不同制瓣方法LASIK术后眼表与细胞因子相关性研究

发布时间：2018-04-29 06:14

本文选题：准分子激光原位角膜磨镶术 + 症状　；参考：《天津医科大学》2012年硕士论文

【摘要】：目的 1.分析飞秒激光制瓣与机械板层刀制瓣LASIK术后眼表症状与临床体征的特点,研究不同制瓣方法术后眼表症状与临床体征的差异。 2．利用细胞因子芯片技术,分析飞秒激光制瓣与机械板层刀制瓣LASIK术前术后,及两种制瓣术式LASIK术后组间细胞因子的变化,通过分析结果对TNF-α及GRO-α两个因子做ELISA定量分析,以期发现TNF-α及GRO-α与不同制瓣方法LASIK术后眼表症状与临床体征之间的关系。方法 1.选取2010年9月至2011年7月在天津医科大学眼科中心接受LASIK手术治疗的患者进行非随机前瞻性对照研究。根据患者对手术的自愿选择原则分为两组：一组为飞秒组,共25例(50眼),另一组为机械板层刀组,共35例(70眼)。于术前,术后1天,1个月,3个月进行干眼问卷调查,角膜知觉检查,裂隙灯眼前节检查,泪膜破裂时间(TBUT)以及荧光素眼表染色检查,SchirmerI试验。 2.随机选择术前病人10例,飞秒组术后病人10例,机械板层刀组术后病人10例,应用细胞因子芯片分析毛细管收集到的泪液。另随机选取两组病人各15例,进行ELISA定量测定泪液中TNF-α及GRO-α的浓度。结果 1术后1周飞秒组有7种症状,机械板层刀组有9种症状的发生率显著高于术前(p0.05)。术后1个月,飞秒组与机械板层刀组分别有3种及4种症状发生率显著高于术前(p0.05),至术后3个月,两组各种症状的发生率均与术前相当(P0.05)。 2术后3个月飞秒组角膜知觉恢复至术前水平,机械板层刀组尚未恢复至术前水平,两组间差异有统计学意义(p0.05)。 3飞秒组术后TBUT变化微小,术后1周,1个月,3个月飞秒组TBUT均显著高于机械板层刀组(p0.05)。 4术后1周,飞秒组荧光素染色得分显著低于机械板层刀组(p0.05),术后1个月、3个月两组间差异没有统计学意义(P0.05)。 5术后1周、1个月、3个月飞秒组与机械板层刀组Schirmer Ⅰ值间差异均没有统计学意义(P0.05),但术后3个月,飞秒组Schirmer Ⅰ值高于机械板层刀组。 6采用细胞芯片技术对不同制瓣方法LASIK术前术后泪液中细胞因子的变化进行筛选,发现机械板层刀组术后有4种细胞因子含量增多,1种下降；飞秒组术后有5种细胞因子增多,1种下降。 7应用ELISA技术定量测定TNF-α及GRO-α的浓度。术后1周,两组泪液中TNF-α浓度均显著上升,至术后3个月,基本恢复至术前水平。各时间点两组间差异均没有统计学意义(P0.05)。术后1周,两组泪液中GRO-α浓度均显著下降,且两组间差异有统计学意义(p0.05),术后1个月,GRO-α浓度有所回升,术后3个月,基本恢复至术前水平,术后1个月、3个月两组间差异没有统计学意义(P0.05)。结论 1飞秒激光制瓣LASIK术后较机械板层刀制瓣术后各项眼表症状及体征较轻,术后3个月,飞秒组基本恢复至术前水平,而机械板层刀组尚未恢复至术前水平。 2术后1周,机械板层刀组GRO-α的下降显著低于飞秒组,推测可能与飞秒激光对角膜的损伤较小有关,另一方面,飞秒组较高的GRO-α水平促进了角膜伤口的愈合,从而飞秒组眼表症状与体征的恢复快于机械板层刀组。 3TNF-α与GRO-α的作用是一个错综复杂的网络,其互相影响,互相制约,又有各自的作用方式,与LASIK术后泪膜的变化,泪液的分泌、感觉的恢复等有复杂而相关的关系,其二者间也是相互影响、相互制约的。
[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.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.63

【参考文献】