Sonigo Bertrand, Iordanidou Vasiliki, Chong-Sit Didier, Auclin Francois, Ancel Jean Marc, Labbé Antoine, Baudouin Christophe
Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, and Assistance Publique des Hopitaux de Paris, School of Medicine, University of Versailles, France.
Invest Ophthalmol Vis Sci. 2006 Jul;47(7):2803-11. doi: 10.1167/iovs.05-1207.
To assess and compare corneal modifications induced by IntraLase PulsionFS femtosecond laser and mechanical microkeratome Hansatome for laser in situ keratomileusis (LASIK) using the new-generation Heidelberg Retina Tomograph II (HRT II)/Rostock Cornea Module confocal microscope.
In this case-control study, 24 eyes of 12 patients were examined with the HRT II in the follow-up of IntraLase femtosecond laser for LASIK myopic surgery. Twenty eyes of 10 patients were also examined after microkeratome Hansatome-LASIK surgery. In both groups, the patients underwent the first follow-up examination on day 7 and the last 12 months after surgery. Morphologic modifications of corneal architecture were evaluated, and comparisons were made between the two flap-formation techniques.
Evaluation of both groups on day 7 showed keratocyte transformation, most likely related to cellular activation beneath the interface. The flap margin after the IntraLase technique appeared microscopically as a clear-cut edge that included the epithelial plug. At month 2, secondary fibrosis, adjacent to the still well-defined IntraLase flap edge, was observed. This reaction diminished with time, leaving a fibrotic scar adjacent to a wound constriction originating from the surrounding stroma. The flap margin of the mechanical microkeratome had the appearance of a less clearly identified fibrotic scar with no epithelial plug.
This study reveals morphologic similarities between the interfaces obtained by femtosecond laser and mechanical microkeratome, probably because the same excimer laser performed the photoablation. However, the IntraLase flap margin showed greater fibrotic scarring than that induced by the mechanical microkeratome.
使用新一代海德堡视网膜断层扫描仪II（HRT II）/罗斯托克角膜模块共聚焦显微镜，评估和比较飞秒激光制瓣的准分子原位角膜磨镶术（LASIK）中IntraLase PulsionFS飞秒激光和机械微型角膜刀Hansatome所引起的角膜改变。
在这项病例对照研究中，12例患者的24只眼在接受IntraLase飞秒激光LASIK近视手术的随访过程中使用HRT II进行了检查。10例患者的20只眼在接受微型角膜刀Hansatome-LASIK手术后也进行了检查。两组患者均在术后第7天进行首次随访检查，并在术后12个月进行末次随访检查。评估角膜结构的形态学改变，并对两种制瓣技术进行比较。
两组在术后第7天的评估均显示角膜细胞转化，这很可能与界面下方的细胞激活有关。IntraLase技术制瓣后的瓣缘在显微镜下呈现为包含上皮栓的清晰边缘。在术后第2个月，观察到与仍然界限清晰的IntraLase瓣缘相邻处出现继发性纤维化。这种反应随时间逐渐减轻，在源于周边基质的伤口收缩处附近留下纤维化瘢痕。机械微型角膜刀制瓣的瓣缘呈现为纤维化瘢痕，界限不太清晰，且没有上皮栓。
本研究揭示了飞秒激光和机械微型角膜刀所形成的界面在形态学上的相似性，这可能是因为使用了相同的准分子激光进行光消融。然而，IntraLase瓣缘的纤维化瘢痕比机械微型角膜刀所引起的更严重。
