共聚焦显微镜对屈光矫治术后角膜瓣缘愈合情况观察

Evaluation of cornea flap margin tissue healing after LASIK and FLEx with confocal microscopy

目的观察准分子激光原位角膜磨镶术（1aser insitu keratomileusis，LASIK）和飞秒激光基质透镜切除术（Femto—Second Lenticule Extraction，FLEx）术后瓣缘切口的愈合情况。方法临床病例不同术式对照研究。对2011年10月至2012年8月在南京中医药大学第一附属医院眼科行LASIK手术患者20例（40只眼）、FLEx手术患者20例（40只眼），术后行激光共聚焦显微镜检查，观察角膜瓣组织在上皮层、前弹力层及基质层于术后1周、1个月和3个月时愈合及组织动态变化。结果两种手术方式的角膜瓣缘在术后均可能于前弹力层及基质层形成缝隙。飞秒激光瓣缘切口较机械刀切口明显整齐，但比机械刀更容易产生缝隙和上皮栓；FLEx手术后瓣缘缝隙宽度自前弹力层至角膜瓣底层呈逐渐增宽趋势（P〈0．01），且以瓣蒂所在位置对侧方位最宽（P〈0．01）。结论飞秒激光和机械刀产生的的瓣缘愈合过程有显著区别，推测FLEx术后角膜瓣基质组织反应较LASIK术式明显，从而造成角膜瓣向心性皱缩是导致这种差异的原因。

Objective To observe the tissue healing of cornea flap margin after laser in situ keratomileusis （LASIK） and Femto-Second Lenticule Extraction （FLEx）. Methods Confocal microsco-py was used to observe cornea flap margin tissue 1 week, 1 month and 3 months after surgery in 80 eyes of 40 LASIK and FLEx patients. Results Two flap-formation techniques created empty spaces at the flap margin with epithelial cells filling in Bowan＇s and stroma layers after operation. Flap border created by the Femtosecond Laser （FS） was more regularly, but with more empty spac-es and epithelial plug. The width of empty spaces broadened as the increasing of depth, and the maximum was in the contralateral side of flap pedicel. Conclusions There is significant difference between LASIK and FLEx in tissue healing of cornea flap margin. It presumes that concentric shrinkage of flap created by stroma edema after FLEx is probably the cause of this difference.