Dawson Daniel G, Kramer Theresa R, Grossniklaus Hans E, Waring George O, Edelhauser Henry F
Emory Eye Center, Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA.
Arch Ophthalmol. 2005 Jun;123(6):741-56. doi: 10.1001/archopht.123.6.741.
To evaluate human corneas after laser-assisted in situ keratomileusis at different postoperative intervals.
Thirty-eight postmortem corneas from 20 patients with postoperative intervals from 2 months to 6.5 years after laser-assisted in situ keratomileusis surgery were collected from eye banks. The corneas were trisected and processed for conventional histologic analysis, transmission electron microscopy, and immunofluorescence.
Light microscopy and transmission electron microscopy showed focal undulations in Bowman layer, focal epithelial hypertrophic modifications, and a variably thick (range, 0.4-16.4-mum) lamellar stromal interface scar in all specimens. The flap wound margin, which was adjacent to the epithelium, healed by producing an approximately 8-mum-thick hypercellular fibrotic stromal scar, whereas the central and paracentral wound regions healed differently because a thinner (approximately 5-mum) hypocellular primitive stromal scar was present in all the corneas examined. Immunofluorescence identified increased type 3 collagen and myofibroblasts in the hypercellular fibrotic scar regions and decreased or absent levels of all corneal stromal components other than type 1 collagen in the hypocellular primitive scar regions.
After laser-assisted in situ keratomileusis surgery, the keratocyte-mediated production of a variably thick lamellar corneal stromal scar occurs, resulting in 2 regional types of scarring. The hypercellular fibrotic scar at the wound margin is usually visible clinically and functions to hold the flap in place, while the more central hypocellular primitive scar is not visible clinically and allows easy lifting of the flap postoperatively.
评估准分子激光原位角膜磨镶术（LASIK）术后不同时间间隔的人角膜情况。
从眼库收集了20例患者的38只死后角膜，这些角膜在LASIK手术后的时间间隔为2个月至6.5年。将角膜三等分并进行常规组织学分析、透射电子显微镜检查和免疫荧光检查。
光学显微镜和透射电子显微镜显示，所有标本的Bowman层均有局灶性起伏，上皮有局灶性肥厚改变，以及厚度不一（范围为0.4 - 16.4微米）的板层基质界面瘢痕。与上皮相邻的瓣伤口边缘通过产生约8微米厚的高细胞性纤维化基质瘢痕愈合，而中央和旁中央伤口区域愈合方式不同，因为在所检查的所有角膜中均存在较薄（约5微米）的低细胞性原始基质瘢痕。免疫荧光显示，高细胞性纤维化瘢痕区域的Ⅲ型胶原蛋白和肌成纤维细胞增加，而低细胞性原始瘢痕区域除Ⅰ型胶原蛋白外的所有角膜基质成分水平降低或缺失。
LASIK手术后，角膜细胞介导产生厚度不一的板层角膜基质瘢痕，导致两种区域类型的瘢痕形成。伤口边缘的高细胞性纤维化瘢痕通常在临床上可见，其作用是将瓣固定在位，而更中央的低细胞性原始瘢痕在临床上不可见，使得术后瓣易于掀起。
