角膜基质透镜修复角膜缺损的实验研究  

Experimental study on corneal refractive lenticule in repairing corneal defect

作　　者：李霞 林芳 雷代坤 高晓唯 刘毅 李鹏[1] 蔡岩 Li Xia;Lin Fang;Lei Daikun;Gao Xiaowei;Liu Yi;Li Peng;Cai Yan(Department of Ophthalmic Center of General Hospital of Xinjiang Military Region,Urumuqi 830013,China)

机构地区：[1]新疆军区总医院眼科中心,乌鲁木齐830013

出　　处：《临床眼科杂志》2020年第6期556-560,共5页Journal of Clinical Ophthalmology

基　　金：飞秒激光角膜基质透镜修复角膜缺损的实验研究(解放军第474医院院内立项,2016474168);透明角膜基质在兔青光眼非穿透性小梁切除术中的实验研究(新疆军区总医院北京路医疗区重点扶持科研项目,2020jzbj1002)。

摘　　要：目的制作角膜基质透镜修复兔角膜缺损的动物模型,观察其与缺损角膜的生物相容性,探讨其在角膜组织损伤修复中的机制及作用,为寻求角膜组织替代物提供理论基础。方法甘油冷冻保存角膜基质透镜[来源于新疆军区总医院临床治疗近视的飞秒激光微小切口角膜基质透镜切除术(SMILE)]。新西兰白兔30只,分为2组,各15只。A组:用2 mm×3 mm×3 mm滤纸模型制作全层角膜缺损模型后,用角膜基质透镜填塞于角膜缺损处,行角膜裂伤清创缝合。B组:用2 mm×2 mm×2 mm滤纸模型制作全层角膜缺损模型后,用角膜基质透镜填塞于角膜缺损处,行角膜裂伤清创缝合。于缝合术后1 d、1周、1个月、2个月、3个月行眼前段照相、眼前节相干光断层成像术(OCT)、裂隙灯观察角膜裂伤愈合情况、眼表炎症反应。于3个月行Pentacam眼前节分析仪、角膜地形图检查,过量麻醉药物处死动物,取其角膜行病理组织检查。结果制作兔角膜缺损修复模型,A组行角膜裂伤缝合时难度较大,术后有伤口渗漏、虹膜前粘连10只眼(66.7%)、角膜新生血管侵入11只眼(73.3%)等并发症发生,B组裂伤处角膜基质透镜间粘附不是太紧密,但6只眼(40.0%)以角膜瘢翳、9只眼(60.0%)以角膜白斑愈合,角膜组织组织逐渐透明,角膜曲率相对平整,拆线后无角膜裂伤陊开等严重的并发症发生,效果良好。B组角膜裂伤修复模型制作成功者,观察3个月后HE染色发现修复处角膜结构略紊乱,部分角膜有新生血管侵入,细胞增多;前节OCT显示角膜层间有间隙形成,但角膜曲率平整,角膜地形图显示仍有散光。结论对于2 mm×3 mm×3 mm的角膜全层缺损患者行角膜基质透镜缝合较为困难,但对于2 mm×2 mm×2 mm的全层角膜缺损、填塞的角膜基质透镜逐渐透明,与角膜组织融合紧密,角膜曲率相对平整,其通过提供纤维支架及细胞扩增分化形式修复角膜,可应用于角膜Objective Corneal refractive lenticule repair of corneal defects in rabbit models were made to observe the biocompatibility of refractive lenticule with the cornea defect,and to explore the mechanism and effect of refractive lenticule in the repair of corneal tissue injury so as to provide a theoretical basis for the corneal tissue substitutes.Methods Corneal refractive lenticule preserved in frozen glycerin(from small lenticule extraction,SMILE)was used.Tirty New Zealand white rabbits were divided into two groups with 15 rabbits in each group.Group A:After the full-thickness corneal defect model was made with 2 mm×3 mm×3 mm filter paper,the corneal defect was filled with refractive lenticule,then debridement and suture of corneal laceration were performed.Group B:After the full-thickness corneal defect model was made with 2 mm×2 mm×2 mm filter paper,the corneal refractive lenticule was used to fill the corneal defect,and corneal laceration was performed.At 1 day,1 week,1 month,2 months,and 3 months after the suture operation,anterior segment photography,OCT and slit lamp were performed to observe the healing of corneal laceration and ocular surface inflammation.After 3 months,Pentacam anterior segment analyzer and corneal topographic map were used to examine the cornea.The animals were sacrificed after overdose of anesthetic drugs,and their corneas were taken for pathological examination.Results In group A,it was difficult to suture the corneal laceration,and complications including wound leakage,iris adhesion were observed in 10 eyes(66.7%)and corneal neovascularization invasion in 11 eyes(73.3%).The corneal matrix lens adhesion was not too tight in group B,but 6 eyes(40.0%)healed with corneal scars and 9 eyes(60.0%)with corneal leukoplakia.The corneal tissue was gradually transparent and the corneal curvature was relatively flat.No serious complications such as corneal laceration and dehiscence occurred after suture removal.The model of corneal laceration repair in group B was successfully made.After 3 mon

关 键 词：角膜基质透镜 角膜缺损 兔 

分 类 号：R47[医药卫生—护理学]