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  本文選題：飛秒激光 + 角膜基質透鏡��； 參考：《復旦大學》2012年博士論文

【摘要】：第一部分飛秒激光角膜基質雙層掃描后基質切除的組織學觀察 目的探討飛秒激光角膜基質雙層掃描的可行性及效應,研究角膜內基質切除后創(chuàng)傷愈合與神經(jīng)損傷修復的組織學特點。 方法15只新西蘭純種白兔,隨機分為三組,根據(jù)使用的飛秒激光儀不同,分為：VisuMax組(VF組)、LDV組(DF組)、Intralase組(IF組)。每只實驗兔自身對照,一眼行飛秒激光掃描后角膜內基質組織板層切除,一眼對照。術眼分別于干預后1天、10天、1月、3月、6月進行檢查及取材。分別應用裂隙燈檢查、活體共聚焦顯微鏡、HE染色后光鏡、透射電鏡等方法觀察。 結果VF組切除組織為透鏡,邊緣相對纖薄,與周圍組織契合度好,而DF組及IF組切除組織為板層,邊緣相對較厚,基質板層切除后早期瓣下潛在間隙相對明顯,兩者切除組織的形態(tài)接近。三組飛秒激光角膜基質板層組織切除后,病理組織學表現(xiàn)為組織從水腫到吸收,愈合線從清晰到漸退,細胞從激活到安靜,細胞外基質從紊亂到規(guī)則,角膜神經(jīng)從細小到粗大到長而分支。 結論飛秒激光角膜基質雙層掃描后基質切除是可行的,三種飛秒中的VisuMax飛秒可切出透鏡組織。飛秒激光角膜基質掃描及組織切除后可發(fā)生較輕的創(chuàng)傷愈合反應,同時,神經(jīng)損傷修復需要一段時間。 第二部分飛秒激光角膜基質透鏡移植的組織學觀察 目的探討VisuMax飛秒激光角膜基質透鏡移植的可行性及移植后創(chuàng)傷愈合與神經(jīng)損傷修復的規(guī)律。 方法10只新西蘭純種白兔,使用德國Zeiss VisuMax飛秒激光儀,每只實驗兔右眼行飛秒激光小切口角膜基質透鏡切除(small incision lenticule extraction, SMILE);左眼用飛秒激光在角膜基質內掃描后制作成囊袋,將右眼切除的基質透鏡移植入左眼角膜基質袋。術眼分別于干預后1天、10天、1月、3月、6月進行檢查及取材。分別應用裂隙燈檢查、活體共聚焦顯微鏡、HE染色后光鏡、透射電鏡等方法觀察。 結果本研究中飛秒激光角膜基質透鏡移植后早期反應相對略重。病理組織學表現(xiàn)為組織從水腫到吸收,細胞外基質從紊亂到規(guī)則,移植組織與受體組織間界從清晰到融合,細胞從激活到安靜,角膜神經(jīng)從細小到粗大到長而分支的變化。 結論VisuMax飛秒激光角膜基質透鏡移植是可行的,透鏡可存活和融合�；|透鏡移植后創(chuàng)傷愈合與神經(jīng)損傷修復需要至少半年時間才達到較平穩(wěn)的程度。 第三部分飛秒LASIK角膜像差臨床研究 目的探討飛秒激光準分子激光原位角膜磨鑲術(LASIK)術后角膜前后表面高階像差的變化情況。 方法前瞻性連續(xù)病例研究。分三個中心收集VisuMax.LDV和Intralase飛秒激光儀輔助的LASIK手術及隨訪觀察資料。入選條件為自愿接受飛秒LASIK手術且經(jīng)嚴格術前檢查確認為適應癥的患者：年齡18-45周歲,屈光狀態(tài)為近視或近視散光,球鏡低于(含)-9.00DS,柱鏡低于(含)-3.00DC。共入選109人(207眼),男32人(62眼),女77人(145眼)。分別在術前、術后1周、1個月、3個月、6個月對術眼進行視力、屈光狀態(tài)及眼前節(jié)三維圖像采集,·采用Pentacam-HR眼前節(jié)分析系統(tǒng),記錄基于角膜前后表面高度圖獲取的分析直徑為5.5mm的角膜前后表面總像差均方根值、高階像差均方根值及各階像差的Zernike系數(shù),計算彗差和初級球差,采用方差分析及t檢驗進行統(tǒng)計分析。 結果1.所有手術病例未發(fā)生術中術后嚴重并發(fā)癥。2.視力：術后6個月VL組UCVA為1.17±0.17,DL組為1.17±0.16,IL組為1.25±0.20,各組裸眼視力較術前最佳矯正視力均有顯著提高(P0.05),各組間視力無統(tǒng)計學差異(P0.05)。3.屈光度：術后各組屈光狀態(tài)均達正視狀態(tài)。術后6個月VL組SE為-0.05±0.26,DL組為-0.02±0.18,IL組為-0.03±0.16,各組間無統(tǒng)計學差異(P0.05)。4.角膜像差：術后6個月VL組前表面RMS值為1.98±0.57,HOA為0.66±0.23,coma為0.41±0.24,Sph.A為0.40±0.18；DL組前表面RMS值為1.90±0.79,HOA為0.67±0.32,coma為0.50±0.25,Sph.A為-0.50±0.28；IL組前表面RMS值為0.30±0.06,HOA為0.29±0.07,coma為0.05±0.01,Sph.A為0.70±0.11。除IL組RMS及coma值外均較術前顯著增高(P0.05)。 結論飛秒LASIK角膜前后表面的像差變化在半年內是波動的,角膜后表面像差變化不明顯。VisuMax飛秒LASIK術后角膜前后表面像差變化與LDV一致。
[Abstract]:Histological observation of matrix excision after femtosecond laser corneal double layer scanning
Objective to investigate the feasibility and effect of femtosecond laser corneal stroma double layer scan, and to study the histological characteristics of wound healing and nerve injury repair after corneal stroma excision.
Methods 15 New Zealand white rabbits were divided into three groups randomly. According to the difference of the femtosecond laser, the rabbits were divided into group VisuMax (group VF), group LDV (group DF) and group Intralase (group IF). Each experimental rabbit's own control, one eye after the femtosecond laser scanning, the lamellar excision of the stroma tissue in the cornea, one eye control. The operation was 1 days, 10 days, January, and March respectively. In June, examination and sampling were performed. Slit lamp examination, in vivo confocal microscopy, HE staining, light microscopy and transmission electron microscopy were used.
Results the excised tissue in group VF was a lens with a relatively thin edge and good agreement with the surrounding tissue. The excised tissue in group DF and group IF was lamellar, and the edge was relatively thick. The early subsurface submergence in the gap was relatively obvious after the lamellar resection. The three groups of femtosecond laser keratomileusis were excised and the pathological form was observed. It is now the tissue from edema to absorption, the healing line from clear to fading, cells from activation to quiet, extracellular matrix from disorder to rules, and the branches of the cornea nerve from small to large to long.
Conclusion the stroma resection of femtosecond laser corneal stroma is feasible. The VisuMax femtosecond of the three femtosecond can cut the lens tissue. After femtosecond laser corneal stroma scanning and tissue resection, a lighter healing reaction can occur. At the same time, the repair of nerve injury needs a period of time.
