMILE术后角膜帽神经损伤情况及其修复规律。 方法对2014年4月至2015年4月于山东医学高等专科学校附属眼科医院接受SMILE手术且按时完成随访的近视患者16例32眼进行回顾性分析。术眼于术前及术后1周、1个月、3个月、6个月进行随访检查，采用激光扫描共焦显微镜对术眼角膜中央部及帽缘切口部位进行0.4 mm×0.4 mm区域的扫描，采用Image-Pro Plus图像分析软件对上皮基底膜下神经纤维丛成像最为清晰的图片进行分析，测定术眼角膜中央每平方毫米范围内图像中神经纤维的总长度，即角膜中央神经纤维密度，并观察帽缘神经纤维分支的修复。 结果术眼术前及术后1周、1个月、3个月、6个月角膜中央神经纤维密度分别为（19 687.45±1 147.59）、（10 500.46±1 056.22）、（12 833.40±1 047.98）、（13 564.04±1 173.01）、（14 661.35±941.92）μm/mm2，手术前后不同时间点总体比较差异有统计学意义（F＝319.440，P＝0.000）。术眼术后角膜神经纤维密度均明显低于术前，手术1个月后随时间推移角膜中央神经纤维密度逐渐增加，各时间点间两两比较差异均有统计学意义（均P〈0.01）。术眼术后角膜上皮基底膜下均发现有较丰富的神经纤维丛，形态与术前接近，术后1周角膜帽缘小切口处可见神经纤维的断端及崩解，角膜帽缘非切口处神经纤维越过角膜帽缘伸入角膜帽；术后1个月角膜帽缘切口处可见新生神经芽穿过角膜切口；术后3～6个月角膜帽缘切口处可见明显的神经纤维连续延伸。 结论SMILE术后部分浅层神经纤维未受到损伤，神经纤维的修复呈从角膜帽外�BackgroundCorneal reinnervation of subbasal nerve plexus have been found after small incision lenticule extraction（SMILE）. However, there were few reports about corneal reinnervation mode and dynamic changes at the corneal cap in different time points postoperation. ObjectiveThe aim of this study was to evaluate the corneal reinnervation at the cap margin after SMILE. MethodsThe clinical data of 32 myopic eyes of 16 patients who received SMILE incision lenticule extraction surgerv in Affiliated Eye Hospital of Shandong Medical College from April 2014 to April 2015 were retrospectively analyzed.The following-up was carried in 1 week, 1 month, 3 months and 6 months after surgery, and in-vivo confocal microscopy was used to acquire images of the central corneal subbasal nerve plexus before and after surgery, with the scan range of 0.4 mm×0.4 mm, from which nerve density and nerve tortuosity were evaluated using Image-Pro Plus imaging analysis software.The overall length of nerve fibers at the central cornea was measured to assess the subbasal nerve density, and the repair of nerve fibers at cap was observed. ResultsThe corneal subbasal nerve density was （19 687.45±1 147.59）, （10 500.46±1 056.22）, （12 833.40±1 047.98）, （13 564.04±1 173.01） and （14 661.35±941.92）μm/mm2 in preoperation and postoperative 1 week, 1 month, 3 months, 6 months, respectively, with a significant difference among different time points （F=319.44, P=0.000）, and the corneal subbasal nerve densitis in postoperative time points were significantly reduced in comparison with the preoperation, and corneal subbasal nerve densities were gradually increased after surgery as the extending of time, showing significant differences between different time points （all at P〈0.01）. Abundant corneal subbasal nerve fibers were seen with the near normal morphology after surgery.However, the fragments and disaggregation of nerve fibers were found at the incision of cap margins, and some nerve fibers extended toward t

关 键 词：角膜神经再生 角膜激光手术 准分子激光/治疗用途 共焦显微镜检查 神经再生/生 理 眼神经/生理 手术瓣 小切口基质透镜取出术 

分 类 号：R779.63[医药卫生—眼科]