中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2015年
7期
520-526
,共7页
魏升升%王雁%左彤%林锦镛%王玉川
魏升升%王雁%左彤%林錦鏞%王玉川
위승승%왕안%좌동%림금용%왕옥천
角膜外科手术,激光%激光,飞秒%角膜基质%显微镜检查,电子,扫描%显微镜检查,电子,透射%微透镜,小切口
角膜外科手術,激光%激光,飛秒%角膜基質%顯微鏡檢查,電子,掃描%顯微鏡檢查,電子,透射%微透鏡,小切口
각막외과수술,격광%격광,비초%각막기질%현미경검사,전자,소묘%현미경검사,전자,투사%미투경,소절구
Corneal surgery,laser%Laser,femtosecond%Corneal stroma%Microscopy,electron,scanning%Microscopy,electron,transmission%Lenticule,small incision
目的:探索飞秒激光光裂解作用对活体人眼角膜组织的早期损伤情况。方法采用Visu Max飞秒激光系统对25只近视眼进行小切口基质内透镜取出术,分别对取出的角膜透镜组织进行光学显微镜、扫描电镜和透射电镜的观察。结果在光学显微镜下,角膜透镜组织中部分胶原纤维有轻度水肿;边缘可见一薄层组织深染,成线状排列;中央区透镜组织浅层可见到少量气泡。在扫描电镜下,透镜的前表面较为光滑,未见明显的组织桥,透镜后表面较前表面略显不规则,可见散在组织桥及之间飞秒激光光爆破作用后残留的痕迹。在透射电镜下,角膜透镜基质中相邻胶原纤维板层相互交叉规则排列,未见明显的胶原纤维的断裂和板层的分离。角膜透镜一侧切割缘胶原纤维断口呈线状。角膜透镜中心部位的角膜基质细胞损伤较轻。而距离透镜边缘较近的角膜基质细胞破坏较为明显,部分角膜细胞被固化,并且断裂成若干碎块。被破坏的角膜基质细胞有的仅留有残骸,部分角膜细胞所占据的空间成为裂隙。结论飞秒激光与人眼角膜组织相互作用后的早期未发现明显的损伤作用,激光聚焦区边缘的组织有轻度热损伤和细胞结构的改变,而非聚焦区域的组织结构未见异常表现。(中华眼科杂志,2015,51:520-526)
目的:探索飛秒激光光裂解作用對活體人眼角膜組織的早期損傷情況。方法採用Visu Max飛秒激光繫統對25隻近視眼進行小切口基質內透鏡取齣術,分彆對取齣的角膜透鏡組織進行光學顯微鏡、掃描電鏡和透射電鏡的觀察。結果在光學顯微鏡下,角膜透鏡組織中部分膠原纖維有輕度水腫;邊緣可見一薄層組織深染,成線狀排列;中央區透鏡組織淺層可見到少量氣泡。在掃描電鏡下,透鏡的前錶麵較為光滑,未見明顯的組織橋,透鏡後錶麵較前錶麵略顯不規則,可見散在組織橋及之間飛秒激光光爆破作用後殘留的痕跡。在透射電鏡下,角膜透鏡基質中相鄰膠原纖維闆層相互交扠規則排列,未見明顯的膠原纖維的斷裂和闆層的分離。角膜透鏡一側切割緣膠原纖維斷口呈線狀。角膜透鏡中心部位的角膜基質細胞損傷較輕。而距離透鏡邊緣較近的角膜基質細胞破壞較為明顯,部分角膜細胞被固化,併且斷裂成若榦碎塊。被破壞的角膜基質細胞有的僅留有殘骸,部分角膜細胞所佔據的空間成為裂隙。結論飛秒激光與人眼角膜組織相互作用後的早期未髮現明顯的損傷作用,激光聚焦區邊緣的組織有輕度熱損傷和細胞結構的改變,而非聚焦區域的組織結構未見異常錶現。(中華眼科雜誌,2015,51:520-526)
목적:탐색비초격광광렬해작용대활체인안각막조직적조기손상정황。방법채용Visu Max비초격광계통대25지근시안진행소절구기질내투경취출술,분별대취출적각막투경조직진행광학현미경、소묘전경화투사전경적관찰。결과재광학현미경하,각막투경조직중부분효원섬유유경도수종;변연가견일박층조직심염,성선상배렬;중앙구투경조직천층가견도소량기포。재소묘전경하,투경적전표면교위광활,미견명현적조직교,투경후표면교전표면략현불규칙,가견산재조직교급지간비초격광광폭파작용후잔류적흔적。재투사전경하,각막투경기질중상린효원섬유판층상호교차규칙배렬,미견명현적효원섬유적단렬화판층적분리。각막투경일측절할연효원섬유단구정선상。각막투경중심부위적각막기질세포손상교경。이거리투경변연교근적각막기질세포파배교위명현,부분각막세포피고화,병차단렬성약간쇄괴。피파배적각막기질세포유적부류유잔해,부분각막세포소점거적공간성위렬극。결론비초격광여인안각막조직상호작용후적조기미발현명현적손상작용,격광취초구변연적조직유경도열손상화세포결구적개변,이비취초구역적조직결구미견이상표현。(중화안과잡지,2015,51:520-526)
Objective To observe the changes of pathology and ultra-microstructure of corneal lenticules extracted by femtosecond laser small incision lenticule extraction surgery and to investigate instantaneous damage of photodisruption of femtosecond laser to human corneal tissue in vivo. Methods The small incision lenticule extraction surgeries in 25 myopic eyes were performed with Carl Zeiss VisuMax femtosecond laser, and the lenticules were observed by light microscopy, scanning electron microscopy and transmission electron microscopy. Results Light microscopy showed slight edema in part of the collagen fibers in the cornea lenticule tissue. A thin layer of deep tissue dyeing at the edge of the lenticule was observed on a linear array. In the center of superficial lenticule tissue existed a few bubbles. Under the scanning electron microscope, the anterior surface of the lenticule was found to be relatively smooth, with no obvious tissue bridge. The posterior surface of the lenticule was slightly irregular compared with the anterior surface. Scattered tissue bridges and residual traces of the effect of femtosecond laser photodisruption could be observed. Under the transmission electron microscope, adjacent collagen fiber layers in the corneal lenticule matrix were detected to cross each other regularly, with no breakage of the collagen fibers or separation of the layers. The incision of the collagen fibers on one side of the lenticule was on a linear alinement. It can also be observed that the central part of the lenticule was mildly damaged. However, the stroma cells near the lenticule limbus were severely damaged. Part of the corneal stroma cells were solidified with several shivers, which might be due to the photodisruption. Some of the damaged corneal stroma cells were observed with remnants, while the spaces occupied by part of the corneal cells became fractured. Conclusions Obvious damage of the femtosecond laser to the corneal tissue at early stage was not observed. At the edge of the area where femtosecond laser focused, there were mild thermal injury and slight structure change. There were not abnormal appearances of the tissue structure at the non-focus area.