LASEK术后配合中药治疗的临床研究

目的：探讨中药对LASEK术后减轻疼痛,促进角膜修复的情况.方法：将符合标准的120例近视患者按随机分为A、B两组.A组术后配合中药治疗,B组为单纯手术组.经术后3,5,15d;1,2,3,4mo的临床随访观察,对术后疼痛,角膜修复,视力恢复等情况进行了临床研究.结果：A组临床效果明显优于B组（P＜0.01）.结论：中药对LASEK术后减轻疼痛,促进角膜修复,提高视力有较好的疗效.     

LASEK术中切削深度与治疗度数的相关性分析

目的　探讨 L ASEK术中切削深度与治疗度数的相关性及其临床意义。方法　对 L ASEK术中采用相同切削直径的切削深度与治疗度数 ,用 SPSS11.5软件包进行统计分析。结果　 113例 (2 10只眼 )的切削深度范围为 34～ 2 18μm ,平均 (137.5 7± 32 .6 0 )μm;治疗度数为 2 .5 0～ 19.2 5 D,平均 (11.2 6± 3.0 3) D。用 SPSS11.5软件包进行相关分析 ,线性回归方程为 :y(切削深度 ) =16 .899+10 .718X(治疗度数 )。结论　 L ASEK术中切削深度与治疗度数成正相关。临床上建立一个切削深度与治疗度数的函数关系公式是必要的。     

准分子激光上皮瓣下角膜磨镶术和准分子激光角膜切削术的疗效比较

目的探讨准分子激光上皮瓣下角膜磨镶术(LASEK)矫治近视的优缺点.方法选择双眼近视程度相近患者46例92只眼,双眼同时手术,1只眼行准分子激光角膜切削术(PRK),另1只眼行准分子激光上皮瓣下角膜磨镶术(LASEK),进行前瞻性自身对照研究,术后随访6个月以上.结果两组术后疼痛程度无明显区别,角膜上皮下雾状混浊(Haze)的发生率在1、3个月时,LASEK组明显较PRK组少、程度轻,6个月时两组比较无明显区别;LASEK组的视力恢复较PRK组更快、更佳.结论准分子激光上皮瓣下角膜磨镶术治疗近视,安全、有效,其雾状混浊发生率低且程度轻,视力恢复更快更佳.     

薄角膜近视患者LASEK术前术后眼压与角膜厚度的相关性分析

目的 评价准分子激光上皮瓣下角膜磨镶术(LASEK)术前、术后非接触眼压(NCT)与角膜中央厚度(CCT)变化的关系及其意义.方法 对薄角膜近视患者40例(80眼)分别于LASEK术前、术后测量NCT与CCT,对所有数据进行t检验和相关性分析.结果 LASEK术前CCT为(475.3±8.55)μm,术后为(398.44±6.21)μm,减少了(91.10±20.98)μm,差异有统计学意义(t=65.06,P<0.001);LASEK术前NCT为(14.79±2.02)mmHg,术后为(10.50±2.50)mmHg,其差值为(4.18±1.87)mmHg,有统计学意义(t=11.93.P<0.001).LASEK术前、术后NCT与CCT呈高度正相关(r=0.307,P<0.01;r=0.325,P<0.01),即角膜厚度变薄,所测眼压均较术前降低.结论 薄角膜近视患者LASEK术后NCT与CCT呈高度线性相关,角膜中央厚度的改变是眼压值下降的主要因素.     

LASIK和LASEK术后角膜后表面高度和前房变化的临床研究

目的应用Pentacam眼前节分析系统研究准分子激光原位角膜磨镶术（laser in situ keratomileusis,LASIK）和准分子激光上皮下角膜磨镶术（laser subepithelial keratomileusis,LASEK）术后角膜后表面高度、前房深度的变化,探讨准分子激光手术对眼前段结构变化的影响。方法对69例（138眼）施行LASIK或LASEK手术的患者资料进行回顾性分析,分别于术前,术后1个月、3个月应用Pentacam眼前节分析系统检测角膜厚度、角膜后表面高度、前房深度的变化。结果 LASIK、LASEK术后1个月、3个月角膜后表面高度均略微增高,LASIK术后1个月与3个月的前凸量分别为（1.89±3.24）μm与（1.18±2.33）μm,LASEK术后1个月与3个月的前凸量分别为（1.07±2.27）μm与（1.12±2.05）μm;术中切削比例对后表面高度的变化影响达到66.18%,术前屈光度对后表面高度的变化影响达到29.31%;LASIK术前、术后1个月和术后3个月前房深度分别为（3.24±0.27）mm、（3.18±0.26）mm和（3.18±0.27）mm;LASEK术前、术后1个月和术后3个月前房深度分别为（3.20±0.27）mm、（3.16±0.26）mm和（3.15±0.27）mm;LASIK、LASEK术后1个月、3个月前房深度变浅。结论 LASIK、LASEK术后均表现为角膜后表面微量前移,LASEK术后角膜后表面高度变化较LASIK更小;切削比例是影响角膜后表面变化最大的因素,两种手术方式术后前房变浅。     

