CAJ | 학술논문

背景眼表结构与功能的正常与稳定是维持角膜透明及视功能的重要保证,在眼化学烧伤传统治疗的基础上对早期眼化学烧伤提出新的治疗理念、掌握合适的手术时机和娴熟的手术技巧可减少碱性物质对角膜及眼内组织的进一步损害. 目的观察飞秒激光辅助的深板层角膜移植术(DLK)治疗角膜急性碱烧伤的组织病理学及超微结构变化,探讨角膜碱烧伤早期DLK治疗的可行性及疗效. 方法采用12只成年健康新西兰白兔,将浸有1 mol/L NaOH溶液30μl的直径6 mm无菌滤纸片置于中央角膜30 s,建立角膜碱烧伤模型.模型兔用随机数字表法分为2个组,飞秒激光辅助的DLK治疗组(治疗组)于角膜碱烧伤后24 h采用飞秒激光辅助的DLK将家兔角膜植片移植到新西兰白兔模型眼,模型对照组不施加任何干预和治疗.分别于术后第1、2、4周各组各处死2只实验兔,将获取的角膜组织进行常规固定和包埋,然后制作切片,行苏木精-伊红染色,分别在光学显微镜和透射电子显微镜下观察角膜的组织病理学变化和超微结构变化.结果造模后可见烧伤区域角膜立刻变为瓷白色,结膜充血.术后4周,裂隙灯显微镜下可见治疗组兔眼角膜植片透明,而模型对照组兔眼角膜水肿,可见角巩膜缘结膜充血和少量新生血管.角膜组织病理学检查可见模型对照组角膜基质层水肿,胶原纤维排列疏松,纤维间可见大量空泡和少量新生血管,并有大量炎性细胞浸润,治疗组仅见角膜植片轻度水肿、透明,组织间未见炎性细胞浸润.透射电子显微镜观察可见,术后第1周治疗组兔角膜上皮细胞层中细胞间桥粒连接较多,细胞核完整;术后第4周角膜中央透明,基质中胶原纤维排列整齐,可见成纤维细胞;而模型对照组术后第4周可见角膜上皮表层扁平细胞的存在,部分上皮细胞脱落,形成角膜溃疡.结论角膜碱烧伤早期采用飞秒激光辅助的DLK进行治疗可有效阻止局部的炎症反应,防止碱性物质向角膜深层组织渗透而损伤角膜内皮及眼内组织,缩短病程. 揹景眼錶結構與功能的正常與穩定是維持角膜透明及視功能的重要保證,在眼化學燒傷傳統治療的基礎上對早期眼化學燒傷提齣新的治療理唸、掌握閤適的手術時機和嫻熟的手術技巧可減少堿性物質對角膜及眼內組織的進一步損害. 目的觀察飛秒激光輔助的深闆層角膜移植術(DLK)治療角膜急性堿燒傷的組織病理學及超微結構變化,探討角膜堿燒傷早期DLK治療的可行性及療效. 方法採用12隻成年健康新西蘭白兔,將浸有1 mol/L NaOH溶液30μl的直徑6 mm無菌濾紙片置于中央角膜30 s,建立角膜堿燒傷模型.模型兔用隨機數字錶法分為2箇組,飛秒激光輔助的DLK治療組(治療組)于角膜堿燒傷後24 h採用飛秒激光輔助的DLK將傢兔角膜植片移植到新西蘭白兔模型眼,模型對照組不施加任何榦預和治療.分彆于術後第1、2、4週各組各處死2隻實驗兔,將穫取的角膜組織進行常規固定和包埋,然後製作切片,行囌木精-伊紅染色,分彆在光學顯微鏡和透射電子顯微鏡下觀察角膜的組織病理學變化和超微結構變化.結果造模後可見燒傷區域角膜立刻變為瓷白色,結膜充血.術後4週,裂隙燈顯微鏡下可見治療組兔眼角膜植片透明,而模型對照組兔眼角膜水腫,可見角鞏膜緣結膜充血和少量新生血管.角膜組織病理學檢查可見模型對照組角膜基質層水腫,膠原纖維排列疏鬆,纖維間可見大量空泡和少量新生血管,併有大量炎性細胞浸潤,治療組僅見角膜植片輕度水腫、透明,組織間未見炎性細胞浸潤.透射電子顯微鏡觀察可見,術後第1週治療組兔角膜上皮細胞層中細胞間橋粒連接較多,細胞覈完整;術後第4週角膜中央透明,基質中膠原纖維排列整齊,可見成纖維細胞;而模型對照組術後第4週可見角膜上皮錶層扁平細胞的存在,部分上皮細胞脫落,形成角膜潰瘍.結論角膜堿燒傷早期採用飛秒激光輔助的DLK進行治療可有效阻止跼部的炎癥反應,防止堿性物質嚮角膜深層組織滲透而損傷角膜內皮及眼內組織,縮短病程.
