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目的 观察准分子激光治疗性角膜切削术 (photo therapeutickeratectomy ,PTK)后兔角膜组织的修复情况 ,探讨PTK的临床疗效、适应证和治疗参数。方法 (1 )实验组采用 8 1 7%硫酸烧灼法制作兔角膜浅层瘢痕模型 ,2周后行PTK ;于术后不同时间进行角膜活体共焦显微镜、神经染色、光镜和透射电镜检查 ,并与对照组进行比较。 (2 )根据临床治疗组 2 6例 (30只眼 )角膜浅层病变患者的病变种类 ,分别行去除上皮和非去除上皮PTK。观察术后不同时间患者的视力、屈光状态和角膜曲率变化情况 ,以及角膜雾状混浊 (haze)的程度。随访时间 6个月。结果 (1 )实验组兔角膜切削区PTK术后早期多形核中性粒细胞和巨噬细胞浸润 ,浅基质成纤维细胞增生活跃 ,新生胶原纤维排列紊乱、疏松 ;术后 6个月趋于正常 ,组织修复稳定。 (2 )临床治疗组PTK术后 6个月最佳矫正视力与术前比较 ,2 1只眼提高 ,5只眼不变 ,4只眼下降 ;其中PTK治疗角膜营养不良和角膜带状变性的效果最佳 ;术后 6个月haze 0级 2 3只眼 ,0 5级 5只眼 ,1级 2只眼 ;平均远视移动度数 +1 52D。结论 兔角膜PTK术后 6个月组织修复趋于稳定 ;临床PTK治疗角膜浅层病变患者 ,方法简便、安全、有效 ,其中以治疗角膜营养不良和角膜带状变性的效果最佳。采用PTK治疗的?
Objective To observe the repair of rabbit corneal tissue after excimer laser photocoagulation (PTK) and discuss the clinical efficacy, indications and treatment parameters of PTK. Methods (1) In the experimental group, a rabbit scalp scar model was made by 8 1 7% sulfuric acid cauterization. PTK was performed after 2 weeks. Confocal microscopy, nerve staining, light microscopy and transmission electron microscopy were performed at different time points after surgery. Control group for comparison. (2) According to the lesions of 26 patients (30 eyes) with corneal superficial lesions in the clinical treatment group, the epithelial and non-epithelial PTK were removed. Visual acuity, refractive status and corneal curvature were observed at different times after surgery, and the degree of corneal haze was observed. Follow-up time of 6 months. Results (1) The infiltration of polymorphonuclear neutrophils and macrophages in the cornea-cutting zone and the proliferation of shallow stromal fibroblasts in the cornea-cutting zone of rabbits in the cornea-cutting zone of the experimental group were disturbed and loosely arranged. After 6 months, Normal, tissue repair stable. (2) In the clinical treatment group, the best corrected visual acuity was 6 months after PTK compared with preoperative, 21 eyes improved, 5 eyes unchanged, 4 eyes decreased; PTK treatment of corneal dystrophy and corneal degeneration The best effect; 6 months after haze 0 2 3 eyes, 0 5 5 eyes, 1 2 eyes; average hyperopia movement degree +1 52D. Conclusions The tissue repair tended to be stable at 6 months after PTK in rabbit cornea. The clinical treatment of PTK in patients with superficial corneal lesions was simple, safe and effective, of which corneal malnutrition and corneal degeneration were the best. PTK treatment?