Calienno Roberta, Curcio Claudia, Lanzini Manuela, Nubile Mario, Mastropasqua Leonardo
Department of Medicine and Ageing Sciences, Ophthalmology Clinic, University"G. d'Annunzio" of Chieti-Pescara, Chieti, Italy.
Department of Medicine and Ageing Sciences, Visual Science Laboratory, CeSI, University"G. d'Annunzio" of Chieti-Pescara, Via dei Vestini, 66100, Chieti, Italy.
Int Ophthalmol. 2018 Aug;38(4):1591-1599. doi: 10.1007/s10792-017-0627-y. Epub 2017 Jul 4.
To investigate, in vivo by means of in vivo confocal microscopy (IVCM) and ex vivo by impression cytology, epithelial cellular damage after excimer laser refractive surgery in patients under different topical lubricant therapies.
Two hundred eyes of 100 patients, undergone bilateral excimer laser refractive surgery for medium myopic error correction [spherical equivalent refraction from -1.75 to -3.50 dioptres (D) with refractive astigmatism under -0.75 D], have been recruited. All patients received, in addition to standard therapy for refractive surgery, high weight hyaluronic acid 0.2% eyedrops in one randomly selected eye and carboxymethylcellulose 1% eyedrop in the comparator eye (control eye) 4 times daily for 90 days. Follow-up included a baseline visit and further examination 7-, 30- and 90-day intervals [clinical evaluation with Schirmer test and tear break-up time (TBUT), IVCM and impression cytology].
No significant difference in Schirmer test and TBUT was observed during the follow-up period in eyes under different therapies. IVCM showed an improvement of conjunctival and corneal epithelial cells quality in eye in treatment with high weight hyaluronic acid 0.2% when compared to carboxymethylcellulose. Conjunctival impression cytology demonstrated an evident positivity for CD44 in eyes treated with both treatments in all follow-up controls. ICAM1 expression showed an increasing positivity starting at 30 days that became statistically significant after 90 days of high weight hyaluronic acid 0.2% therapy (p = 0.0167).
In vivo and in vitro results showed the effectiveness of high weight hyaluronic acid 0.2% in facilitating cell-cell interaction, migration, cell proliferation, stabilizing epithelial barrier of the ocular surface. Moreover, use of high weight hyaluronic acid in treatment of corneal tissue damage after refractive surgery, in concordance with standard topical corticosteroids and antibiotics therapy, could be effective in promoting corneal epithelial wound healing with consequent good results in clinical outcome and patients' satisfaction.
通过共聚焦显微镜（IVCM）进行体内研究，并通过印迹细胞学进行体外研究，探讨不同局部润滑剂治疗下准分子激光屈光手术后患者的上皮细胞损伤情况。
招募了100例患者的200只眼睛，这些患者均接受了双侧准分子激光屈光手术以矫正中度近视[等效球镜度为-1.75至-3.50屈光度（D），屈光性散光小于-0.75 D]。所有患者除接受屈光手术的标准治疗外，在一只随机选择的眼睛中每天4次滴入0.2%的高浓度透明质酸眼药水，在对照眼（对侧眼）中每天4次滴入1%的羧甲基纤维素眼药水，持续90天。随访包括基线检查以及在7天、30天和90天间隔时的进一步检查[通过泪液分泌试验和泪膜破裂时间（TBUT）进行临床评估、IVCM和印迹细胞学检查]。
在不同治疗方法下的眼睛随访期间，泪液分泌试验和TBUT均未观察到显著差异。与羧甲基纤维素相比，IVCM显示使用0.2%高浓度透明质酸治疗的眼睛结膜和角膜上皮细胞质量有所改善。在所有随访对照中，两种治疗方法治疗的眼睛结膜印迹细胞学检查均显示CD44明显呈阳性。ICAM1表达从30天开始呈阳性增加，在0.2%高浓度透明质酸治疗90天后具有统计学意义（p = 0.0167）。
体内和体外结果均显示0.2%高浓度透明质酸在促进细胞间相互作用、迁移、细胞增殖以及稳定眼表上皮屏障方面有效。此外，在屈光手术后角膜组织损伤的治疗中，使用高浓度透明质酸并结合标准的局部皮质类固醇和抗生素治疗，可能有效地促进角膜上皮伤口愈合，从而在临床结果和患者满意度方面取得良好效果。
