活体共聚焦显微镜观察有瓣和无瓣epi-LASIK上皮愈合情况
Comparison of in vivo Confocal Microscopic Findings Between epi-LASIK by Different Management of Epithelial Flaps.
[Invest Ophthalmol Vis Sci. 2011 Feb 25. [Epub ahead of print]
Chen WL, Shen EP, Hsieh YT, Yeh PT, Wang TJ, Hu FR.
Source
Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan;

Abstract
Purpose: To compare the wound healing process examined by in vivo confocal microscopy of epikeratome laser-assisted in situ keratomileusis (epi-LASIK) through different management of epithelial flaps. Materials and Methods: This prospective study comprised of 46 eyes in the on-flap group and 47 eyes in the off-flap group. Epithelial flaps were repositioned or removed for on- and off-flap eyes, respectively. In vivo confocal microscopy was performed preoperatively, postoperative 1 and 2 weeks, and at 1, 3, and 6 months. Corneal epithelial thickness, basal/apical surface epithelial morphology, and stromal reactions were analyzed. Results: Complete epithelialization by slit-lamp biomicroscopy was faster for mitomycin C (MMC) treated off-flap (4.27 ± 0.70 days) than on-flap (5.84 ± 0.08 days) eyes (P=0.01). The percentage of eyes recovering to preoperative basal epithelial cell confocal morphology for on- and off-flap groups was 87.5% and 92.3% for MMC treated eyes, and 86.3% and 90.5% for eyes without MMC treatment at postoperative 1 month. 50% and 100% of eyes returned to preoperative apical epithelial morphology by 3 months in on-flap and off-flap group for both MMC treated and untreated eyes, respectively. Regression analysis revealed repositioned flap resulted in significant delay of epithelialization and apical/basal epithelial recovery (P<0.01). Stromal reaction did not differ significantly at all time points. Corneal epithelial thickness was significantly thicker for on-flap eyes (54.2±4.5 um) than off-flap eyes (26.7±5.8 um) at postoperative 1 month (P<0.01). Conclusions: On-flap and off-flap epi-LASIK showed comparable clinical outcomes postoperatively. Off-flap epi-LASIK had more rapid re-epithelialization and normalization of epithelial morphology compared to on-flap epi-LASIK by in vivo confocal microscopy.

　　这项研究发表于2011年2月的美国眼科研究与视力学杂志上，该研究分为两组，一组为有瓣组（保留并复位上皮瓣），46眼，另一组为无瓣组（去掉上皮瓣），47眼，在术后1周，2周，1月，3月，6月，用共聚焦显微镜观察上皮和基质愈合情况。结果显示无瓣epi-LASIK比有瓣epi-LASIK恢复的更快。
　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　（黄正 译）