本文選題：不同切削深度 + 準分子激光角膜切削術　； 參考：《南華大學》2011年碩士論文

【摘要】：目的研究不同切削深度兔準分子激光屈光性角膜切削術(Photorefractive keratectomy,PRK)和去瓣EPI-LASIK( Epipolis laser in-situ keratomileusis,EPI-LASIK)術后角膜上皮和基質(zhì)中細胞形態(tài)、炎癥細胞、以及細胞因子堿性成纖維細胞生長因子(Basicity fibroblast growth factor,bFGF)、核轉錄因子(Nuclear transcription factors,NF-κB)的表達,探討兩種手術方式在不同切削深度時早期角膜愈合反應,為臨床工作提供理論依據(jù)。 方法將所選實驗兔22只隨機分為三個組,高度切削組10只(-10.00D)、低度切削組10只(-3.00D)、剩余2只為空白對照組。建立實驗動物模型,右眼去瓣EPI-LASIK,左眼PRK,高度切削組和低度切削組于術后1d、3d、5d、7d空氣栓塞法每天隨機處死1只,共8只動物,剩余14只于術后7d一并處死,沿角膜緣取角膜組織。用熒光染色法每日觀察實驗動物術后眼部的基本狀況、角膜上皮的愈合情況以及愈合的時間;石蠟切片行HE染色光鏡觀察角膜上皮與基質(zhì)細胞的形態(tài)學變化和炎癥反應情況,并在光鏡下計數(shù)炎癥細胞的數(shù)量;免疫組化方法檢測早期角膜創(chuàng)傷愈合反應時細胞因子bFGF、NF-κB的表達,應用Image Pro Plus 5.0圖像分析系統(tǒng)進行定量分析;TUNEL法檢測角膜基質(zhì)細胞的凋亡情況。所有數(shù)據(jù)應用SPSS17.0行統(tǒng)計學分析。 結果1、眼部狀況:PRK眼術后癥狀明顯,3d時有所減輕,去瓣EPI-LASIK術后3d時癥狀基本消失,高度切削組較低度組癥狀明顯。2、角膜上皮愈合情況:熒光染色觀察,高度切削組PRK眼角膜上皮愈合時間最短3d,最長6d,平均為4.33d,去瓣EPI-LASIK眼角膜上皮愈合時間最短3d,最長5d,平均為3.83d,低度切削組愈合較快。3、角膜的形態(tài)學改變:在低度切削組,PRK術后角膜上皮過度增生,細胞排列紊亂,可見大量空泡細胞,基質(zhì)層排列紊亂,炎癥細胞浸潤。去瓣EPI-LASIK術后角膜上皮未見明顯增生,細胞和基質(zhì)層排列稍紊亂,未見明顯的空泡細胞和炎癥細胞浸潤。高度切削組形態(tài)學改變明顯。4、炎癥反應:低度切削組,PRK與去瓣EPI-LASIK角膜中炎癥細胞數(shù)量相比,差異無統(tǒng)計學意義(t=2.20,P0.05)。高度切削組,PRK較去瓣EPI-LASIK角膜中炎癥細胞的數(shù)量明顯增加,差異有統(tǒng)計學意義(t=10.32,P0.01)。5、角膜基質(zhì)細胞凋亡情況:低度切削組,PRK與去瓣EPI-LASIK相比,凋亡細胞的數(shù)量未見明顯異常(t=2.45,P0.05),而高度切削組,PRK較去瓣EPI-LASIK凋亡細胞的數(shù)量明顯增加,差異有統(tǒng)計學意義(t=6.03,P0.01)。6、角膜中bFGF、NF-κB的表達:PRK和去瓣EPI-LASIK術后角膜中bFGF、NF-κB的表達均較空白對照組增加,低度切削組,PRK與去瓣EPI-LASIK角膜中bFGF、NF-κB表達未見明顯異常(t=2.55,t=2.13,t=1.02,t=2.22,P0.05),而高度切削組,PRK較去瓣EPI-LASIK角膜中bFGF的表達減少,NF-κB的表達增加,兩者均有統(tǒng)計學意義(P0.01)。 結論去瓣EPI-LASIK用微型角膜刀制作上皮瓣并去除,基底膜完整,可以阻擋淚液及損傷細胞所釋放的各種因子,使術后角膜上皮愈合快,炎癥反應輕,尤其在高度切削時,去瓣EPI-LASIK較PRK有顯著的優(yōu)越性。
[Abstract]:Objective to study the effect of different cutting depth in rabbits after excimer laser photorefractive keratectomy (Photorefractive keratectomy PRK) and EPI-LASIK (Epipolis laser in-situ flap keratomileusis, EPI-LASIK) after cell morphology of corneal epithelium and stromal inflammatory cells, and cytokine basic fibroblast growth factor (Basicity fibroblast, growth factor, bFGF), nuclear transcription factors (Nuclear transcription factors, NF- K B) the expression of two kinds of operation mode in different cutting depth of early corneal wound healing response, and provide a theoretical basis for clinical work.
Methods the selected 22 experimental rabbits were randomly divided into three groups, high cutting group 10 (-10.00D), low cutting group 10 (-3.00D), the remaining 2 mice as control group. The establishment of experimental animal model, the right to left PRK, EPI-LASIK valve, high cutting group and low cutting group after operation. 1D, 3D, 5D, 7d were sacrificed 1 day air embolism method, a total of 8 animal, the remaining 14 rats at 7d after operation. All were killed, along the limbal corneal tissue. The basic condition of staining observed daily experimental animal postoperative ocular fluorescence, corneal epithelial healing and healing time of paraffin; the slices were stained by HE staining and morphological changes of the inflammatory response of light microscope to observe the corneal epithelium and stromal cells, and in the light microscope to count the number of inflammatory cells; immunohistochemical method to detect early corneal wound healing response of cytokine bFGF, expression of NF- kappa B, Image Pro with Plus 5 image The analysis system was used for quantitative analysis. The apoptosis of corneal stromal cells was detected by TUNEL method. All data were statistically analyzed by SPSS17.0.
The results of 1 eye condition: PRK eye postoperative symptoms, 3D decrease to EPI-LASIK flap 3D after the symptoms disappeared, high cutting group less obvious symptoms of group.2, corneal epithelial healing: fluorescent staining, the shortest 3D height of cornea ablation group PRK epithelial healing time, the longest 6D that was an average of 4.33d to EPI-LASIK corneal epithelial flap healing time 3D, the longest 5D, average 3.83d, low cutting group heal faster.3, the change of corneal morphology in low cutting group, PRK corneal epithelial hyperplasia, cell arrangement disorder, vacuoles cells, stromal layer derangement the infiltration of inflammatory cells. The postoperative corneal epithelial flap EPI-LASIK no obvious hyperplasia cells and stroma arranged a little disorder. No obvious vacuolar degeneration and inflammatory cell infiltration. Change the high cutting group obvious morphological.4, inflammatory reaction, low cutting group, PRK Compared with the number of inflammatory cells in the corneal flap EPI-LASIK, there was no statistically significant difference (t=2.20, P0.05). High cutting group, PRK compared to the number of inflammatory cells in the corneal flap EPI-LASIK increased significantly, the difference was statistically significant (t=10.32, P0.01).5, corneal stromal cell apoptosis: low cutting group, compared with PRK to flap EPI-LASIK, number of apoptotic cells was significantly abnormal (t=2.45, P0.05), and high cutting group, the number of apoptotic cells compared to the PRK EPI-LASIK flap was significantly increased, the difference was statistically significant (t=6.03, P0.01).6, corneal bFGF, expression of NF- kappa B: bFGF PRK and EPI-LASIK corneal flap in the expression of NF- kappa B increased significantly compared with the blank control group, low cutting group, PRK and bFGF to EPI-LASIK in NF- corneal flap, kappa B expression had no obvious abnormalities (t=2.55, t=2.13, t=1.02, t=2.22, P0.05), and high cutting group, compared to the PRK bFGF EPI-LASIK in the form of corneal flap The expression of NF- kappa B increased, and both had statistical significance (P0.01).
Conclusion EPI-LASIK flap made by microkeratome flap and removal of basement membrane integrity, various factors can stop the tear and damage cells release, the postoperative corneal epithelium healing, less inflammatory reaction, especially in high cutting, to flap EPI-LASIK than PRK has obvious advantages.

