Linna T U, Pérez-Santonja J J, Tervo K M, Sakla H F, Alió y Sanz J L, Tervo T M
Department of Ophthalmology, University of Helsinki, Haartmaninkatu 4 C, Helsinki, 00290, Finland.
Exp Eye Res. 1998 Jun;66(6):755-63. doi: 10.1006/exer.1998.0469.
Morphological changes in the corneal nerves after laser in situ keratomileusis (LASIK) were investigated and the changes were compared with those observed after creation of the keratectomy flap without subsequent photoablation. After creating the hinged flap, a multizone excimer laser photoablation (myopic correction from 6.00 to 6.66 D; diameter 6 mm) was performed on 27 rabbit corneas. Seven of these 27 rabbits received an automated keratectomy without laser photoablation on the fellow eye. A histochemical acetylcholinesterase reaction was used to demonstrate the changes in the morphology of the corneal nerves 3 days, 2.5 and 5 months after the operations. In all specimens the deepest stromal nerve bundles showed normal morphology. Cut nerve trunks were found at the wound margins and at the level of the flap interphase in the stromal bed. At 3 days, both epithelial and basal epithelial/subepithelial nerves were found at the hinge of the flap but the rest of the flap showed a major loss of epithelial, basal epithelial/subepithelial and superficial stromal nerves. A few new regenerating thin nerve fibers were found to emerge from the cut stromal nerve trunks. They appeared to pass the wound margin into the flap area below the epithelium. At 2.5 and 5 months an increasing number of regenerating nerve leashes were observed to emerge from the cut stromal nerve trunks. They appeared to send anastomosing fibers among the neighboring stromal nerves. By this time the epithelial, basal epithelial/subepithelial and anterior stromal innervation had gained an almost normal nerve density and architecture. In the corneas with the flap only, the epithelial innervation was slightly better spared in the center of the flap, and the stromal changes were somewhat less prominent compared with the LASIK corneas.
研究了准分子激光原位角膜磨镶术（LASIK）后角膜神经的形态学变化，并将这些变化与制作角膜瓣后未进行后续光消融的情况进行了比较。制作带蒂角膜瓣后，对27只兔角膜进行了多区准分子激光光消融（近视矫正度数为6.00至6.66 D；直径6 mm）。这27只兔中有7只的对侧眼接受了自动角膜切除术但未进行激光光消融。采用组织化学乙酰胆碱酯酶反应来显示术后3天、2.5个月和5个月时角膜神经形态的变化。在所有标本中，最深层的基质神经束形态正常。在伤口边缘和基质床中角膜瓣界面水平发现了切断的神经干。术后3天时，在角膜瓣的铰链处发现了上皮神经和基底上皮/上皮下神经，但角膜瓣的其余部分显示上皮、基底上皮/上皮下和浅层基质神经大量缺失。发现有一些新的再生细神经纤维从切断的基质神经干中长出。它们似乎穿过伤口边缘进入上皮下方的角膜瓣区域。在2.5个月和5个月时，观察到越来越多的再生神经束从切断的基质神经干中长出。它们似乎在相邻的基质神经之间发出吻合纤维。此时，上皮、基底上皮/上皮下和前基质神经支配的神经密度和结构已几乎恢复正常。在仅制作角膜瓣的角膜中，角膜瓣中央的上皮神经支配稍好一些，与LASIK角膜相比，基质变化也稍不明显。
