人眼波前像差表示、测量及矫正研究

目的:波前像差引导的准分子激光角膜消融是屈光手术的新方法,研究人眼波前像差的测量原理、方法、表示、人眼波前像差准分子激光矫正的原理,以此理论用于准分子激光人眼像差矫正系统。方法:采用理论研究、计算机模拟、实验室实验等手段。分析人眼像差的概念和产生的原因,用数学的Zern ike多项式来表示像差,理论上定量分析Zern ike多项式表示的波前像差与角膜切削深度的关系,研究准分子激光切削角膜的机理,研究准分子激光进行矫正人眼像差的原理框图。结果:通过计算机模拟和实验室实验,用准分子激光矫正低阶和高阶像差是可行的。结论:用波前像差来引导屈光手术,使人眼的视力能够达到20/10上,并能避免当前PRK、LASIK屈光手术前后像差增大而引起的对视觉质量的影响。     

PRK,LASIK技术在中国的应用

准分子激光屈光性角膜切削术（ＰＲＫ）和准分子激光原位角膜磨镶术（ＬＡＳＩＫ）是一种治疗眼球屈光不正的新技术,美国、德国、日本和中国（台湾）等国发展了多种准分子激光屈光治疗机以及相应的手术器械及软件,我国从１９９３年引进第一台ＰＲＫ机以来,已引进近百台机器,治疗屈光不正病例已超过十万。作者通过问卷调查和专家访问,对ＰＲＫ、ＬＡＳＩＫ技术在中国的应用状况进行了调查,在调查的基础上进行了分析,并对ＰＲＫ     

准分子激光双面式切削原位角膜磨镶术的研究进展

准分子激光双面式切削原位角膜磨镶术(Both-sided LASIK,BSL)是准分子激光原位角膜磨镶术(laser in situ keratomileusis, LASIK)的改良,BSL将部分激光切削分布在角膜瓣基质面,因而减少了对角膜基质床的切削,最大限度的保留了角膜基质床的剩余厚度,为降低术后角膜膨出提供可能,对屈光度相对偏高和/或角膜相对偏薄的患者,尽量增加手术的安全性,并为LASIK术后屈光回退的增强手术提供了一种新的方法。本文对近年BSL的研究进展作一综述。     

准分子激光原位角膜磨镶术的护理体会

准分子激光原位角膜磨镶术（LASIK）是目前安全性、准确性、稳定性以及疗效的预测性都较好的一种屈光不正矫治术．是目前治疗近视及近视散光首选的屈光手术之一。其原理是用显微板层成形系统掀开一个角膜瓣．在瓣下角膜基质层上用准分子激光根据近视、远视和散光度数进行精确切削。我院于2008年2月从德国引进世界上先进的第八代爱丽丝智能高速扫描准分子激光治疗系统。自4月份开展该术以来。共有212例（408只眼）患者要求手术,通过术前资料评估及术前检查．筛查确定出198例进行LASIK术。通过术前的心理护理、术中密切配合以及术后的详细指导及定期复查随访．疗效满意．现将护理体会总结如下。     

XeCl准分子激光消融几种生物组织的实验结果

本文报道了３０８ｎｍＸｅＣｌ准分子激光对人牙硬组织和猪肉软组织消融的实验研究结果,在国内首次开展了ＸｅＣｌ准分子激光牙科应用的基础研究,为准分子激光在牙科的临床应用提供了实验依据。     

新型准分子激光角膜屈光矫正系统

小光斑高速飞点扫描的准分子激光系统以其具有的治疗时间短、矫正精度高、角膜切削表面极其光滑,易于集成波前像差技术实现“个体化切削”方案等优点,成为眼科屈光矫正激光手术发展趋势。本文从理论基础、光学系统等方面综述了具有自主知识产权的飞点扫描式激光系统,此系统已经在临床动物实验和盲眼实验中取得了非常好的效果。     

角膜屈光手术后屈光回退的手术治疗进展*

屈光回退是角膜屈光手术后的并发症之一,其治疗方法主要为药物治疗和手术治疗。对于需要再次手术的患者,应根据初次手术方式、距离初次手术时间、回退度数,在充分评价角膜情况后合理选择增效术,确保手术的安全性和有效性。目前,准分子激光原位角膜磨镶术和飞秒激光小切口角膜基质透镜取出术是治疗近视和近视散光的主要手术方式。本文就两者术后屈光回退手术治疗的适应症、不同增效术的优缺点及注意事项作一综述。     

