飞秒激光LASIK与飞秒激光基质透镜切除术后角膜神经再生的激光扫描共聚焦显微镜观察

The morphological observation of corneal nerve regeneration after femtosecond laser in situ keratomileusis and femtosecond lenticule extraction

目的采用共聚焦显微镜观察改良飞秒激光基质透镜切除术(FLEx)及飞秒激光辅助的准分子激光原位角膜磨镶术(FS-LASIK),手术后角膜基质细胞及角膜神经的形态学变化情况。方法收集2016年10~12月来我院屈光手术中心行角膜屈光手术的患者7例(14只眼),其中男性6例,女性1例。等效球镜度数为-3.5^-7.125 D,平均(-4.76±1.09)D;平均角膜厚度为(510.93±25.27)μm,其中3例行改良FLEx,4例行FS-LASIK术。对所有患者进行常规术前检查,同时术前及术后1周、1个月均行激光扫描共聚焦显微镜检查分别观察两种手术方式角膜中央区的组织形态。结果 (1)FS-LASIK组:由于角膜瓣的制作及基质切削,术后1周中央角膜上皮下可见到不连续的细小神经纤维,切口处有神经纤维爬过,术后1个月可见到神经纤维增长,越过切口;(2)改良FLEx组:取透镜区域术后1周角膜神经纤维不连续,见高反光沿切口分布,术后1个月可见细小神经纤维爬过;未掀瓣区术后1周角膜神经纤维部分切断,但仍然保留了大部分的神经纤维,在术后1个月即可见到完整的神经纤维。结论在各方面都可以媲美SMILE手术的改良FLEx技术在术后干眼、角膜神经修复方面超越了FS-LASIK手术,在临床中的应用不可忽视,对于角膜基质透镜移植方面也将会体现出特殊的价值。

Objective To observe the morphological changes of corneal stromal cells and corneal nerves after femtosecond laser in situ keratomileusis（ FS-LASIK） and improved femtosecond lenticule extraction（ FLEx）. Methods 7 patients（ 14 eyes） who underwent refractive surgery in our hospital were enrolled. Average spherical equivalent（ SE） was-4. 76 ± 1. 09 D. 4 patients received FS-LASIK and 3 patients received improved FLEx. All patients were subjected to general ophthalmic examinations. The morphological changes of corneal stromal cells and corneal nerves were observed by laser scanning confocal microscope at 1 week and 1 month after FS-LASIK and improved FLEx. Results 1） FS-LASIK：Due to the production of flap,there were only short and independent sub-basal nerve fibers at central cornea in 1 week after surgery. After 1 month,the length of sub-basal nerve fibers became longer. 2） Improved FLEx： The nerve fibers in the lenticule extraction area were not continuous in 1 week. Distribution of high reflector was observed along the incision. Nerve fibers were cut off after 1 week of operation without the flap,but most remained,and complete fibers were seen 1 month after surgery. Conclusions FLEx was better than FS-LASIK in nerve morphology changes 1 month after surgery. Clinical application should not be ignored,and the corneal stroma lens transplantation will also reflect special value.