准分子激光原位角膜磨镶术对角膜内皮细胞的影响

目的探讨准分子激光角膜原位磨镶术（LASIK）后角膜厚度及角膜内皮细胞的变化。方法近视眼行LASIK手术157例（306只眼），按术前是否配戴角膜接触镜（CL）分为A、B两组：A组未配戴CL，共98例（190只眼）；B组配戴CL并于停戴2周后接受手术，共59例（116只眼）。术前等值球镜屈光度～5．00 D～1500D，平均为（～8．24±1．23）D，切削深度平均为（123±20．37）μm。分别于术前和术后3个月行角膜内皮显微镜检查，观察角膜内皮细胞密度和形态，并分析切削深度与内皮细胞的相关性。结果A组术前平均角膜内皮细胞密度为（3006．35±345．11）个／mm^2，术后3个月为（3056．75±357．36）个／mm^2，两者比较差异无显著性（P〉0．05）。B组术后平均角膜内皮细胞密度较术前增加（260．7±102．4）个／mm^2，有显著性差异（P〈0．01）。术后角膜内皮细胞形态结构无明显改变。A组角膜切削深度与术后平均角膜内皮细胞密度无显著相关性，（r=0．0267，P〉0．05）。结论LASIK术后早期不引起中央部角膜内皮细胞密度和形态的改变，是一种矫正近视眼安全的角膜屈光手术，但其对角膜内皮细胞的远期影响有待于进一步观察研究。

The study of changes in the corneal endothelium after LASIK

Objective To study the change in the corneal endothelium after laser-assisted subepithelial LASIK. Methods LASIK was perfomed on 306 eye of 157 patients who were divided into two groups：group A had worn contact lenses before treatment; group B had not worn contact lenses. The spherical equivalent refraction was between - 5.0Dand- 15.0D（ average, - 8.24 ± 1.2D）. The mean depth of laser ablation was （ 123 ± 20.37 ） pan. Corneal endothelial cell densi- ty and morphology were taken by specular microscopy before LASIK and 3 months after the procedure . The correlation between depth of laser ablation and endothelial cell dersity was analyzwd. Results The average corneal endothelial cell density for group A was 3006.35 ± 345.11/mm^2 before and 3056.75 ± 357.36/mm^2 after LASIK. There was no significant difference between them（ P 〉 0.05 ）. However,density increative by 260.7 ± 102.4/mm^2 in group B after surgery compared to preoperative levels and the difference was very significant（ P 〈0.01 ）. There were no significant changes in the morphology of the corneal endotbelium ,There ane no significant correlation between ablation depth and the mean density of corneal endothelial cells （ r = 0.0267, P 〉 0.05 ）. Conclusion LASIK was safely used to treat high myopia. It does not induce changes in the early stages after surgery. Further follow-up must be done to determine the defects on the corneal endothelium over a longer period of time.