배경 안표결구여공능적정상여은정시유지각막투명급시공능적중요보증,재안화학소상전통치료적기출상대조기안화학소상제출신적치료이념、장악합괄적수술시궤화한숙적수술기교가감소감성물질대각막급안내조직적진일보손해. 목적 관찰비초격광보조적심판층각막이식술(DLK)치료각막급성감소상적조직병이학급초미결구변화,탐토각막감소상조기DLK치료적가행성급료효. 방법 채용12지성년건강신서란백토,장침유1 mol/L NaOH용액30μl적직경6 mm무균려지편치우중앙각막30 s,건립각막감소상모형.모형토용수궤수자표법분위2개조,비초격광보조적DLK치료조(치료조)우각막감소상후24 h채용비초격광보조적DLK장가토각막식편이식도신서란백토모형안,모형대조조불시가임하간예화치료.분별우술후제1、2、4주각조각처사2지실험토,장획취적각막조직진행상규고정화포매,연후제작절편,행소목정-이홍염색,분별재광학현미경화투사전자현미경하관찰각막적조직병이학변화화초미결구변화.결과 조모후가견소상구역각막립각변위자백색,결막충혈.술후4주,렬극등현미경하가견치료조토안각막식편투명,이모형대조조토안각막수종,가견각공막연결막충혈화소량신생혈관.각막조직병이학검사가견모형대조조각막기질층수종,효원섬유배렬소송,섬유간가견대량공포화소량신생혈관,병유대량염성세포침윤,치료조부견각막식편경도수종、투명,조직간미견염성세포침윤.투사전자현미경관찰가견,술후제1주치료조토각막상피세포층중세포간교립련접교다,세포핵완정;술후제4주각막중앙투명,기질중효원섬유배렬정제,가견성섬유세포;이모형대조조술후제4주가견각막상피표층편평세포적존재,부분상피세포탈락,형성각막궤양.결론 각막감소상조기채용비초격광보조적DLK진행치료가유효조지국부적염증반응,방지감성물질향각막심층조직삼투이손상각막내피급안내조직,축단병정.
Background To maintain corneal transparency is important for good visual function.A new treatment concept and the selection of surgical techniques and timing of surgery are critical for stopping the infringement of cornea tissue after alkali burning and other chemical warfare agents.Objective This study was to investigative the ultrastructure and histopathological status following the femtosecond laser-assisted deep lamellar keratoplasty (DLK) for acute alkali burn of cornea.Methods Acute corneal alkali burn models were established in 12 New Zealand rabbits by putting the 6 mm filter paper with 1 mol/L NaOH at the central cornea for 30 seconds.The rabbits were randomly allocated to femtosecond laser-assisted DLK group and model control group according to the randomized number table method.Femtosecond laser-assisted DLK was performed to transplant the corneal grafts of domestic rabbits to the model rabbits 24 hours after burning.The rabbits were sacrificed 1 week,2 weeks and 4 weeks after modeling,and the corneas were extracted for the preparation of corneal section.The cornea were performed with hematoxylin and eosin staining to assess the histopathological status under the optical microscope,and the ultrastructure of grafts and corneas was examined under the transmission electron microscope (TEM).Results Acute corneal alkali bourn models were successfully eatablished.In the fourth week after surgery,corneal graft was clear in the femtosecond laser-assisted DLK group.However,corneal swelling,conjunctival congestion and neovascularization were found in the model control group.Histopathological examination revealed the defect of corneal epithelium,edema of stroma,loose arrangement of collagen fibers,much vacuoles,few neovascularization and infiltration of a large number of inflammatory cells in the model control group,but in the femtosecond laser-assisted DLK group,the inflammatory response was slight.More desmosomes among the endothelial cells were seen,and the nuclei were intact in the grafts.In the fourth week after surgery,the transplanted corneas were transparent with the regular arrangement of collagen fibers and entire fibroblasts in the femtosecond laser-assisted DLK group under the TEM.However,flat surface corneal epithelial cells and shedding of some epithelial cells were exhibited in the modelcontrol group.Conclusions Femtosecond laser-assisted DLK can effectively alleviate the inflammatory response,promote epithelial healing and enhance intercellular tight junction in the cornea with acute alkali burn.