近视眼激光角膜切除术原理及控制方法

本文从理论上研究了激光人眼角膜切除术的原理和控制方法。详细分析了角膜前表面的曲率半径对近发消融深度和治疗结果的影响。     

准分子激光切削角膜的数学模型与切削技术研究

本文在分析国内外研究人眼角膜的数学模型的基础上,提出了能够用于进行近视、远视、散光等屈光手术的数学模型,并就准分子激光的切削原理和“飞点扫描”技术进行了研究,本文的研究成果直接用于准分子激光眼科治疗机,取得了满意的手术效果。     

紫外激光消融主动脉斑块和感生荧光光谱观测

利用XeCI准分子激光辐照主动脉血管正常组织和斑块组织,观察到组织被激光消融。消融所产生的凹坑与辐射时间呈对数直线关系。308nm激光感生的血管壁荧光光谱在可见波段出现二个荧光极大值,用二极值的相对强度之比可以判断正常或斑块组织。     

全飞秒激光与飞秒激光辅助Lasik治疗高度近视患者的效果及对角膜曲率、视觉质量的影响分析

摘要 目的：探究全飞秒激光与飞秒激光辅助Lasik治疗高度近视患者的效果,并分析治疗对患者角膜曲率、视觉质量的影响。方法：选择2020年7月至2022年7月在我院接受治疗的120例（240眼）高度近视患者为研究对象,按照随机数字表法结合患者意愿的方式将其区分为研究组（n=60,接受飞秒激光辅助Lasik治疗）与对照组（n=60,接受全飞秒激光治疗）,对比两组患者术前术后调制传递函数截止频率（MTF）值及客观散射指数（OSI）、角膜曲率变化、屈光度差异、视力情况差异,统计两组患者各类并发症发生率并进行比较。结果：（1）两组患者术前MTF值及OSI组间差异无统计学意义（P>0.05）,术后研究组患者的MTF值和OSI值均明显低于对照组,差异具有统计学意义（P<0.05）;（2）术前、术后90 d两组患者的最佳矫正视力组间差异无统计学意义（P>0.05）,但组内前后比较两组患者的最佳矫正视力均较术前有明显提高（P<0.05）;（3）术前两组患者的角膜前表面曲率以及后表面曲率组间差异均无统计学意义（P>0.05）,术后90 d时开展组间比较,研究组患者角膜前表面曲率中K1、K2以及Km值均明显低于对照组（P<0.05）,但后表面曲率中K1、K2以及Km值组间差异无统计学意义（P>0.05）;进一步分析显示,两组患者术前术后前表面曲率K1、K2以及Km值有明显变化（P<0.05）,后表面曲率K1、K2以及Km值前后差异无统计学意义（P>0.05）;（4）统计研究组患者共出现弥漫性层间反应2例,感染1例,角膜内生1例,并发症总发生率3.33%（4/120）,明显高于对照组的0.00%（0/120）（P<0.05）。结论：全飞秒激光和飞秒激光辅助Lasik术对高度近视均具有较好的治疗效果,相比于全飞秒激光术,飞秒激光辅助Lasik术在改善患者视觉质量方面明显占优,但其并发症发生率同样更高,全飞秒激光术术后视觉质量,但安全性更高,建议临床上结合患者实际情况灵活选择术式,以改善高度近视患者预后。     

The effect of excimer laser keratectomy on corneal glutathione-related enzymes in rabbits

Glutathione related enzymes are involved in the metabolism and detoxification of cytotoxic and carcinogenic compounds as well as reactive oxygen species. Excimer laser is a very useful tool for the treatment of refractive errors and removing superficial corneal opacities. Previous studies have shown that excimer laser may initiate free radical formation in the cornea. In the present study, we evaluated the effect of excimer laser keratectomy on corneal glutathione-related enzyme activities in rabbits. Animals were divided into five groups, and all groups were compared with the controls (group 1), after epithelial scraping (group 2), transepithelial photorefractive keratectomy (PRK) (group 3), traditional PRK (group 4) and deep traditional PRK (group 5). Corneal glutathione peroxidase (GPx), glutathione S-transferase (GST) and glutathione reductase (GR) activities were measured after 24h. Corneal GPx and GR activities significantly decreased only in group 5 (p < 0.05) but GST activities significantly decreased in all groups when compared with the control group (p < 0.05). In conclusion, excimer laser inhibits the glutathione dependent defense system in the cornea, this effect becomes more prominent after high doses of excimer laser energy and antioxidants may be useful to reduce free radical mediated complications.     

