Bergmann L, Hartmann C, Renard G, Saragoussi J J, Pouliquen Y
Universitäts-Augenklinik, Köln, Bundesrepublik Deutschland.
Fortschr Ophthalmol. 1991;88(4):368-73.
In our experimental study on 53 rabbits we compared the amount of corneal endothelial damage caused by radial keratotomy (RK) referred to (1) the number of incisions (4, 8, or 16), (2) the postoperative interval (0 h, 48 h) and (3) the direction of the incision [centripetal (cp), centrifugal (cf)]. The endothelial damage was quantified by means of the Janus green photometry technique. Morphological changes were evaluated by scanning electron microscopy (SEM). Depending on the group examined, we found endothelial damage extending over 3-7% of an analysed surface of 64 mm2. One perforation caused endothelial damage of up to 17% of the surface examined. Increasing the number of incisions from 4 to 8 or 16 resulted in a statistically significant increase in the amount of endothelial damage (4.2%, 5.1%, 5.8%; P less than 0.05). At 0 h it was significantly higher than after 48 h (5.5%, 4.6%; P less than 0.05). The direction of the incision had no statistically significant influence in our study (zp: 5.2%, zf: 4.9%). The morphological changes in the rabbit corneal endothelium examined directly after the RK procedure were ruptures in the cell membranes, loss of cells, and posterior corneal protrusions beneath the incisions. After 48 h, we found fewer damaged cells and no denuded Descemet's membranes, but larger polymorphy of the cells and a numerical increase in the microvilli of the cells surrounding the damaged cells. Our results support the crucial argument against RK: the alteration and destabilization of healthy corneal tissue up to the endothelium.
在我们对53只兔子的实验研究中，我们比较了放射状角膜切开术（RK）所造成的角膜内皮损伤程度，具体涉及以下几个方面：（1）切口数量（4个、8个或16个）；（2）术后间隔时间（0小时、48小时）；（3）切口方向[向心（cp）、离心（cf）]。通过Janus绿光度测量技术对内皮损伤进行量化。通过扫描电子显微镜（SEM）评估形态学变化。根据所检查的组别，我们发现内皮损伤范围占64平方毫米分析表面的3%-7%。一次穿孔导致的内皮损伤高达所检查表面的17%。将切口数量从4个增加到8个或16个会导致内皮损伤量在统计学上显著增加（4.2%、5.1%、5.8%；P小于0.05）。在0小时时，损伤程度显著高于48小时后（5.5%、4.6%；P小于0.05）。在我们的研究中，切口方向没有统计学上的显著影响（向心：5.2%，离心：4.9%）。RK手术后直接检查的兔角膜内皮的形态学变化包括细胞膜破裂、细胞丢失以及切口下方的角膜后凸。48小时后，我们发现受损细胞减少，后弹力层没有裸露，但细胞多形性增大，受损细胞周围细胞的微绒毛数量增加。我们的结果支持了反对RK的关键论点：健康角膜组织直至内皮的改变和不稳定。
