准分子激光原位角膜磨镶术后角膜细菌性感染的实验研究

Experimental study on bacterial infection of cornea after laser in situkeratomileusis

摘要:

目的:建立日本大耳白兔LASIK术后感染模型,了解LASIK术后细菌性角膜炎的病理过程,为LASIK术后细菌性角膜炎诊断、治疗提供依据。方法:选取健康成年日本大耳白兔20只,右眼行LASIK术后接种金黄色葡萄球菌,在术后12h；1,3,5,10d各时期行肉眼、数字化裂隙灯和共焦显微镜观察,10d后处死实验动物取角膜行病理切片。结果:18眼成功建立了LASIK术后细菌性角膜炎模型。其早期表现为角膜瓣浅基质层点状或小斑片状炎性浸润,随着时间的推移慢慢融合,并以层间为起点同时向前（角膜瓣）和向后（深基质层）发展,晚期造成角膜瓣移位、角膜瓣溃疡、穿孔伴前房积脓。结论:建立LASIK术后细菌性角膜炎模型可行。LASIK术后细菌性角膜炎会导致严重的病理损害。

Abstract:

AIM:To investigate a new approach of establishing rabbit bacterial infection keratitis model after laser in situkeratomileusis (LASIK), so as to provide reference for the diagnosis and treatment of the post-LASIK bacterial infection keratitis. METHODS:Twenty healthy adult rabbits were selected to perform LASIK on their right eyes, and inoculated with staphylococcus aureus after surgery. Examinations were performed at 12 hours, on the first, 3^rd, 5^th and 10^th days after surgery using ocular, digital slit-lamp and confocal microscopy. After 10 days operation, the corneas were collected for pathological examination. RESULTS:Eighteen eyes bacterial infection keratitis model post-LASIK were successfully established. The infectious infiltrates appeared as dots or spots at the shallow layer of stroma underneath the corneal flap at the early stage, and gradually merged together over the infection time. The infectious infiltrates also spread bi-directionally towards the corneal flap and the deeper stromal layer from the flap interface, where the corneal flap showed more severe infection than the deeper stromal layer. At the late period the infection caused the corneal flap melting or dislocation, corneal flap ulcer and perforation with hypopyon. CONCLUSION:It would be feasible to establish bacterial infection keratitis after LASIK. Bacterial infection would lead to serious pathological damage after LASIK.