用二次谐波成像技术研究经飞秒激光切削后角膜变化

本文用二次谐波成像技术（second harmonic generation SHG）来研究飞秒激光切削后角膜结构的变化.在生物学研究,材料科学等方面都有很广泛应用的SHG成像技术能在不破坏的角膜情况下获得高对比度的角膜层析图像,分辨率为500 nm,实验装置是利用现有的双光子显微镜.本文还根据成像结果评价了飞秒激光在角膜切削中的质量,为飞秒激光微米级的精确切削和临床应用提供了实验支持.     

A Mouse Model of the Cornea Pocket Assay for Angiogenesis Study

A normal cornea is clear of vascular tissues. However, blood vessels can be induced to grow and survive in the cornea when potent angiogenic factors are administered ¹. This uniqueness has made the cornea pocket assay one of the most used models for angiogenesis studies. The cornea composes multiple layers of cells. It is therefore possible to embed a pellet containing the angiogenic factor of interest in the cornea to investigate its angiogenic effect ^2,3. Here, we provide a step by step demonstration of how to (I) produce the angiogenic factor-containing pellet (II) embed the pellet into the cornea (III) analyze the angiogenesis induced by the angiogenic factor of interest. Since the basic fibroblast growth factor (bFGF) is known as one of the most potent angiogenic factors ⁴, it is used here to induce angiogenesis in the cornea.Download video file.^{(38M, mov)}     

In-vivo intratissue ablation by nanojoule near-infrared femtosecond laser pulses

Non-invasive intratissue ablation was performed in the cornea of living rabbits by using 80 MHz near-infrared intense nanojoule femtosecond laser pulses. The intratissue surgical effect was induced by multiphoton absorption at a wavelength of 800 nm and was ascertained by histological examination. Highly precise intratissue ablation was obtained with no detrimental effects to the overlying or underlying layers. Activated keratocytes in the laser-treated corneas were detected with two-photon imaging postoperatively. Intratissue femtosecond laser ablation thus has potential as a effective technique in refractive surgery for the treatment of visual disorders. This work was supported in part by the German Science Foundation.     

Lens formation from the cornea following implantation into hindlimbs of larval Xenopus laevis: the influence of limb innervation and extent of differentiation

Corneal fragments of larval Xenopus laevis at stage 48 (according to Nieuwkoop and Faber, '56), were implanted into sham denervated unamputated hindlimbs, denervated unamputated hindlimbs, amputated and sham denervated hindlimbs, and amputated and denervated hindlimbs of larvae at stages 52 and 57. The results show that unamputated limbs at stage 52, either innervated or denervated, manifest a weak capacity to promote the first lens-forming transformations of the outer cornea. This capacity is absent in both limb types at stage 57. After amputation, limbs of both early and late stages form a regenerative blastema and support lens formation from the outer cornea. Denervation of early stage limbs has no appreciable effect on blastema formation and lens-forming transformation of corneal implants. However, denervation of late stage limbs inhibits both processes. These results indicate that the limb tissues of the early stage limbs contain non-neural inductive factors at a low level and that after limb amputation and blastema formation the level of these factors becomes high enough to promote lens formation from implanted cornea, even after denervation. In contrast, the limb tissues of late stage limbs do not contain a suitable level of non-neural inductive factors.     