【學位授予單位】：南華大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R779.63

【參考文獻】

相關期刊論文 前10條

1 沈政偉;尹禾;吳金桃;李立婕;李麗;;上皮瓣棄留對Epi-LASIK矯正近視臨床療效影響的研究[J];國際眼科雜志;2007年06期

2 張建華,鄭磊,柳林,王康孫,廉井財;PRK后兔角膜成纖維細胞分泌產(chǎn)生bFGF、TGF-β_1及其對成纖維細胞增殖的影響[J];眼科新進展;2000年03期

3 牟章兵;杜之渝;晏丕松;;漢防己甲素等5種抗纖維化藥物對離體兔角膜基質(zhì)細胞的抑制作用[J];眼科新進展;2006年08期

4 李紅,郭玉,廖端芳,袁滿紅;甘草次酸抑制兔準分子激光角膜切削術后角膜上皮下混濁的作用[J];中國藥理學通報;2004年03期

5 陳兵,廉井財;中藥滴眼液治療準分子激光角膜切削術后角膜上皮下霧狀混濁[J];中國中醫(yī)眼科雜志;2003年04期

6 康鳳英,陶靖,李前進,祝壽榮,鄧愛軍,劉曉方;準分子激光屈光性角膜切削術后兔角膜基質(zhì)細胞凋亡及其防治的研究[J];中華眼科雜志;2002年07期

7 馬曉華,李鏡海,畢宏生,周芳,李艷;準分子激光角膜切削術與準分子激光原位角膜磨鑲術角膜創(chuàng)口愈合的對比實驗研究[J];中華眼科雜志;2003年03期

8 戴錦暉,陳沖達,褚仁遠,周行濤,瞿小妹,王曉瑛,于志強,張寶華;機械法準分子激光角膜上皮瓣下磨鑲術矯治高度近視[J];中華眼科雜志;2005年03期

9 李巖,龐國祥,詹素華,金玉梅,孫玉敏,李瑩,李維業(yè);準分子激光兔角膜切削術后細胞凋亡和增殖[J];中華眼科雜志;1999年01期

10 杜之渝,鄭晴,張大勇,郭紅,陳曜,尹宏民;角膜Bowman′s層功能的研究[J];中國實用眼科雜志;2002年10期

，

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