LASEK术中应用丝裂霉素C对角膜内皮细胞形态影响的研究

发布时间：2018-05-13 21:29

本文选题：准分子激光上皮瓣下角膜磨镶术 + 丝裂霉素C　；参考：《宁夏医科大学》2012年硕士论文

【摘要】：目的：研究准分子激光上皮瓣下角膜磨镶术（LASEK）中使用丝裂霉素C（MMC）对角膜内皮细胞的影响及其与残余角膜基质厚度、MMC作用时间的关系，并分析该手术中MMC使用的安全性问题。方法：选择行LASEK手术的病例49例（98只眼），术中激光切削后，使用0.02%丝裂霉素C吸血海绵片覆盖于残余角膜基质床上，根据预矫屈光度数调整MMC的使用时间。分组方式一，根据预矫屈光度数计算残余角膜基质厚度（d），分为A、B、C三组，其中A组：300μm≤d320μm，共11只眼；B组：320μm≤d340μm，共10只眼；C组：d≥340μm，共77只眼；分组方式二：按照术中MMC与角膜基质接触的时间（t），分为T1、T2两组，其中T1组：15s≤t≤45s，，共65只眼；T2组：45st≤70s，共33只眼。分别于术前,术后1周、1月、3月、6月时，采用非接触式角膜内皮细胞计测定角膜中央点、周边四点的角膜内皮细胞密度、六边形细胞百分比、变异系数、平均细胞面积、面积标准差、最大细胞面积、最小细胞面积，并利用SPSS软件统计数据，分析角膜内皮细胞各个参数的变化情况。结果：1.不同残余角膜基质厚度组间、不同MMC作用时间组间中央、周边角膜内皮细胞密度、变异系数、面积标准差、六边形细胞百分比、平均细胞面积、最大细胞面积、最小细胞面积分别互相比较时，均无显著性差异（P0.05）；每组在相同时期中央与周边角膜内皮细胞相同参数比较差异均无统计学意义（P0.05）。 2.按残余角膜基质厚度分组时：A、B、C三组术后不同时期，中央、周边角膜内皮细胞参数与术前相比： 1)角膜内皮细胞密度、面积标准差、最大细胞面积、最小细胞面积均与术前相比无显著性差异（P0.05）； 2) B组术后1月时中央角膜内皮细胞变异系数与术前相比差异有统计学意义（P0.05），术后1月明显大于术前，其余与术前相比无显著性差异（P0.05）； 3) A、B、C三组术后1周时中央角膜内皮细胞六边形细胞百分比与术前相比差异均有统计学意义（P0.05），术后1周明显小于术前，其余与术前相比无显著性差异（P0.05）； 4) B、C组术后1周时周边角膜内皮细胞平均面积与术前相比差异均有统计学意义（P0.05），术后1周明显大于术前，其余与术前相比无显著性差异（P0.05）。 3.按MMC不同作用时间分组：T1、T2两组术后不同时期，中央、周边角膜内皮细胞参数与术前相比： 1)角膜内皮细胞密度，面积标准差，最大、最小细胞面积与术前相比均无显著性差异（P0.05）； 2) T1、T2组术后1周时中央角膜内皮细胞变异系数与术前相比差异均有统计学意义（P0.05），术后1周大于术前，其余与术前相比无显著性差异（P0.05）； 3) T1、T2组术后1周时中央角膜内皮六边形细胞百分比与术前比差异均有统计学意义（P0.05），术后1周小于术前，其余与术前相比无显著性差异（P0.05）； 4) T1、T2组术后1周时周边角膜内皮细胞平均面积与术前相比差异均有统计学意义（P0.05），术后1周大于术前，其余与术前相比无显著性差异（P0.05）。结论:1.LASEK术中一次性使用MMC，在合理的浓度和时间范围内，不会引起角膜内皮细胞密度变化；术后短期内会有中央角膜内皮六边形细胞百分比降低、变异系数升高、周边角膜内皮细胞平均面积增大，均为短暂的、一过性改变，随着时间逐渐恢复至术前水平。 2.角膜内皮细胞计数应列为LASEK手术的常规检查之一，以更加灵敏、准确的评价角膜健康状态。
[Abstract]:Objective: To study the effect of mitomycin C (MMC) on corneal endothelial cells and the relationship with the thickness of corneal stroma and the time of MMC action in the excimer laser keratomileusis (LASEK), and to analyze the safety of MMC in the operation.
Methods: 49 cases (98 eyes) with LASEK operation were selected. After intraoperative laser cutting, 0.02% mitomycin C blood sucking sponge was used to cover the residual corneal stroma bed, and the use time of MMC was adjusted according to the pre correction diopter. The group method was divided into groups of A, B, C three according to the pre corrected diopter count (d), which were divided into groups of A, A, and C. Group: 300 mu m < D320 m, a total of 11 eyes, group B: 320 mu m < D340 mu m, a total of 10 eyes, C group: d > 340 mu m, 77 eyes, two: according to the time of contact between the MMC and the corneal stroma during the operation (t), two groups, including 65 or less than 33 eyes, respectively, before the operation, 1 weeks, January, 3, respectively. During the month and June, the corneal endothelial cell density, the percentage of hexagonal cells, the coefficient of variation, the average cell area, the area of the cell, the maximum cell area, the minimum cell area, and the variation of the parameters of the corneal endothelial cells were analyzed by the contact corneal endothelial cell meter, the corneal endothelial cell density at four peripheral points, the percentage of hexagonal cells, the average cell area, the area standard difference, the area of the cell, the minimum cell area. Change the situation.
Results: 1. there were no significant differences in the density, coefficient of variation, area standard deviation, percentage of hexagonal cells, average cell area, maximum cell area and minimum cell area (P0.05) in the central corneal endothelial cell density, coefficient of variation, area standard deviation, average cell area and minimum cell area (P0.05), each group was in the same period. Each group was in the same period (MMC). There was no significant difference in the same parameters between central and peripheral corneal endothelial cells (P0.05).
