【摘要】 目的评估飞秒激光辅助的基质透镜移植术的安全性、屈光度的变化及组织的修复。方法 6只新西兰大白兔,麻醉后左眼行飞秒激光小切口角膜基质透镜取出术(SMILE),右眼行飞秒激光辅助的自体角膜基质透镜术。术后1天、1周、1月、2月、3月行眼表反应、前节OCT、屈光状态、Pentacam角膜地形图及角膜共焦激光显微镜观察,术后3月观察完毕后处死兔子,行眼球摘除术,分离兔角膜,经苏木精-伊红染色,行光学显微镜观察。结果术后观察透镜保持透明,未见排斥反应。中央角膜厚度在透镜植入术前为(357.17±12.97)μm,术后1周、1月、3月分别为(433.67±12.19)μm、(423.50±13.49)μm、(417.33±12.08)μm;等效球镜术前为(0.57±1.13)D,术后1周、1月、3月的等效球镜分别为(-1.98±1.18)D、(-2.65±0.47)D、(-1.84±0.68)D;前表面Km术前为(47.80±1.02)D,术后1周、1月、3月分别(53.85±0.99)D、(52.67±1.32)D、(52.53±0.96)D;后表面Km术前为(-6.18±0.15)D,术后1周、1月、3月分别为(-5.78±0.19)D、(-5.73±0.20)D、(-5.50±0.14)D。整体比较术前术后的中央角膜厚度、等效球镜、前表面Km和后表面Km,差异均具有统计学意义(P<0.001),各个指标术后1周、1月、3月分别与术前相比差异均具有统计学意义(均为P<0.05),而各个指标在术后不同时间点两两相比差异均无统计学意义(P>0.05)。术后3个月随访前节OCT检查均可观察到透镜界面,但透镜界线随时间延长逐渐模糊;角膜共焦激光显微镜检查术后早期透镜界面可见高反光颗粒,1月可见神经纤维长入透镜,术后2月角膜细胞形态接近正常,术后3个月角膜细胞形态、数量基本正常,神经纤维可见细小分支;HE染色见角膜结构完整,移植的透镜在位,可观察到透镜的前后界面,纤维排列整齐,平行分布,结构清晰。结论自体角膜基质透镜植入有较好的安全性、有效性及稳定性。透镜植入术后角膜重塑及屈光度的变化尚需要更长时间和更多样本的观察研究。更多还原

【Abstract】 Objective To evaluate the safety, refraction changes and tissue repair of stromal lenticule transplantation assisted by femtosecond laser.Methods Six New Zealand white rabbits underwent SMILE in left eyes after anesthesia, and underwent femtosecond laser-assisted autologous corneal stromal lenticule surgery in right eyes. We observed the ocular inflammation, anterior segment OCT, refractive status, Pentacam corneal topography and corneal confocal laser microscope 1 day, 1 week, 1 month, 2 months, and 3 months after the operation. After 3 months of observation, the rabbits were sacrificed, the eyeballs were removed, the rabbit corneas were separated, stained with hematoxylin and eosin, and observed under an optical microscope.Results During the postoperative follow-up, the lenticule remained transparent and no rejection was seen. The central corneal thickness before lenticule implantation was(357.17±12.97) μm, it was(433.67±12.19) μm,(423.50±13.49) μm,(417.33±12.08) μm 1 week, 1 month, and 3 months after the operation. The spherical equivalent was(0.57±1.13)D before the surgery, and it was(-1.98±1.18)D,(-2.65±0.47)D,(-1.84±0.68)D 1 week, 1 month, and 3 months after the surgery. The anterior surface Km was(47.80±1.02) D before the surgery, and it was(53.85±0.99) D,(52.67±1.32) D,(52.53±0.96)D 1 week, 1 month, and 3 months after the surgery. The posterior surface Km was(-6.18±0.15)D before the surgery, and it was(-5.78±0.19)D and(-5.73±0.20)D,(-5.50±0.14)D 1 week, 1 month, and 3 months after the surgery. After the overall comparison of the preoperative and postoperative central corneal thickness, spherical equivalent, anterior surface Km and posterior surface Km, the differences were statistically significant(P<0.001). The indexes of 1 week, 1 month, and 3 months after the surgery were significantly different from those before the surgery(P<0.05), but no significant changes of each index were seen among different time points after the surgery(P>0.05). After 3 months of follow-up, the lenticule interface can be observed in the anterior segment OCT examination, but the lenticule boundary gradually becomes blurred with time. At early postoperatively, high reflective particles can be seen at the lenticule interface by corneal confocal laser microscopy. Nerve fibers can be seen to grow into the lenticule at 1 month after the surgery. The morphology of corneal cells was close to normal at 2 months after the surgery, and the morphology and number of corneal cells were basically normal at 3 months after the surgery, with small branches of nerve fibers. HE staining showed that the corneal structure was intact, the transplanted lenticule was in place, and the front and back interface of the lenticule could be observed. The fibers are arranged neatly, distributed in parallel, and the structure is clear. Conclusion Autologous corneal stromal lenticule implantation is safe, predictable, and has potential clinical value. Corneal remodeling and changes in refraction after corneal implantation need to be observed for a longer period of time with more samples.更多还原