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目的 应用共焦显微镜观察圆锥角膜患者表面角膜镜片术 (epikeratophakia,EP)后不同时期的镜片组织 ,了解低温冷冻脱水角膜材料移植后组织细胞和神经重建的动态过程。方法 对 2 4例 (2 4只眼 )圆锥角膜患者行EP ,应用共焦显微镜分别对术后不同时期的角膜镜片组织细胞、神经重建过程进行活体动态观察 ,并摄像记录。结果 镜片上皮层 :术后 3或 4d ,组织镜片表面已被角膜表层上皮细胞覆盖 ,镜片边缘可见翼状细胞及形态不规则、低密度的基底细胞 ;术后 1个月 ,上皮基底细胞完全覆盖角膜镜片 ;术后 6个月 ,基底细胞密度及形态趋于正常 ,可见上皮下散在神经丛 ;术后2年 ,神经丛形态接近正常。镜片基质层 :术后 1年内 ,镜片基质细胞无变化 ,细胞少、形态不规则 ;术后 2年 ,镜片边缘偶见正常形态的基质细胞 ;术后 5年 ,镜片中央仍未见正常形态的基质细胞 ,镜片前后基质细胞相同。镜片基质神经 :术后 6个月 ,有神经干伸入镜片基质内 ;术后 2年 ,基质神经数量增多 ;术后 5年 ,基质神经尚未达到正常密度。结论 冷冻的非活性角膜组织行EP后组织镜片各层细胞、神经重建的时间各不相同 ,但并不影响植片透明度
Objective To observe the microstructure of keratomileus after epikeratophakia (EP) at different stages by confocal microscopy, and to understand the dynamic process of tissue cells and nerve reconstruction after cryogenic dehydration corneal transplantation. Methods Twenty-four patients (24 eyes) with keratoconus were treated with EP. Confocal microscopy was used to observe the dynamic changes of corneal lens cells and the process of nerve reconstruction at different stages respectively. Results The lens epithelial layer: 3 or 4 days after surgery, the surface of the tissue lens has been covered by the corneal epithelial cells, the lens edge of the visible wing cells and irregularly shaped, low density of basal cells; 1 month after surgery, epithelial basal cells completely cover the cornea At 6 months after operation, the basal cell density and morphology tended to be normal, and the plexus scattered in the plexus. After 2 years, the shape of plexus was close to normal. Lens matrix: Within 1 year after surgery, there was no change of lens stroma cells, few cells, irregular shape; 2 years after operation, occasional normal lens stroma cells; 5 years after surgery, the lens has not yet seen the normal form of the central Stromal cells, lens cells before and after the same. Lens matrix nerve: 6 months after surgery, there are nerve fibers into the lens matrix; 2 years after surgery, increased the number of stromal cells; 5 years after surgery, the stromal nerve has not yet reached the normal density. Conclusion Frozen non-active corneal tissue cells in all layers of the lens after EP, nerve reconstruction time vary, but does not affect the transparency of the graft