摘要
目的探讨准分子激光原位角膜磨镶术（LASIK）后弥漫性板层角膜炎（DLK）的临床病理学特征及发病机制。方法LASIK术后DLK患者30例（39只眼）（Ⅰ～Ⅳ期），术后1、3、5、7d及1个月进行裂隙灯显微镜检查，术后3、7d及1个月进行共焦显微镜检查。结果Ⅰ期及Ⅱ期DLK的典型表现出现在术后3d，共焦显微镜观察所见：角膜板层切口前基质及层间可见大量直径12～20μm的圆形或卵圆形细胞，反光较强，散在分布或排列成行，细胞内可见偏心的高反光的核和低反光的细胞内结构。层间还可见大量直径8～12μm的圆形细胞，强反光，多聚集成簇或排列成行，细胞核形态不规则。术后7d上述细胞几乎消失。Ⅲ期DLK出现于术后3～5d，表现为前基质中的细胞浸润更浓密，层间无定形的高反光物质较明显。Ⅳ期DLK在术后5～7d出现明显的前基质结构模糊，高反光，角膜瓣全层皱褶，晚期形成大量高反光的瘢痕组织。结论LASIK术后弥漫性板层角膜炎是角膜瓣层间的炎性反应，主要病理学特征为角膜瓣层间的炎性细胞浸润，其发病是多种因素通过内源性途径和外源性途径共同作用的结果。
Objective To investigate the clinical pathologic characteristics and the pathogenesis of diffuse lamellar keratitis（DLK） after laser in situ keratomileusis（LASIK）. Methods On 30 patients with 39 eyes being diagnosed with DLK（ grade Ⅰ -grade Ⅳ） after LASIK,slit-lamp examinations were performed 1,3,5, 7 and 30 days postoperatively, and scanning slit confocal microscope in vivo were performed 3, 7 and 30 days postoperatively. Results Typical characteristics of grade Ⅰ and grade Ⅱ DLK by confocal microscope examination showed up at 3 days postoperatively. We found that the epithelium, the posterior stroma and the endothelium were normal. In the lamella in front of the incision, many round or oval-shaped cells with diameter of approximately 12 - 20 μm were detected. These cells had eccentric, highly reflective nuclei and less reflective intracellular structures. They were most likely to be mononuclear cells. These cells distributed diffusely or arranged in line shape. In the lamella, clusters and lines of small, highly reflective, irregular shaped cells 8 to 10μm in diameter were seen. They were similar to granulocytes or lymphocytes. Seven days postoperatively, these cells almost disappeared. Grade Ⅲ DLK appeared from 3 to 5 days postoperatively, with more dense infiltration and more highly reflective irregular shape materials in the lamella. GradeIV DLK appeared 5 to 7 days postoperatively. Anterior stroma structure became unclear, with highly reflective and folded corneal flap. Numerous highly reflective scarring formed late. Conclusions DLK after LASIK is a inflammatory response in corneal lamella, its typical pathologic characteristic is inflammatory cells infiltration in the lamella. Several factors work together to cause DLK through endogenous and exogenous mechanisms.
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2006年第4期330-333,共4页
Chinese Journal of Ophthalmology
