中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2011年
4期
336-340
,共5页
准分子激光角膜上皮瓣下磨镶术%准分子激光角膜切削术%角膜%创伤愈合%碱性成纤维细胞生长因子%核转录因子%屈光度
準分子激光角膜上皮瓣下磨鑲術%準分子激光角膜切削術%角膜%創傷愈閤%堿性成纖維細胞生長因子%覈轉錄因子%屈光度
준분자격광각막상피판하마양술%준분자격광각막절삭술%각막%창상유합%감성성섬유세포생장인자%핵전록인자%굴광도
Epipolis laser in situ-keratomileusis%Photorefractive keratectomy%Cornea%Wound healing%Basic fibroblast growth factor%Nuclear transcription factor-KB%Diopter
背景去瓣准分子激光角膜上皮瓣下磨镶术(Epi-LASIK)术后上皮愈合快,创伤反应轻,受到眼科医师的关注.但去瓣Epi-LASIK术后上皮愈合的机制一直是目前研究的热点.目的研究兔准分子激光角膜切削术(PRK)和去瓣Epi-LASIK对不同屈光度眼切削术后早期角膜基质中炎性细胞、碱性成纤维细胞生长因子(bFGF)、核转录因子(NF-κB)的表达,探讨两种手术方式在不同切削深度时角膜创伤愈合反应的机制.方法将16只新西兰大白兔按随机数字表法分为高度切削组(-10.00 D)6只、低度切削组(-3.00 D)6只和空白对照组2只.实验组取一侧眼行PRK,对侧眼行去瓣Epi-LASIK,术后每日裂隙灯下观察活体兔角膜愈合情况.术后7 d空气栓塞法处死兔,角膜组织用苏木精-伊红染色和免疫组织化学法检测早期角膜上皮及基质中炎性细胞、bFGF和NF-κB的表达.结果裂隙灯检查表明,去瓣Epi-LASIK手术眼术后炎症反应轻于PRK眼.在低度切削组,2种术式间术后角膜炎性细胞的数量以及NF-κB和bFGF在角膜组织中表达的差异均无统计学意义(P＞0.05),而在高度切削组,PRK手术眼角膜中炎性细胞数量为(12.25 ±1.22)个/400倍视野,明显高于去瓣Epi-LASIK手术眼的(6.67±0.31)个/400倍视野,差异有统计学意义(t=-8.87,P＜0.01).角膜中PRK手术眼NF-κB的表达量(A)分别为6.11±1.36、41.82±8.71,较去瓣Epi-LASIK手术眼的3.01±0.81、11.59±4.55明显增加,而角膜中PRK手术眼bFGF的表达量(A)分别为33.59±6.98、123.68±18.81,较去瓣Epi-LASIK手术眼的69.20±8.85、123.68±18.81降低,差异均有统计学意义(P＜0.05).去瓣Epi-LASIK上皮愈合速度快于PRK组,而随着切削深度的增加,愈合速度减慢.结论在低度切削时,去瓣Epi-LASIK手术眼角膜上皮的愈合速度与PRK手术眼无明显差别,但在高度切削时,去瓣Epi-LASIK术眼角膜上皮的愈合速度稍快于PRK术眼,炎症反应程度轻.
揹景去瓣準分子激光角膜上皮瓣下磨鑲術(Epi-LASIK)術後上皮愈閤快,創傷反應輕,受到眼科醫師的關註.但去瓣Epi-LASIK術後上皮愈閤的機製一直是目前研究的熱點.目的研究兔準分子激光角膜切削術(PRK)和去瓣Epi-LASIK對不同屈光度眼切削術後早期角膜基質中炎性細胞、堿性成纖維細胞生長因子(bFGF)、覈轉錄因子(NF-κB)的錶達,探討兩種手術方式在不同切削深度時角膜創傷愈閤反應的機製.方法將16隻新西蘭大白兔按隨機數字錶法分為高度切削組(-10.00 D)6隻、低度切削組(-3.00 D)6隻和空白對照組2隻.實驗組取一側眼行PRK,對側眼行去瓣Epi-LASIK,術後每日裂隙燈下觀察活體兔角膜愈閤情況.術後7 d空氣栓塞法處死兔,角膜組織用囌木精-伊紅染色和免疫組織化學法檢測早期角膜上皮及基質中炎性細胞、bFGF和NF-κB的錶達.結果裂隙燈檢查錶明,去瓣Epi-LASIK手術眼術後炎癥反應輕于PRK眼.在低度切削組,2種術式間術後角膜炎性細胞的數量以及NF-κB和bFGF在角膜組織中錶達的差異均無統計學意義(P＞0.05),而在高度切削組,PRK手術眼角膜中炎性細胞數量為(12.25 ±1.22)箇/400倍視野,明顯高于去瓣Epi-LASIK手術眼的(6.67±0.31)箇/400倍視野,差異有統計學意義(t=-8.87,P＜0.01).角膜中PRK手術眼NF-κB的錶達量(A)分彆為6.11±1.36、41.82±8.71,較去瓣Epi-LASIK手術眼的3.01±0.81、11.59±4.55明顯增加,而角膜中PRK手術眼bFGF的錶達量(A)分彆為33.59±6.98、123.68±18.81,較去瓣Epi-LASIK手術眼的69.20±8.85、123.68±18.81降低,差異均有統計學意義(P＜0.05).去瓣Epi-LASIK上皮愈閤速度快于PRK組,而隨著切削深度的增加,愈閤速度減慢.結論在低度切削時,去瓣Epi-LASIK手術眼角膜上皮的愈閤速度與PRK手術眼無明顯差彆,但在高度切削時,去瓣Epi-LASIK術眼角膜上皮的愈閤速度稍快于PRK術眼,炎癥反應程度輕.