Experimental analysis of lens-forming capacity in Xenopus borealis larvae

Previously, the only anuran amphibians known to have the capacity to regenerate a lens after lentectomy were Xenopus laevis and Xenopus tropicalis. This regeneration process occurs during the larval life through transdifferentiation of the outer cornea promoted by inductive factors produced by the retina and accumulated inside the vitreous chamber. However, the capacity of X. tropicalis to regenerate a lens is much lower than that of X. laevis. This study demonstrates that Xenopus borealis, a species more closely related to X. laevis than to X. tropicalis, is not able to regenerate a lens after lentectomy. Nevertheless, some morphological modifications corresponding to the first stages of lens regeneration in X. laevis were observed in the outer cornea of X. borealis. This suggested that in X borealis the regeneration process was blocked at early stages. Results from histological analysis of X. borealis and X. laevis lentectomized eyes and from implantation of outer cornea fragments into the vitreous and anterior chambers demonstrated that: (i) in X. borealis eye, the lens-forming competence in the outer cornea and inductive factors in the vitreous chamber are both present, (ii) no inhibiting factors are present in the anterior chamber, the environment where lens regeneration begins, (iii) the inability of X. borealis to regenerate a lens after lentectomy is due to an inhibiting action exerted by the inner cornea on the spreading of the retinal factor from the vitreous chamber towards the outer cornea. This mechanical inhibition is assured by two distinctive features of X. borealis eye in comparison with X. laevis eye: (i) a weaker and slower response to the retinal inducer by the outer cornea; (ii) a stronger and faster healing of the inner cornea. Unlike X. tropicalis and similar to X. laevis, in X. borealis the competence to respond to the retinal factor is not restricted to the corneal epithelium but also extends to the pericorneal epidermis.     

Cornea-lens transdifferentiation in the anuran, Xenopus tropicalis

Previously, the only anuran amphibian known to regenerate the lens of the eye was Xenopus laevis. This occurs during larval stages through transdifferentiation of the outer cornea epithelium under control of factors presumably secreted by the neural retina. This study demonstrates that a distantly related species, X. tropicalis, is also able to regenerate lenses through this process. A transgenic line of X. tropicalis was used to examine the process of cornea-lens transdifferentiation in which green fluorescent protein (GFP) is expressed in differentiated lens cells under the control of the Xenopus gamma1-crystallin promoter element. Unlike X. laevis, the process of cornea-lens transdifferentiation typically occurs at a very low frequency in X. tropicalis due to the rapid rate at which the inner cornea endothelium heals to recover the pupillary opening. The inner cornea endothelium serves as a key physical barrier that normally prevents retinal signals from reaching the outer cornea epithelium. If this barrier is circumvented by implanting outer cornea epithelium of transgenic tadpoles directly into the vitreous chamber of non-transgenic X. tropicalis larval eyes, a higher percentage of cases formed lenses expressing GFP. Lenses were also formed if these tissues were implanted into X. laevis larval eyes, suggesting the same or similar inducing factors are present in both species. When pericorneal ectoderm and posteriolateral flank ectoderm were implanted into the vitreous chamber, only in rare cases did pericorneal ectoderm form lens cells. Thus, unlike the case in X. laevis, competence to respond to the inducing factors is tightly restricted to the cornea epithelium in X. tropicalis. As controls, all these tissues were implanted into the space located between the inner and outer corneas. None of these implants, including outer cornea epithelium, exhibited GFP expression. Thus, the essential inductive factors are normally contained within the vitreous chamber. One explanation why this type of lens regeneration is not seen in some other anurans could be due to the rapid rate at which the inner cornea endothelium heals to recover the pupillary opening once the original lens is removed. These findings are discussed in terms of the evolution of this developmental process within the anurans.     

Avian corneal innervation: Inhibition of nerve ring formation by 6-diazo-5-oxo-l-norleucine

Normal innervation of embryonic avian cornea is achieved in two distinct phases. During phase I, nerves extend from the ventrotemporal region both dorsally and ventrally around the cornea, but not into it, ultimately encircling the 10th-day cornea. Phase II commences as nerves extend radially from the ring into the corneal stroma and from there into the epithelium. The effect of the glutamine analog, 6-diazo-5-oxo-l-norleucine (DON), on this normal sequence of events has been examined. In ovo administration of 5 μg DON on the 5th day of development inhibits the incorporation of [³⁵S]sulfate in sulfated glycosaminoglycans in both the cornea and control tissues and inhibits the completion of phase I. Phase II of corneal innervation appears to be affected only indirectly and extension of nerves into the cornea does occur. However, the number of nerves entering the DON-treated cornea is dramatically reduced. Administration of DON on the 7th or 9th days of development does not affect corneal innervation, but does demonstrate a clear effect on [³⁵S]sulfate incorporation in sulfated glycosaminoglycans by the cornea and control tissues. These data suggest that nerve ring completion is not a prerequisite for extension of nerves into the cornea and suggest an integral role for glycosaminoglycans in facilitating phase I, but not phase II, of corneal innervation.