飞秒激光蘑菇状穿透性环切角膜对环切口及内皮细胞的影响  

Effects of femtosecond laser mushroom-like penetrating ring-cut on ring incision and corneal endothelial cells

作　　者：贾桂祯 施昀青 程梦雅 曹雪倩 王林农[1] Jia Guizhen;Shi Yunqing;Cheng Mengya;Cao Xueqian;Wang Linnong(Department of Ophthalmology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China;Children's Hospital of Nanjing Medical University)

机构地区：[1]南京医科大学附属南京医院,南京市第一医院眼科,210006 [2]南京医科大学附属儿童医院

出　　处：《中华实验眼科杂志》2020年第4期300-304,共5页Chinese Journal Of Experimental Ophthalmology

基　　金：南京市医学科技发展项目(ZKX14034)。

摘　　要：目的比较分析不同点/线间距、不同激光能量的飞秒激光蘑菇状穿透性环切角膜对环切口光滑度及内皮细胞的影响,并与普通穿透性环切进行比较。方法根据点/线间距及爆破能量,采用随机数字表法将48只猪眼角膜随机分为6个组,每组8只,其中A、B、C、D和E组点/线间距分别为4/4、4/4、8/8、8/8和4/2μm,爆破能量分别为1.5、2.0、1.5、2.0和2.0μJ;F组为负压环钻进行穿透性环切。使用200 kHz的飞秒激光在猪角膜上制作相应的蘑菇状穿透切口,并与环钻环切组进行比较。分别采用光学显微镜和激光扫描电子显微镜评估各组环切口光滑度。采用飞秒激光对4片人角膜进行蘑菇状穿透性环切,参数为点/线间距4/2μm,爆破能量为1.5μJ,作为实验组;3片采用负压环钻进行穿透性环切,作为对照组。对实验组和对照组角膜内皮细胞的丢失率进行观察和比较。结果飞秒激光蘑菇状穿透性环切口完成率均为100%。光学显微镜下可见,A组和E组环切口剖面最光滑,激光扫描电子显微镜下可见E组环切口表面最光滑。光学显微镜下各组猪角膜环切口表面光滑度评分总体比较,差异有统计学意义(F=22.75,P<0.01),其中A组切口光滑度较B组高,C组切口光滑度评分较D组高,差异均有统计学意义(均P<0.05)。激光扫描电子显微镜下各组猪角膜环切口表面光滑度评分总体比较差异有统计学意义(F=122.33,P<0.01),其中A组切口光滑度评分较B组高,C组切口光滑度评分较D组高,差异均有统计学意义(均P<0.05)。实验组角膜内皮细胞形态规则,连接紧密,对照组角膜内皮细胞形态欠规则,连接疏松。实验组平均内皮细胞丢失率为(2.2±1.3)%,明显低于对照组的(6.7±2.1)%,差异有统计学意义(t=3.569,P<0.05)。结论飞秒激光可制作完美蘑菇状穿透环切口,环切口光滑度明显优于环钻切割。飞秒激光环切对角膜内皮损失更小。Objective To evaluate the effect of mushroom-like pattern femtosecond laser enabled penetrating keratoplasty with different laser energies on the ring incision and corneal endothelial cells,and compare with conventional penetrating keratoplasty.Methods According to the point/line separation and blasting energy,48 porcine corneas were randomly divided into 6 groups by using a random number table.In group A,B,C,D and E,the point/line separation was 4/4,4/4,8/8,8/8 and 4/2μm,and the blasting energy was 1.5,2.0,1.5,2.0 and 2.0μJ;In group F,a negative pressure ring drill was used to make penetrating incisions.There were 8 porcine corneas in each group.Femtosecond laser of 200 kHz was used to make corresponding mushroom-shaped penetrating incisions on the porcine corneas,and compared with porcine corneas incisions with a ring drill.The optical and scanning electron microscope images were used to evaluate the glossiness of ring incisions.Four human corneas used femtosecond laser for mushroom-like penetrating incisions with point/line separation 8/8μm,and blasting energy 2.0μJ as the experimental group;three human corneas received a negative pressure ring drill for penetrating incisions as the control group.The loss rate of corneal endothelial cells was observed and compared between experimental group and control group.The donor guardians agreed to the acquisition and use of the donors'cornea and signed informed consents.This study protocol was approved by the Ethics Committee of Nanjing First Hospital.Results Femtosecond laser mushroom penetrating ring incision completion rate was 100%.The corneal ring incision in each group was stepped,and sections of ring incisions in group A and group E were glossiest by the light microscope.Sections of ring incisions in group E were glossiest by the laser scanning electron microscope.The overall glossiness scores of the corneal ring incisions among various groups were statistically significantly different by the light microscopy(F=22.75,P<0.01).Among them,the glossiness scores i

关 键 词：飞秒激光 蘑菇状穿透性环切 环切口质量 内皮细胞丢失率 

分 类 号：R77[医药卫生—眼科]