非球面引导的LASEK及LASIK治疗近视患者的对比研究

目的观察非球面引导的LASEK及LASIK治疗近视散光患者的临床疗效。方法近视散光患者随机分成两组,其中43例86眼行非球面引导的LASEK手术,45例90眼行非球面引导的LASIK手术。对所有患者术后1周、术后1月、3月裸眼视力达到1.0的比例进行比较,对术后1月、3月残余屈光度、角膜像差结果按屈光度分组进行对比分析。结果 LASIK组患者术后1周、1月裸眼视力达1.0比例者较LASEK组多,术后3月两组差异无统计学意义。两组患者术后1月及3月残余屈光度差异无统计学意义(P>0.05)。术后高度近视组两种术式在术后1月、3月角膜像差两组间差别无统计学意义。低中度近视组患者两种术式在术后1月角膜像差均有所增加,术后3月LASEK组像差有所恢复,较LASIK组像差值有所减少,差异有统计学意义(P<0.05)。结论非球面引导的LASEK及LASIK治疗近视散光患者术后视力及屈光预测性良好,利用LASEK治疗低中度近视患者较LASIK手术更有利于角膜像差的恢复。     

Keratocyte density in the retroablation area after LASEK for the correction of myopia

Purpose During excimer laser photoablation keratocyte cell death is induced in the retroablation area. Afterwards this area is repopulated by keratocyte mitosis and migration from the adjacent stroma. The aim of this study was to investigate keratocyte density in the retroablation area and in the posterior stroma during the first year after LASEK for the correction of myopia. Methods In a prospective study LASEK surgery was performed in 17 eyes of 10 consecutive patients for the correction of myopia (−2.25 D to −9.0 D, mean −5.0 D). Confocal microscopy (Nidek Confoscan 2) was performed before surgery and 1 month, 3 months, 6 months and 12 months after LASEK. Keratocyte density was assessed in the anterior retroablation area at depths of 5 μm and 25 μm and in the posterior stroma at distances of 5 μm and 100 μm from the corneal endothelium and compared with the corresponding area before surgery. Results Keratocyte density was statistically significant reduced in the retroablation area at all timepoints after LASEK. At a depth of 5 μm, cell densities were decreased by 64%, 47%, 43%, and 28% at 1 month, 3 months, 6 months and 12 months after LASEK compared with preoperative values. At a depth of 25 μm, cell densities were decreased by 51%, 32%, 28%, and 18% at 1 month, 3 months, 6 months and 12 months after LASEK compared with preoperative values. In the posterior stroma no significant change in keratocyte density was observed at any time after LASEK. Conclusions Keratocyte density in the anterior retroablation area recovers during the first year after LASEK for the correction of myopia, but does not go back to preoperative values.     

准分子激光上皮下角膜磨镶术后角膜上皮活性与haze的关系

目的探讨LASEK治疗近视的效果及手术中角膜上皮的活性与术后发生haze的关系。方法对LASEK手术105例（210眼）进行随诊观察，手术中根据不同年龄及术前配戴角膜接触镜时间决定酒精浸泡的时间，尽可能缩短酒精浸泡的时间，以保证角膜上皮细胞的活性，减少术后反应及haze的形成。结果术后裸眼视力达到或超过术前最佳矫正视力者197眼，占93．81％；术后裸眼视力低于术前最佳矫正视力者13眼，占6．19％。发生haze者8眼，占3．8％，均为1级，其中5眼为摘除角膜接触镜后出现角膜上皮缺损，3眼术前为高度近视。结论LASEK手术安全、有效，不断地提高手术技巧，制作完整的角膜上皮瓣，最大限度地保护角膜上皮细胞活性，可以减少haze的发生。     

Pathogenesis and treatments of TGFBI corneal dystrophies

Transforming growth factor beta-induced (TGFBI) corneal dystrophies are a group of inherited progressive corneal diseases. Accumulation of transforming growth factor beta-induced protein (TGFBIp) is involved in the pathogenesis of TGFBI corneal dystrophies; however, the exact molecular mechanisms are not fully elucidated. In this review article, we summarize the current knowledge of TGFBI corneal dystrophies including clinical manifestations, epidemiology, most common and recently reported associated mutations for each disease, and treatment modalities. We review our current understanding of the molecular mechanisms of granular corneal dystrophy type 2 (GCD2) and studies of other TGFBI corneal dystrophies. In GCD2 corneal fibroblasts, alterations of morphological characteristics of corneal fibroblasts, increased susceptibility to intracellular oxidative stress, dysfunctional and fragmented mitochondria, defective autophagy, and alterations of cell cycle were observed. Other studies of mutated TGFBIp show changes in conformational structure, stability and proteolytic properties in lattice and granular corneal dystrophies. Future research should be directed toward elucidation of the biochemical mechanism of deposit formation, the relationship between the mutated TGFBIp and the other materials in the extracellular matrix, and the development of gene therapy and pharmaceutical agents.     

LASIK与LASEK术后角膜神经损伤和修复的实验研究

目的 比较兔眼LASIK与LASEK两种准分子激光手术后角膜神经损伤和再生修复情况.方法 选用健康、纯种新西兰白兔30只,随机分为6组,每组5只,1组为正常对照组,其余5组为实验组,实验组白兔一眼行LASIK手术;另一眼行LASEK手术.术后1、7 d,1、3、6m取兔角膜行氯化金染色,光镜下观察LASIK与LASEK术后角膜神经损伤及修复情况.结果 LASIK与LASEK手术后不同时期角膜神经损伤和再生修复有明显差异.结论 LASIK术后角膜神经损伤的程度比LASEK重,角膜神经再生修复速度慢.