角膜屈光手术的生物学-PRK、PTK、LASIK、SMILE、嵌体和其他屈光手术。
Biology of keratorefractive surgery- PRK, PTK, LASIK, SMILE, inlays and other refractive procedures.
机构信息
Cole Eye Institute, I-32, Cleveland Clinic, 9500, Euclid Ave, Cleveland, OH, United States.
出版信息
Exp Eye Res. 2020 Sep;198:108136. doi: 10.1016/j.exer.2020.108136. Epub 2020 Jul 10.
The outcomes of refractive surgical procedures to improve uncorrected vision in patients-including photorefractive keratectomy (PRK), laser in-situ keratomileusis (LASIK), Small Incision Lenticule Extraction (SMILE) and corneal inlay procedures-is in large part determined by the corneal wound healing response after surgery. The wound healing response varies depending on the type of surgery, the level of intended correction of refractive error, the post-operative inflammatory response, generation of opacity producing myofibroblasts and likely poorly understood genetic factors. This article details what is known about these specific wound healing responses that include apoptosis of keratocytes and myofibroblasts, mitosis of corneal fibroblasts and myofibroblast precursors, the development of myofibroblasts from keratocyte-derived corneal fibroblasts and bone marrow-derived fibrocytes, deposition of disordered extracellular matrix by corneal fibroblasts and myofibroblasts, healing of the epithelial injury, and regeneration of the epithelial basement membrane. Problems with epithelial and stromal cellular viability and function that are altered by corneal inlays are also discussed. A better understanding of the wound healing response in refractive surgical procedures is likely to lead to better treatments to improve outcomes, limit complications of keratorefractive surgical procedures, and improve the safety and efficiency of refractive surgical procedures.
改善未经矫正视力的屈光手术(包括准分子激光角膜切削术[PRK]、激光原位角膜磨镶术[LASIK]、小切口微透镜切除术[SMILE]和角膜镶嵌术)的结果在很大程度上取决于手术后的角膜愈合反应。愈合反应因手术类型、预期矫正屈光不正的程度、术后炎症反应、产生产生混浊的肌成纤维细胞的程度以及可能尚不清楚的遗传因素而异。本文详细介绍了这些特定的愈合反应,包括角膜细胞和成纤维细胞的凋亡、角膜成纤维细胞和肌成纤维细胞前体的有丝分裂、由角膜成纤维细胞和骨髓来源的纤维细胞来源的角膜细胞衍生的肌成纤维细胞的发育、角膜成纤维细胞和肌成纤维细胞分泌的细胞外基质的紊乱沉积、上皮损伤的愈合以及上皮基底膜的再生。还讨论了角膜镶嵌术改变的上皮和基质细胞活力和功能的问题。更好地了解屈光手术中的愈合反应可能会导致更好的治疗方法,以改善结果,限制角膜屈光手术的并发症,并提高屈光手术的安全性和效率。