CAJ | 학술논문

背景飞秒激光技术在角膜屈光手术中的应用已日渐成熟,其术后角膜基质床表面的形态特点值得关注. 目的观察并分析飞秒激光光爆破作用对角膜基质表面的影响及特点,探究不同能量的激光脉冲在飞秒激光制作角膜瓣中对角膜基质床表面显微结构的影响,并与机械性角膜板层刀手术后角膜基质床结构进行比较.方法分别采用125、155、195 nJ脉冲能量的Visu Max飞秒激光和Moria-M2角膜板层刀对16只新鲜猪眼球进行光爆破及角膜瓣的制作,每组4只眼.术后用S-3400N型扫描电子显微镜观察术后角膜基质床表面的显微结构特点,对飞秒激光和Moria-M2角膜板层刀制瓣后角膜基质床表面的结构进行对比分析.结果飞秒激光制作角膜瓣后发生光爆破作用处的角膜组织被汽化,产生光滑的表面,气泡之间可见残留的组织间桥.125 nJ脉冲能量飞秒激光制瓣组表面光滑,可见散在的组织间桥.155nJ脉冲能量飞秒激光制瓣组角膜表面光滑,无组织间桥和机械性损伤.195 nJ脉冲能量飞秒激光制瓣组角膜表面可见大量组织间桥和机械性划痕,并可见较大气泡引起的圆形和椭圆形凹痕.飞秒激光制作角膜瓣后的侧切部位组织排列规则,边缘清晰、锐利,周围组织接近正常；机械性角膜板层刀制瓣组角膜基质床表面可见大量翘起的纤维组织,表面组织卷曲,排列不规则,侧切边缘呈钝角,并有纵行划痕.结论与机械性角膜板层刀制瓣法比较,飞秒激光制作角膜瓣后角膜基质床表面的结构更规则,角膜表面更光滑,飞秒激光制瓣法选择155 nJ的脉冲能量最为适宜.
배경 비초격광기술재각막굴광수술중적응용이일점성숙,기술후각막기질상표면적형태특점치득관주. 목적 관찰병분석비초격광광폭파작용대각막기질표면적영향급특점,탐구불동능량적격광맥충재비초격광제작각막판중대각막기질상표면현미결구적영향,병여궤계성각막판층도수술후각막기질상결구진행비교.방법 분별채용125、155、195 nJ맥충능량적Visu Max비초격광화Moria-M2각막판층도대16지신선저안구진행광폭파급각막판적제작,매조4지안.술후용S-3400N형소묘전자현미경관찰술후각막기질상표면적현미결구특점,대비초격광화Moria-M2각막판층도제판후각막기질상표면적결구진행대비분석.결과 비초격광제작각막판후발생광폭파작용처적각막조직피기화,산생광활적표면,기포지간가견잔류적조직간교.125 nJ맥충능량비초격광제판조표면광활,가견산재적조직간교.155nJ맥충능량비초격광제판조각막표면광활,무조직간교화궤계성손상.195 nJ맥충능량비초격광제판조각막표면가견대량조직간교화궤계성화흔,병가견교대기포인기적원형화타원형요흔.비초격광제작각막판후적측절부위조직배렬규칙,변연청석、예리,주위조직접근정상；궤계성각막판층도제판조각막기질상표면가견대량교기적섬유조직,표면조직권곡,배렬불규칙,측절변연정둔각,병유종행화흔.결론 여궤계성각막판층도제판법비교,비초격광제작각막판후각막기질상표면적결구경규칙,각막표면경광활,비초격광제판법선택155 nJ적맥충능량최위괄의.
Background The application of femtosecond laser in the corneal refractive surgery has made great progression recent years,but the morphology characteristic of corneal stroma surface after making-flap of femtosecond laser is closely concerned.Objective This study was to analyze the influence of photodisrnption of femtosecond laser on the corneal stroma surface and to investigate the effect of different laser pulse energy on the sudace ultrastructure of corneal stroma.Methods Corneal flaps were made with Visu Max femtosecond laser in 16 fresh porcine eyes with the pulse energy 125 nJ,155 nJ and 195 nJ respectively,and Moria-M2 microkeratome was used as control.Scanning electron microscopy (S-3400N Hitachi High-Technologies Corp) was used to observe and compare the ultrastructural characteristic of corneal stroma bed surface after making of corneal flap.Results The corneal strnma was evaporated and created a smooth surface when photodisrnption happened in the femtosecond laser group.Residual tissue bridges could been exhibited among the cavitation bubbles under the scanning electron microscope.Corneal strnma surface was smooth in the 125 nJ pulse energy group,but some tissue bridges still were visible.In the 155 nJ pulse energy group,much more smooth surface was seen without tissue bridges and mechanical damages on the corneal surface.However,the surface quality was worse and many tissue bridges and grooves existed in the 195 nJ pulse energy group.In addition,different sizes of slots caused by big cavitation bubbles were visible with the round and oval shape.The edges were regular and sharp with small damage zone after cutting with femtoseeond laser.However,many elevated fibril tissues could be seen on the corneal surface after making of flap with microkeratome.Many crimp and irregularity tissues were found on the surface.Blunt surface and indentations appeared in the cutting edge.Conclusions The mierostrueture of corneal stroma surface is more smoother after making of corneal flap with fentosecond laser in comparison with microkeratome.Pulse energy of 155 nJ is preferably during the making-flap with femtosecond laser.