2. according to the residual corneal stroma thickness: A, B, C three groups at different times after operation, the central and peripheral corneal endothelial cell parameters were compared with those before operation.
1) corneal endothelial cell density, area standard deviation, maximum cell area and minimum cell area were not significantly different from those before operation (P0.05).
2) there was a significant difference in the coefficient of variation of the central corneal endothelium in the central corneal endothelium in the B group in January (P0.05), and the postoperative January was significantly greater than that before the operation, and there was no significant difference between the rest and the preoperative (P0.05).
3) the percentage of hexagonal cells of central corneal endothelial cells in A, B and C three groups were statistically significant (P0.05) at 1 weeks after operation (P0.05). There was no significant difference between the two groups (P0.05).
4) the average area of corneal endothelial cells in peripheral cornea was statistically significant (P0.05) at 1 weeks after operation (P0.05) at 1 weeks after operation (P0.05), and 1 weeks after operation was significantly greater than that before operation, and the rest had no significant difference compared with preoperative (P0.05).
3. according to MMC different time groups: T1, T2 two groups at different times after operation, the central and peripheral corneal endothelial cell parameters were compared with those before operation.
1) corneal endothelial cell density, area standard deviation, maximum and minimum cell area were not significantly different from those before operation (P0.05).
2) T1, in group T2, there were significant differences in the coefficient of variation of the central corneal endothelial cells at 1 weeks after operation (P0.05), and 1 weeks after the operation were greater than that before the operation, and the rest were not significantly different from that before the operation (P0.05).
3) the percentage of hexagonal cells in the central corneal endothelium was statistically significant (P0.05) at 1 weeks after operation (P0.05) at 1 weeks after operation (P0.05), and 1 weeks after operation was less than that before the operation, and the rest was not significantly different from that before operation (P0.05).
4) T1, in group T2, the average area of corneal endothelial cells in peripheral cornea was significantly different from preoperative (P0.05) at 1 weeks after operation (P0.05), and there was no significant difference between the rest and preoperative (P0.05). Conclusion: the use of MMC in 1.LASEK during a reasonable concentration and time would not cause the change of corneal endothelial cell density. In the short term, the percentage of hexagonal cells in the central corneal endothelium, the coefficient of variation and the average area of the peripheral corneal endothelial cells increased in a short time after the operation, which were both transient, and gradually recovered to the preoperative level.
2. corneal endothelial cell count should be listed as one of the routine examinations of LASEK surgery to evaluate the corneal health status more sensitively and accurately.

【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.6

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