飞秒激光截囊术与连续环形撕囊术晶状体前囊瓣超微结构比较

Comparison of ultrastructure of anterior lens capsule flap derived from manual capsulorrhexis and femtosecond laser-assisted capsulotomy

目的比较飞秒激光辅助白内障超声乳化术与常规超声乳化连续环形撕囊术取下的晶状体前囊瓣超微结构。方法2014年6月至2014年7月间年龄在55～65岁的年龄相关性白内障28例（28只眼），男17例，女11例，其中16例（16只眼），接受传统晶状体超声乳化术，12例（12只眼）接受飞秒激光辅助白内障手术。将术中取下的晶状体前囊瓣随机平均分成两组，由光学显微镜观察一组，另一组由透射电子显微镜观察。着重观察囊瓣边缘及靠近边缘组织的超微结构。结果连续环形撕囊术取下的晶状体前囊在光镜和透射电镜下观察发现其边缘光滑，细胞结构整齐规则且充满晶状体前囊的游离断端。飞秒激光取下的晶状体前囊边缘有一宽约60μm的带状细胞变性坏死带，其间元细胞结构，且其边缘有齿状不规则突起。结论飞秒激光截囊术取下的晶状体前囊边缘有变性坏死带和不规则的断端，其产生原因可能与飞秒激光强大的瞬时功率形成等离子体微爆破效应进而产生一定程度的冲击波有关。

Objective To compare the ultrastructure of anterior lens capsule flap derived from manual capsulorrhexis and femtosecond laser-assisted capsulotomy. Methods Twenty-eight eyes of 28 cases with cataract aged from 55 to 65 years old were collected for traditional phacoemulsification and intra0cular lens implantation. These patients included 17 males and 11 females. In which, 16 flaps of anterior lens capsule were derived from manual continuous circular capsulorhexis and 12 flaps were derived from femtosecond laser-assisted capsulotomy. The anterior lens capsule flaps were subdivided into two groups randomly, and were examined by light microscopy （LM） and transmission electron microscope （TEM） respectively. The ulrastructnre of the flap edge and the tissue near the flap edge were examined carefully. Results The flap derived from manual capsulorrhexis had smooth edge, no cell destruction was found, and the cells fully filling into the cutting edge were observed under LM and TEM examination. The anterior capsule flap derived from femtosecond laser-assisted capsulotomy showed an approximate 60μm banded area of cell degeneration and necrosis, with dentiform prominences at the edge of the capsule flaps, and no cell structrue was observed at this area. Conclusion The flap by femtosecond laser-assisted capsulotomy has a rougher edge, with banded degeneration and necrosis area at the cutting border, which may be related to the shock wave caused by strong instant power of femtosecond laser.