飞秒激光角膜基质透镜移植实验与飞秒LASIK角膜像差临床研究

发布时间：2018-04-21 23:35

本文选题：飞秒激光 + 角膜基质透镜　；参考：《复旦大学》2012年博士论文

【摘要】：第一部分飞秒激光角膜基质双层扫描后基质切除的组织学观察目的探讨飞秒激光角膜基质双层扫描的可行性及效应,研究角膜内基质切除后创伤愈合与神经损伤修复的组织学特点。方法15只新西兰纯种白兔,随机分为三组,根据使用的飞秒激光仪不同,分为：VisuMax组(VF组)、LDV组(DF组)、Intralase组(IF组)。每只实验兔自身对照,一眼行飞秒激光扫描后角膜内基质组织板层切除,一眼对照。术眼分别于干预后1天、10天、1月、3月、6月进行检查及取材。分别应用裂隙灯检查、活体共聚焦显微镜、HE染色后光镜、透射电镜等方法观察。结果VF组切除组织为透镜,边缘相对纤薄,与周围组织契合度好,而DF组及IF组切除组织为板层,边缘相对较厚,基质板层切除后早期瓣下潜在间隙相对明显,两者切除组织的形态接近。三组飞秒激光角膜基质板层组织切除后,病理组织学表现为组织从水肿到吸收,愈合线从清晰到渐退,细胞从激活到安静,细胞外基质从紊乱到规则,角膜神经从细小到粗大到长而分支。结论飞秒激光角膜基质双层扫描后基质切除是可行的,三种飞秒中的VisuMax飞秒可切出透镜组织。飞秒激光角膜基质扫描及组织切除后可发生较轻的创伤愈合反应,同时,神经损伤修复需要一段时间。第二部分飞秒激光角膜基质透镜移植的组织学观察目的探讨VisuMax飞秒激光角膜基质透镜移植的可行性及移植后创伤愈合与神经损伤修复的规律。方法10只新西兰纯种白兔,使用德国Zeiss VisuMax飞秒激光仪,每只实验兔右眼行飞秒激光小切口角膜基质透镜切除(small incision lenticule extraction, SMILE);左眼用飞秒激光在角膜基质内扫描后制作成囊袋,将右眼切除的基质透镜移植入左眼角膜基质袋。术眼分别于干预后1天、10天、1月、3月、6月进行检查及取材。分别应用裂隙灯检查、活体共聚焦显微镜、HE染色后光镜、透射电镜等方法观察。结果本研究中飞秒激光角膜基质透镜移植后早期反应相对略重。病理组织学表现为组织从水肿到吸收,细胞外基质从紊乱到规则,移植组织与受体组织间界从清晰到融合,细胞从激活到安静,角膜神经从细小到粗大到长而分支的变化。结论VisuMax飞秒激光角膜基质透镜移植是可行的,透镜可存活和融合。基质透镜移植后创伤愈合与神经损伤修复需要至少半年时间才达到较平稳的程度。第三部分飞秒LASIK角膜像差临床研究目的探讨飞秒激光准分子激光原位角膜磨镶术(LASIK)术后角膜前后表面高阶像差的变化情况。方法前瞻性连续病例研究。分三个中心收集VisuMax.LDV和Intralase飞秒激光仪辅助的LASIK手术及随访观察资料。入选条件为自愿接受飞秒LASIK手术且经严格术前检查确认为适应症的患者：年龄18-45周岁,屈光状态为近视或近视散光,球镜低于(含)-9.00DS,柱镜低于(含)-3.00DC。共入选109人(207眼),男32人(62眼),女77人(145眼)。分别在术前、术后1周、1个月、3个月、6个月对术眼进行视力、屈光状态及眼前节三维图像采集,·采用Pentacam-HR眼前节分析系统,记录基于角膜前后表面高度图获取的分析直径为5.5mm的角膜前后表面总像差均方根值、高阶像差均方根值及各阶像差的Zernike系数,计算彗差和初级球差,采用方差分析及t检验进行统计分析。结果1.所有手术病例未发生术中术后严重并发症。2.视力：术后6个月VL组UCVA为1.17±0.17,DL组为1.17±0.16,IL组为1.25±0.20,各组裸眼视力较术前最佳矫正视力均有显著提高(P0.05),各组间视力无统计学差异(P0.05)。3.屈光度：术后各组屈光状态均达正视状态。术后6个月VL组SE为-0.05±0.26,DL组为-0.02±0.18,IL组为-0.03±0.16,各组间无统计学差异(P0.05)。4.角膜像差：术后6个月VL组前表面RMS值为1.98±0.57,HOA为0.66±0.23,coma为0.41±0.24,Sph.A为0.40±0.18；DL组前表面RMS值为1.90±0.79,HOA为0.67±0.32,coma为0.50±0.25,Sph.A为-0.50±0.28；IL组前表面RMS值为0.30±0.06,HOA为0.29±0.07,coma为0.05±0.01,Sph.A为0.70±0.11。除IL组RMS及coma值外均较术前显著增高(P0.05)。结论飞秒LASIK角膜前后表面的像差变化在半年内是波动的,角膜后表面像差变化不明显。VisuMax飞秒LASIK术后角膜前后表面像差变化与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.

【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R779.6

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