Histological observation of second slice femtosecond laser corneal stroma lens transplantation
Objective to investigate the feasibility of VisuMax femtosecond laser corneal stroma transplantation and the rule of wound healing and nerve repair after transplantation.
Methods 10 New Zealand pure white rabbits were treated with the Zeiss VisuMax femtosecond laser apparatus in Germany. The right eye of each rabbit was excised by the small incision of the femtosecond laser stroma lens (small incision lenticule extraction, SMILE). The left eye was made into a bag with a femtosecond laser in the corneal stroma, and the left eye was transplanted into the left eye. Corneal stroma bags were performed on 1 days, 10 days, January, March, and June, respectively. The results were observed by slit lamp examination, confocal microscopy, HE staining and transmission electron microscopy, respectively.
Results in this study, the early reaction of the femtosecond laser corneal stroma lens was relatively slight. The histopathology showed tissue from edema to absorption, the extracellular matrix from disorder to rule, the intercellular boundary between the transplanted tissue and the receptor tissue from clear to fusion, the cell from activation to quiet, the angular membrane nerve from small to long and long to long.
Conclusion the VisuMax femtosecond laser corneal stroma lens transplantation is feasible and the lens can survive and fuse. It takes at least half a year to achieve a more stable degree of wound healing and repair of nerve injury after the matrix lens transplantation.
Clinical study of third parts of femtosecond LASIK corneal aberration
Objective to investigate the changes of corneal anterior and posterior surface high order aberrations after femtosecond laser in situ keratomileusis (LASIK).
Methods a prospective continuous case study. The VisuMax.LDV and Intralase femtosecond laser assisted LASIK surgery and follow-up observation data were collected in three centers. The conditions were eligible for voluntary femtosecond LASIK surgery and confirmed by strict preoperative examination: age 18-45, myopia or myopia astigmatism, and low sphere lens A total of 109 (207 eyes), 32 men (62 eyes) and 77 women (145 eyes) were selected from (207 eyes), 32 men and 145 eyes. The visual acuity, refractive state and three-dimensional image of the eyes were collected before operation, 1, 1 months, 3 months, and 6 months, respectively. The Pentacam-HR anterior segment analysis system was used to record the height map of the front and rear surface of the cornea. The total root mean square root of the front and rear surface of the cornea, the root mean square value of the high order aberration and the Zernike coefficient of each order aberration were analyzed, and the comet difference and the primary spherical aberration were calculated, and the analysis of variance analysis and t test were used for statistical analysis.
Results 1. of all the surgical cases did not have postoperative severe postoperative complications.2. vision: 6 months after operation, group VL UCVA was 1.17 + 0.17, group DL was 1.17 + 0.16, IL group was 1.25 + 0.20. The visual acuity of all groups was significantly higher than before operation (P0.05). There was no statistical difference (P0.05).3. diopter between each group: postoperative refractive state of each group 6 months after operation, group VL SE was -0.05 + 0.26, DL group was -0.02 0.18, IL group was -0.03 + 0.16. There was no statistical difference between groups (P0.05).4. corneal aberration: 6 months after operation, RMS value was 1.98 + 0.57, HOA was 0.41 + 0.23, 0.41 + 0.24 and 0.40 + 0.18. Coma was 0.50 + 0.25 and Sph.A was -0.50 + 0.28. The RMS value of the front surface of group IL was 0.30 + 0.06, HOA was 0.29 + 0.07, coma was 0.05 + 0.01, Sph.A was 0.70 + 0.11. except RMS and coma values.
Conclusion the aberration of the surface of femtosecond LASIK cornea fluctuates in half a year. The change of posterior corneal surface aberration is not obvious in.VisuMax femtosecond LASIK, and the change of corneal surface aberration is the same as that of LDV.

【學位授予單位】：復旦大學
【學位級別】：博士
【學位授予年份】：2012
【分類號】：R779.6

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本文編號：1784638