全飞秒激光微小切口基质透镜切除术（SMILE）和准分子原位角膜磨镶术（PRK）术后的超微结构变化与角膜伤口愈合
Ultrastructural Changes and Corneal Wound Healing After SMILE and PRK Procedures.
作者信息
Wei Shengsheng, Wang Yan, Wu Di, Zu PeiPei, Zhang Hui, Su Xiaolian
机构信息
a Tianjin Eye Hospital & Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science , Tianjin Medical University , Tianjin , China.
出版信息
Curr Eye Res. 2016 Oct;41(10):1316-1325. doi: 10.3109/02713683.2015.1114653. Epub 2016 Feb 10.
PURPOSE
To compare keratocyte activation, cellular morphologic changes and wound healing after SMILE and PRK procedures using transmission electron microscope (TEM).
METHODS
In this study, 22 New Zealand white rabbits (10- to 15-week old) were used. The right eyes of all animals underwent SMILE procedure and the left eyes underwent PRK procedure. Cornea samples taken 1 day and 1 week postoperatively were examined using TEM.
RESULTS
Using TEM 1 day after SMILE procedure, the organization of collagen fibers seemed to have been preserved without thermal alterations. Keratocyte activation was observed in the anterior stroma. Disrupted collagen arrangement and debris of cells are visible in the area of damage, and some phagocytic cells and a large number of secondary lysosomes are visible in those cells. At the perimeter zone of the interface, many coenocytes and collagen fragments could be found within the phagocytic cell. One week after SMILE procedure, potential lacuna could be discerned. A large part of the interface of the lenticule extracted had an appearance of clearly being adhered to some mucus secretions. One day after PRK procedure, an irregular epithelial surface was visible using TEM. Keratocytes had been activated and the rough endoplasmic reticulum in those cells had expanded. One week after PRK procedure, the epithelial surface still was irregular and keratinization of the epithelium was still visible in some areas. Corneal endothelium cells were mildly damaged and some vacuoles within the cytoplasm could be discerned. In the anterior stroma, some unhealthy activated keratocytes could still be observed. New collagen fibrils were found present near the activated keratocytes.
CONCLUSION
Using TEM, keratocyte activation could still be observed after SMILE compared to after PRK procedure. Fewer cellular ultrastructural changes were seen after SMILE procedure. Unlike in PRK procedure, no damaged epithelium and endothelium were found after SMILE.
目的
使用透射电子显微镜（TEM）比较小切口基质透镜切除术（SMILE）和准分子激光角膜切削术（PRK）术后的角膜细胞活化、细胞形态学变化及伤口愈合情况。
方法
本研究使用了22只10至15周龄的新西兰白兔。所有动物的右眼接受SMILE手术，左眼接受PRK手术。术后1天和1周采集的角膜样本用TEM检查。
结果
SMILE手术后1天，使用TEM观察到胶原纤维结构似乎得以保留，未发生热改变。在前基质中观察到角膜细胞活化。在损伤区域可见胶原排列紊乱和细胞碎片，在这些细胞中可见一些吞噬细胞和大量次级溶酶体。在界面的周边区域，吞噬细胞内可发现许多多核细胞和胶原碎片。SMILE手术后1周，可辨别出潜在的腔隙。取出的透镜界面大部分明显附着有一些黏液分泌物。PRK手术后1天，使用TEM可见上皮表面不规则。角膜细胞已被激活，这些细胞中的粗面内质网扩张。PRK手术后1周，上皮表面仍然不规则，在一些区域仍可见上皮角质化。角膜内皮细胞轻度受损，细胞质内可辨别出一些空泡。在前基质中，仍可观察到一些不健康的活化角膜细胞。在活化的角膜细胞附近发现有新的胶原纤维。
结论
使用TEM观察发现，与PRK手术后相比，SMILE手术后仍可观察到角膜细胞活化。SMILE手术后细胞超微结构变化较少。与PRK手术不同，SMILE手术后未发现上皮和内皮受损。
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