摘要
目的对比研究去瓣型准分子激光上皮下角膜磨镶术(epi-polis laser in-situ keratomileusis,Epi-LASIK)和准分子激光屈光性角膜切削术(photorefractive keratectomy,PRK)对兔角膜病理的影响。方法新西兰白兔34只,随机取其中32只兔的右眼行去瓣型Epi-LASIK(A组),左眼行PRK(B组),另外2只兔(4只未手术眼)为正常对照组(C组)。术后4h、1d、3d、5d、7d、14d、1个月、3个月取角膜标本,HE染色观察角膜前基质细胞的数量变化,免疫细胞化学染色观察角膜中央区Ki-67、α-SMA阳性细胞数量及角膜切削缘区PCNA阳性细胞数量,同时透射电镜观察角膜超微结构的变化。结果正常角膜前基质细胞数量为每400倍光镜(88.00±5.38)个;术后各时间点B组前基质细胞数量均较A组少,差异均有显著统计学意义(均为P<0.01)。正常角膜上皮细胞基底层PCNA阳性细胞数量为每400倍光镜(15.94±3.02)个;术后1d、3d、5d、7d、14d A组PC-NA阳性细胞数量均较B组少,差异均有统计学意义(均为P<0.05或0.01)。正常角膜基质层几乎不表达Ki-67;术后4h、1d、3d、5d、7d、14d A组Ki-67阳性细胞数均较B组少,差异均有显著统计学意义(均为P<0.01)。正常角膜几乎不表达α-SMA;术后5d、7d、14d、1个月、3个月A组α-SMA阳性细胞数均较B组少,差异均有显著统计学意义(均为P<0.01)。透射电镜检查显示,术后7d之内A组细胞之间结合更紧密,3个月时基质内胶原纤维排列较整齐。结论去瓣型Epi-LASIK比PRK有着更轻的角膜上皮损伤反应,更少的角膜上皮细胞和角膜基质细胞增殖反应以及更低的向肌成纤维母细胞转化潜能,所以角膜上皮下雾状混浊(haze)发生的可能性更低。
Objective To investigate and compare the effects of off-flap epi-polis laser in-situ keratomileusis （Epi-LASIK） and photorefractive keratectomy （PRK） on corneal pathology in rabbits. Methods About 32 rabbits of 34 New Zealand white rabbits were randomly chosen in the experiment. Off-flap Epi-LASIK was performed on right eyes of 32 rabbits（ group A）and PRK on the left eyes（ group B）. The other 2 rabbits （4 eyes without operation） were treated as control group （ group C）. Corneal specimen were collected at postoperative 4 hours, 1 day,3 days,5 days,7 days, 14 days, 1 month and 3 months. HE staining was used to observe amount changes of anterior corneal stromal cells; Immunohistochemical staining was used to measure amounts of Ki-67 and a-SMA positive cells at corneal central areas and PCNA positive cells at corneal remotion limbus. At the same time, transmission electron microscope was used to observed changes of corneal ultrastrnctures. Results The number of anterior corneal stromal cells was（88.00 ± 5.38 ） at each 400 time light microscope in normal corneas; The number of anterior corneal stromal cells in group B was lower than that in group A at each postoperative time point, and there were significant differences （all P 〈 0.01 ）. The number of PCNA positive cells was （ 15.94 ± 3.02 ） at each 400 time light microscope in basal layer of normal corneal epithelial cells. The numbers of PCNA positive cells in group A were lower than those in group B at postoperative 1 day,3 days,5 days,7 days and 14 days（ all P 〈 0.05 or P 〈 0.01 ）. Ki-57 was hardly found in hypothallus of normal retinas; Ki-57 positive cells in group A were lower than those in group B at postoperative 4 hours, 1 day, 3 days, 5 days, 7 days and 14 days, and statistical differences were found （ all P 〈 0. 01 ）. a-SMA was hardly found in normal retinas;The numbers of a-SMA positive cells in group A were less than those in group B at postoperative 5 days,7 days, 14 days, 1 month,3 months,and significant difference were found （ all P 〈0.01 ）. Transmission electron microscope showed that the conjunction of cells in group A was more compacted within 7 days after operation,and the collagen fibers arranged more regularly at postoperative 3 months. Conclusion Compared with the PRK, the off-flap Epi-LASIK has the lower injury of corneal epithelium, proliferation response of corneal epithelial cells and corneal stromal cells,and the lower potentiality of the transformation to the myofibroblast, therefore, incidence of haze is lowest.
出处
《眼科新进展》
CAS
北大核心
2010年第8期718-722,共5页
Recent Advances in Ophthalmology