배경거판준분자격광각막상피판하마양술(Epi-LASIK)술후상피유합쾌,창상반응경,수도안과의사적관주.단거판Epi-LASIK술후상피유합적궤제일직시목전연구적열점.목적연구토준분자격광각막절삭술(PRK)화거판Epi-LASIK대불동굴광도안절삭술후조기각막기질중염성세포、감성성섬유세포생장인자(bFGF)、핵전록인자(NF-κB)적표체,탐토량충수술방식재불동절삭심도시각막창상유합반응적궤제.방법장16지신서란대백토안수궤수자표법분위고도절삭조(-10.00 D)6지、저도절삭조(-3.00 D)6지화공백대조조2지.실험조취일측안행PRK,대측안행거판Epi-LASIK,술후매일렬극등하관찰활체토각막유합정황.술후7 d공기전새법처사토,각막조직용소목정-이홍염색화면역조직화학법검측조기각막상피급기질중염성세포、bFGF화NF-κB적표체.결과렬극등검사표명,거판Epi-LASIK수술안술후염증반응경우PRK안.재저도절삭조,2충술식간술후각막염성세포적수량이급NF-κB화bFGF재각막조직중표체적차이균무통계학의의(P＞0.05),이재고도절삭조,PRK수술안각막중염성세포수량위(12.25 ±1.22)개/400배시야,명현고우거판Epi-LASIK수술안적(6.67±0.31)개/400배시야,차이유통계학의의(t=-8.87,P＜0.01).각막중PRK수술안NF-κB적표체량(A)분별위6.11±1.36、41.82±8.71,교거판Epi-LASIK수술안적3.01±0.81、11.59±4.55명현증가,이각막중PRK수술안bFGF적표체량(A)분별위33.59±6.98、123.68±18.81,교거판Epi-LASIK수술안적69.20±8.85、123.68±18.81강저,차이균유통계학의의(P＜0.05).거판Epi-LASIK상피유합속도쾌우PRK조,이수착절삭심도적증가,유합속도감만.결론재저도절삭시,거판Epi-LASIK수술안각막상피적유합속도여PRK수술안무명현차별,단재고도절삭시,거판Epi-LASIK술안각막상피적유합속도초쾌우PRK술안,염증반응정도경.
Background Free-flap Epi-LASIK surgery show a fast epithelial healing and mild trauma responses.Its mechanism is notable. Objective The aim of this study was to compare the corneal epithelial healing response following photorefractive keratectomy(PRK)and flap-free Epi-LASIK surgery. Methods Twelve experimental rabbits were randomly assigned to high cutting group(-10.00 D)and low cutting group(-3.00 D),and 2 normal matched rabbits were used as controls.PRK was performed in lateral eyes and flap-free epipolis laser in situkeratomileusis(Epi-LASIK)surgery was curried out in the fellow eyes.The corneal wound healing response in early stage of post-operation was examined under the slim lamp,and the inflammatory cells infiltration in cornea,basic fibroblast growth factor(bFGF)and nuclear transcription factor(NF-KB)expressions in corneal stroma were detected by hematine-eosin staining and immunohistochemstry in the seventh day after operation. Results The inflammatory reaction was milder in the eyes with Epi-LASIK than ones of PRK under the slim lamp.No significant difierences were found in numbers of inflammatory cells in cornea.expressions of bFGF and NF-κB in corneal stroma between two types of surgeries in low cutting group(P＞0.05).In high cutting group,the numbers of inflammatory cells were(12.25±1.22)/400 field in PRK eyes,and those of free-flap Epi-LASIK eyes were(6.67±0.31)/400 field,showing obvious difference between them(t=-8.87,P＜0.01).Expressions of NF-κB(A value)in cornea were 6.11±1.36 and 41.82±8.7 1 in PRK eyes of low cutting group and high cutting group.and those in free-flap Epi-LASIK were 3.01±0.81 and 11.59±4.55.indicating a drastically increase in PRK eyes(P＜0.05).The expressions of bFGF(A value)in corneal stroma were 33.59±6.98 and 123.68±18.81 in PRK eyes and those in free-flap Epi-LASIK eyes were 69.20±8.85 and 123.68±1 8.81 in low cutting group and high cutting group,presenting a considerably decrease in PRK eyes (P＜0.05).The corneal epithelial healing was faster in free-flap Epi-LASIK eyes than that in PRK eyes.and deeper cutting slowed the healing procedure. Conclusion In low cutting group,healing time of corneal epithelium is close between PRK and flap-free Epi-LASIK.But in high cutting group,epithelial healing is faster and inflammatory reaction is lighter in flap-free Epi-LASIK compared with PRK.
