紫外光核黄素胶原交联对兔角膜碱烧伤作用的实验研究

Effects of riboflavin-ultraviolet-A-induced collagen cross-linking on rabbit corneal alkali burn

目的探讨紫外光核黄素胶原交联对兔角膜碱烧伤的治疗作用。方法新西兰兔48只,随机分为单纯碱烧伤组及碱烧伤联合核黄素胶原交联治疗组。单纯碱烧伤组建立单纯碱烧伤模型,治疗组建立碱烧伤模型后立即行角膜胶原交联治疗,两组分别于烧伤后1d、3d、1周、2周、4周、6周行裂隙灯观察,测量角膜上皮缺损面积,同时行角膜共聚焦显微镜检查以及HE染色,观察各时间点角膜损伤的变化情况。结果单纯碱烧伤组在烧伤后2周时100%眼出现角膜溃疡,溃疡深及浅基质层,上皮缺损面积为(4.70±1.01)pixels2;碱烧伤联合核黄素胶原交联治疗组11眼仅出现上皮缺损,1眼角膜溃疡深及浅层基质,上皮缺损面积为(2.63±1.59)pixels2,差异有统计学意义(P<0.05)。烧伤后4周时两组上皮缺损区域逐渐缩小,单纯碱烧伤组8眼上皮缺损,上皮缺损面积为(4.08±1.65)pixels2;治疗组5眼(5/8)上皮愈合,2眼角膜仅有少量点状荧光着染,1眼仍有深及浅基质层角膜溃疡,上皮缺损面积为(1.23±2.32)pixels2,差异有统计学意义(P<0.05)。角膜共聚焦显微镜检查显示胶原交联治疗后2周浅基质层炎症反应较轻,较晚出现浅基质层的广泛纤维化。HE染色显示胶原交联治疗后角膜浅基质板层结构密度增加,炎性细胞浸润减少。结论紫外光核黄素胶原交联治疗可减轻兔角膜碱烧伤后的基质损伤,角膜溃疡愈合时间缩短,基质炎性细胞浸润减轻。

Objective To investigate the effects of riboflavin-ultraviolet-A-induced cross-linldng on rabbit corneal alkali burn. Methods Forty-eight New Zealand white rabbits were randomly divided into single alkali burn group and corneal crosslinking treatment group. Control group only received corneal alkali burns, and the treatment group received the riboflavin-ultraviolet-A-induced cross-linking immediately after corneal alkali burn. Clinical slit lamp observation, corneal ulcer area measurement, corneal confocal microscopy scanning and HE staining were performed at 1 day, 3 days, 1 week,2 weeks,4 weeks and 6 weeks after alkali burn. Results All eyes（ 100% ） in single alkali burn group appeared anterior cornea stroma ulcer at 2 weeks, the epithelial defect area of control group was （4.70 ± 1.01 ） pixels^2. 11 eyes （ 11 / 12） of the treatment group only appeared epithelial defect, the epithelial defect area was （ 2.53 ± 1.59 ） pixels^2 ,there was statistical difference（P 〈0.05 ）. The epithelial defect area of two groups gradually reduced at 4 weeks. Eight eyes （ 8/8 ） of single alkali burn group had epithelial defect, and the area was （4.08 ± 1.55 ）pixels^2. Five eyes （5/8） of treatment group had epithelial healing,2 eyes only had small amounts of dot fluorescent dye, 1 eye still had anterior cornea stroma ulcer, and the epithelial defect area was （ 1. 23 ± 2.32 ） pixels^2.There was statistical difference （P 〈 0.05 ）. Corneal confocal microscopy through focusing suggested that the inflammatory reaction in anterior stroma at 2 weeks was slighter after cross-linking, and extensive fibrosis appeared later. HE staining showed that the density of anterior stroma lamellar structure was increased after cross-linking, and the inflammatory cells infiltration was reduced. Conelus｜on Riboflavin-ultraviolet-A-induced cross-linking can reduce the damage of the rabbit corneal stroma after alkali burn, shorten the cornea ulcer healing time, and reduce the inflammatory cells infiltration in stroma.