本文選題：準(zhǔn)分子激光原位角膜磨鑲術(shù) + 癥狀��； 參考：《天津醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的 1.分析飛秒激光制瓣與機(jī)械板層刀制瓣LASIK術(shù)后眼表癥狀與臨床體征的特點(diǎn),研究不同制瓣方法術(shù)后眼表癥狀與臨床體征的差異。 2．利用細(xì)胞因子芯片技術(shù),分析飛秒激光制瓣與機(jī)械板層刀制瓣LASIK術(shù)前術(shù)后,及兩種制瓣術(shù)式LASIK術(shù)后組間細(xì)胞因子的變化,通過分析結(jié)果對(duì)TNF-α及GRO-α兩個(gè)因子做ELISA定量分析,以期發(fā)現(xiàn)TNF-α及GRO-α與不同制瓣方法LASIK術(shù)后眼表癥狀與臨床體征之間的關(guān)系。 方法 1.選取2010年9月至2011年7月在天津醫(yī)科大學(xué)眼科中心接受LASIK手術(shù)治療的患者進(jìn)行非隨機(jī)前瞻性對(duì)照研究。根據(jù)患者對(duì)手術(shù)的自愿選擇原則分為兩組：一組為飛秒組,共25例(50眼),另一組為機(jī)械板層刀組,共35例(70眼)。于術(shù)前,術(shù)后1天,1個(gè)月,3個(gè)月進(jìn)行干眼問卷調(diào)查,角膜知覺檢查,裂隙燈眼前節(jié)檢查,淚膜破裂時(shí)間(TBUT)以及熒光素眼表染色檢查,SchirmerI試驗(yàn)。 2.隨機(jī)選擇術(shù)前病人10例,飛秒組術(shù)后病人10例,機(jī)械板層刀組術(shù)后病人10例,應(yīng)用細(xì)胞因子芯片分析毛細(xì)管收集到的淚液。另隨機(jī)選取兩組病人各15例,進(jìn)行ELISA定量測(cè)定淚液中TNF-α及GRO-α的濃度。 結(jié)果 1術(shù)后1周飛秒組有7種癥狀,機(jī)械板層刀組有9種癥狀的發(fā)生率顯著高于術(shù)前(p0.05)。術(shù)后1個(gè)月,飛秒組與機(jī)械板層刀組分別有3種及4種癥狀發(fā)生率顯著高于術(shù)前(p0.05),至術(shù)后3個(gè)月,兩組各種癥狀的發(fā)生率均與術(shù)前相當(dāng)(P0.05)。 2術(shù)后3個(gè)月飛秒組角膜知覺恢復(fù)至術(shù)前水平,機(jī)械板層刀組尚未恢復(fù)至術(shù)前水平,兩組間差異有統(tǒng)計(jì)學(xué)意義(p0.05)。 3飛秒組術(shù)后TBUT變化微小,術(shù)后1周,1個(gè)月,3個(gè)月飛秒組TBUT均顯著高于機(jī)械板層刀組(p0.05)。 4術(shù)后1周,飛秒組熒光素染色得分顯著低于機(jī)械板層刀組(p0.05),術(shù)后1個(gè)月、3個(gè)月兩組間差異沒有統(tǒng)計(jì)學(xué)意義(P0.05)。 5術(shù)后1周、1個(gè)月、3個(gè)月飛秒組與機(jī)械板層刀組Schirmer Ⅰ值間差異均沒有統(tǒng)計(jì)學(xué)意義(P0.05),但術(shù)后3個(gè)月,飛秒組Schirmer Ⅰ值高于機(jī)械板層刀組。 6采用細(xì)胞芯片技術(shù)對(duì)不同制瓣方法LASIK術(shù)前術(shù)后淚液中細(xì)胞因子的變化進(jìn)行篩選,發(fā)現(xiàn)機(jī)械板層刀組術(shù)后有4種細(xì)胞因子含量增多,1種下降；飛秒組術(shù)后有5種細(xì)胞因子增多,1種下降。 7應(yīng)用ELISA技術(shù)定量測(cè)定TNF-α及GRO-α的濃度。術(shù)后1周,兩組淚液中TNF-α濃度均顯著上升,至術(shù)后3個(gè)月,基本恢復(fù)至術(shù)前水平。各時(shí)間點(diǎn)兩組間差異均沒有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后1周,兩組淚液中GRO-α濃度均顯著下降,且兩組間差異有統(tǒng)計(jì)學(xué)意義(p0.05),術(shù)后1個(gè)月,GRO-α濃度有所回升,術(shù)后3個(gè)月,基本恢復(fù)至術(shù)前水平,術(shù)后1個(gè)月、3個(gè)月兩組間差異沒有統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論 1飛秒激光制瓣LASIK術(shù)后較機(jī)械板層刀制瓣術(shù)后各項(xiàng)眼表癥狀及體征較輕,術(shù)后3個(gè)月,飛秒組基本恢復(fù)至術(shù)前水平,而機(jī)械板層刀組尚未恢復(fù)至術(shù)前水平。 2術(shù)后1周,機(jī)械板層刀組GRO-α的下降顯著低于飛秒組,推測(cè)可能與飛秒激光對(duì)角膜的損傷較小有關(guān),另一方面,飛秒組較高的GRO-α水平促進(jìn)了角膜傷口的愈合,從而飛秒組眼表癥狀與體征的恢復(fù)快于機(jī)械板層刀組。 3TNF-α與GRO-α的作用是一個(gè)錯(cuò)綜復(fù)雜的網(wǎng)絡(luò),其互相影響,互相制約,又有各自的作用方式,與LASIK術(shù)后淚膜的變化,淚液的分泌、感覺的恢復(fù)等有復(fù)雜而相關(guān)的關(guān)系,其二者間也是相互影響、相互制約的。
[Abstract]:objective
1. to analyze the characteristics of the ocular surface symptoms and clinical signs after the femtosecond laser making and mechanical lamellar knife LASIK, and to study the difference between the ocular surface symptoms and the clinical signs after different valve making methods.
