5％高渗盐水和20％酒精对LASEK角膜上皮影响的比较研究

【作者】 张慧卿；

【导师】 牟国营；

【作者基本信息】 山东大学 ， 眼科学， 2007， 硕士

【摘要】 目的：评价用5％高渗盐水制作角膜上皮瓣的准分子激光上皮瓣下角膜磨镶术(LASEK)的有效性和安全性，并从组织病理学和细胞生物学方面比较5％高渗盐水和20％酒精对角膜上皮细胞活性的影响。方法：对84例中低度近视患者(168眼)随机取一眼行20％酒精制作角膜上皮瓣的LASEK术(A-LASEK)，另一眼行5％高渗盐水制作角膜上皮瓣的LASEK术(HS-LASEK)。术眼分别在20％酒精或5％高渗盐水浸泡25秒，松解角膜上皮，在制作上皮瓣前先沿瓣缘标记内侧刮取少量角膜上皮片(1mm×3mm大小)，随机取21例(42眼)的角膜上皮片用台盼蓝排斥法观察细胞存活率，21例(42眼)立即浸入装有培养液的无菌瓶中于30分钟内行细胞培养，21例(42眼)石蜡包埋，行HE染色，光镜下组织学观察。其余21例(42眼)做正常对照组，于浸泡前刮取角膜上皮行光镜观察及细胞培养。术后观察角膜上皮修复时间及裸眼视力、屈光度及角膜上皮下雾状混浊(Haze)情况，随访时间为6月。结果：正常角膜上皮细胞排列整齐致密，细胞无染色。20％酒精和5％高渗盐水浸泡25秒后的角膜上皮细胞存活率分别为(74.47±1.13)％、(89.15±1.27)％，差异有统计学意义。光镜组织学观察可见：酒精浸泡的角膜上皮细胞，表层上皮轻度水肿，基底细胞体积增大；高渗盐水处理的角膜上皮表层细胞未见异常，基底细胞轻度脱水。20％酒精及5％高渗盐水浸泡的角膜上皮细胞行细胞培养后能正常贴壁伸展，说明浸泡后的角膜上皮具有生物学活性。术后HS-LASEK眼上皮修复时间约为(3.65±0.28)天，A-LASEK眼上皮修复时间约为(4.29±0.57)天，两组比较差异有统计学意义(P＜0.05)；术后3天裸眼视力达到0.8者A-LASEK中有22眼(26.2％)，HS-LASEK中有40眼(47.6％)；术后1天A-LASEK者有21眼(25.0％)有明显的疼痛；HS-LASEK仅有10眼(11.9％)有明显疼痛(P＜0.05)。结论：高渗盐水制作的上皮瓣细胞活性高于酒精组，临床观察结果也表明术后患者角膜反应较轻，角膜上皮修复快，术后视力两组无显著差异。高渗盐水制作角膜上皮瓣的LASEK术是一种安全有效、预测性好的屈光手术。更多还原

【Abstract】 Objective: To compare the effectiveness of 5% hypertonic saline versus 20% alcohol to corneal epithelium in histopathology and cytobiology, and evaluate the effectiveness and safety of hypertonic saline (5% sodium chloride) -assisted laser-assisted subepithelial keratectomy (HS-LASEK). Methods: 84 patients(168 eyes) with moderate and low myopia were offered the choices to receive HS-LASEK in one eye and A-LASEK in the other eye (randomly assigned). After 5% hypertonic saline (or 20% achohol) application, a bit of corneal epithelium were scraped up for light microscopes, trypan blue staining and cell culture. Results: From the study of trypan blue staining, the corneal epithelial cells which were infiltrated by 5% hypertonic saline remained satisfactory vitality. The vitality of the corneal epithelial cells between 5% hypertonic saline-exposed and 20% alcohol-exposed had a significant difference. From light microscopic study, the corneal epithelial cells which were infiltrated by 20% alcohol were edema obviously, and some cells were breaded, while in 5% hypertonic saline-exposed corneal epithelium, the basal cells were dehydration. The mean time to epithelial healing was (4.29±0.57) days in A-LASEK eyes, while (3.65±0.28) days in HS-LASEK eyes. 3days after operation, 26.2% (22/84) of A-LASEK eyes and 47.6% (40/84) of HS-LASEK eyes had a visual acuity of 0. 8 or more. One day after operation 22eyes(26.2%) of A-LASEK and 21eyes(25.0%) of HS-LASEK has obvious pains, the difference between the two groups was statistically significant(P<0.05).Conclusion: The cytoactive of corneal epithelium in HS-LASEK was higher than in A-LASEK, In view of recent evidence regarding the epithelial toxic effects of alcohol, HS-LASEK might be a better treatment alternative.更多还原