准分子激光原位角膜磨镶术对角膜内皮细胞的影响

The study of changes in the corneal endothelium after LASIK

目的探讨准分子激光角膜原位磨镶术(LASIK)后角膜厚度及角膜内皮细胞的变化。方法近视眼行LASIK手术157例(306只眼),按术前是否配戴角膜接触镜(CL)分为A、B两组:A组未配戴CL,共98例(190只眼);B组配戴CL并于停戴2周后接受手术,共59例(116只眼)。术前等值球镜屈光度~5.00D^1500D,平均为(~8.24±1.23)D,切削深度平均为(123±20.37)μm。分别于术前和术后3个月行角膜内皮显微镜检查,观察角膜内皮细胞密度和形态,并分析切削深度与内皮细胞的相关性。结果A组术前平均角膜内皮细胞密度为(3006.35±345.11)个/mm2,术后3个月为(3056.75±357.36)个/mm2,两者比较差异无显著性(P>0.05)。B组术后平均角膜内皮细胞密度较术前增加(260.7±102.4)个/mm2,有显著性差异(P<0.01)。术后角膜内皮细胞形态结构无明显改变。A组角膜切削深度与术后平均角膜内皮细胞密度无显著相关性,(r=0.0267,P>0.05)。结论LASIK术后早期不引起中央部角膜内皮细胞密度和形态的改变,是一种矫正近视眼安全的角膜屈光手术,但其对角膜内皮细胞的远期影响有待于进一步观察研究。

Objective To study the change in the corneal endothelium after laser-assisted subepithelial LASIK. Methods LASIK was perfomed on 306 eye of 157 patients who were divided into two groups：group A had worn contact lenses before treatment; group B had not worn contact lenses. The spherical equivalent refraction was between - 5.0Dand- 15.0D（ average, - 8.24 ± 1.2D）. The mean depth of laser ablation was （ 123 ± 20.37 ） pan. Corneal endothelial cell densi- ty and morphology were taken by specular microscopy before LASIK and 3 months after the procedure . The correlation between depth of laser ablation and endothelial cell dersity was analyzwd. Results The average corneal endothelial cell density for group A was 3006.35 ± 345.11/mm^2 before and 3056.75 ± 357.36/mm^2 after LASIK. There was no significant difference between them（ P 〉 0.05 ）. However,density increative by 260.7 ± 102.4/mm^2 in group B after surgery compared to preoperative levels and the difference was very significant（ P 〈0.01 ）. There were no significant changes in the morphology of the corneal endotbelium ,There ane no significant correlation between ablation depth and the mean density of corneal endothelial cells （ r = 0.0267, P 〉 0.05 ）. Conclusion LASIK was safely used to treat high myopia. It does not induce changes in the early stages after surgery. Further follow-up must be done to determine the defects on the corneal endothelium over a longer period of time.