2. using the cytokine chip technique, the changes of the cell factors between the femtosecond laser disc and the mechanical lamellar knife LASIK before and after the two kinds of valve operation were analyzed. Through the analysis, two factors of TNF- A and GRO- a were analyzed by ELISA quantitative analysis, in order to find the ocular surface disorder after LASIK operation of TNF- alpha and GRO- A and different valve making methods. The relationship between the symptoms and the clinical signs.
Method
1. selected patients who were treated with LASIK surgery in Ophthalmological Center of Tianjin Medical University from September 2010 to July 2011 were divided into two groups: one group was femtosecond group, 25 cases (50 eyes), and another group of mechanical plate knife group, 35 cases (70 eyes). Before operation, 1 days after operation, 1 The dry eye questionnaire survey, corneal perception examination, slit lamp anterior segment examination, tear film rupture time (TBUT) and fluorescein ocular staining examination, and SchirmerI test were conducted in the month, 3 months.
2. randomly selected 10 cases of preoperative patients, 10 patients in femtosecond group and 10 patients in mechanical lamellar knife group, using cell factor chip to analyze the capillary collected by capillary. Another two groups of patients were randomly selected in 15 cases, and the concentration of TNF- A and GRO- alpha in tears was measured by ELISA.
Result
There were 7 symptoms in the femtosecond group at the 1 week after 1, and the incidence of 9 symptoms in the mechanical plate knife group was significantly higher than that before the operation (P0.05). 1 months after the operation, 3 and 4 symptoms in the femtosecond group and the mechanical plate knife group were significantly higher than that before the operation (P0.05), and the incidence of all kinds of symptoms in the two group was equal to that before the operation (P0.05).
2 after 3 months, the femtosecond corneal sensation recovered to the preoperative level, and the mechanical lamina knife group had not been restored to the preoperative level. The difference between the two groups was statistically significant (P0.05).
3 the TBUT changes in the femtosecond group were slight, and the femtosecond TBUT in 1 weeks, 1 months and 3 months after operation were significantly higher than those in the mechanical lamina knife group (P0.05).
4 after 1 weeks, the score of fluorescein staining in the femtosecond group was significantly lower than that in the mechanical lamina knife group (P0.05). There was no significant difference between the two groups at 1 months and 3 months after operation (P0.05).
There was no significant difference in the Schirmer I value between the 1 weeks, 1 months, 3 months and the mechanical plate knife group (P0.05), but the Schirmer I value of femtosecond group Schirmer I was higher than that of the mechanical lamellar knife group at 3 months after the operation.
6 cell chip technique was used to screen the changes of cytokines in the tears of LASIK before and after different valve making methods. It was found that there were 4 kinds of cytokines in the mechanical plate knife group and 1 kinds of cytokines, 5 cytokines increased and 1 decreased after the femtosecond group.
7 ELISA technique was used to quantify the concentration of TNF- A and GRO- alpha. 1 weeks after operation, the concentration of TNF- alpha in the two groups of tears was significantly increased to 3 months after the operation. The difference between the two groups was not statistically significant (P0.05). The concentration of GRO- alpha in the tears of the two groups decreased significantly at the 1 weeks after the operation, and the difference between the two groups was statistically significant. Significance (P0.05), 1 months after operation, the concentration of GRO- alpha recovered, 3 months after operation, basically recovered to the preoperative level, 1 months after the operation, 3 months between the two groups had no statistical significance (P0.05).
conclusion
The symptoms and signs of the eye surface after the 1 femtosecond laser disc LASIK were less than that of the mechanical lamellar knife. 3 months after the operation, the femtosecond group basically recovered to the preoperative level, while the mechanical plate knife group had not recovered to the preoperative level.
At the 1 week after 2, the decrease of GRO- alpha in the mechanical plate knife group was significantly lower than that in the femtosecond group. It is presumed that it may be related to the smaller damage to the cornea by the femtosecond laser. On the other hand, the higher GRO- alpha level in the femtosecond group promotes the healing of the corneal wound, thus the recovery of the symptoms and signs of the eye surface in the femtosecond group is faster than that of the mechanical lamina knife group.
The role of 3TNF- alpha and GRO- alpha is an intricate network, which affects each other, restricts each other, and has its own way of action. It has a complex and related relationship with the changes in tear film after LASIK, the secretion of tears, and the recovery of feeling. The two are also interrelated and mutually restricted.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R779.63

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