摘要
目的探讨紫杉醇对准分子激光上皮下角膜磨镶术(laser subepithelial keratomileusis, LASEK)后角膜上皮下雾状混浊(Haze)形成的影响。方法取无眼部疾病的健康新西兰大白兔108只(216眼)随机分为3组,每组36只兔(72只眼),均行LASEK,第一组术中给予紫杉醇0.3 mg/ml治疗(P组),第二组术中给予0.02%丝裂霉素(MMC)治疗(M组),第三组术中给予平衡盐液(B组),分别于术后1周、1个月、3个月各组随机选取12只(36只眼)大白兔空气栓塞处死取角膜标本。术后3 d借助裂隙灯观察兔眼部体征、角膜上皮愈合进程,术后1周、1个月、3个月观察各组动物角膜Haze分级情况;术后1周、1个月、3个月行免疫组织化学染色观察3组角膜基质层细胞转化生长因子β1(TGF-β1)表达情况。结果 LASEK术后裂隙灯显微镜检查示:兔眼均未见感染和新生血管形成,各组兔角膜上皮均在术后3～5 d愈合;术后1周、1个月、3个月P组角膜Haze程度与M组相似(P>0.05),P组与M组角膜Haze程度较B组轻微(P均<0.01)。P组与M组术后1周、1个月、3个月角膜基质层细胞TGF-β1表达比较差异无统计学意义(P>0.05),P组和M组术后1周、1个月、3个月角膜基质层细胞TGF-β1表达均低于B组(P<0.01);且术后角膜基质层TGF-β1表达水平随时间的延长而呈下降趋势(P<0.01)。结论紫杉醇能够较好地抑制LASEK术后兔眼角膜细胞增殖和胶原纤维形成,显著降低术后兔眼早期角膜基质层中TGF-β1的表达,从而对角膜Haze的形成有明显的抑制作用。
Objective To investigate the effects of paclitaxel on corneal haze formation after subepithelial keratomileusis(LASEK) in rabbits. Methods A total of 108(216 eyes) healthy New Zealand white rabbits without eye diseases underwent LASEK. They were randomly divided into three groups, with 36(72 eyes) rabbits in each group. During the operation, the first group was given 0.3 mg/ml paclitaxel(group P), the second group was given 0.02% Mitomycin(MMC)(group M), and the third group was given a balanced salt solution(group B). At 1 week, 1 month and 3 months after the operation, 12(36 eyes) rabbits were randomly selected and sacrificed by air embolization to take corneal specimens. At 3 d postoperatively, the signs of rabbit eye and corneal epithelial healing process were observed under slit lamp microscope, and corneal Haze grading was observed at 1 week, 1 month and 3 months after operation. Corneal tissues were observed 3 months after operation by histopathology and transmission electron microscopy, and immunohistochemical staining was used to observe the expression of TGF-β 1 in corneal stromal cells of three groups at 1 week, 1 month and 3 months after operation. Results The results of slit lamp microscopic examination after LASEK showed that no infection and neovascularization were observed in rabbit eyes. Corneal epithelium was healed within 3-5 d after operation, and the degree of corneal Haze in group P was similar to that in group M after 1 week, 1 months and 3 months, and the degree of Haze in group P and M was slightly lower than that in group B(P<0.05). Pathological examination of corneal section showed a small amount of corneal stromal cell aggregation in group P and group M(P<0.01). Electron microscopic examination of the corneae showed that compared with group M and group B, there were fewer fibroblasts in the anterior corneal stroma in group P, and the corneal stroma collagen fiber was similar in diameter, which was arranged regularly. The fibroblasts were small in size, with fewer organelles and were in a stable state. There was no significant difference in the expression of TGF-β 1 in corneal stromal cells in group P and group M at 1 week, 1 month and 3 months after operation(P>0.05). The expression of TGF-β 1 in corneal stromal cells in group P and group M was lower than that of group B at 1 week, 1 month, and 3 months after operation(P<0.01), and the expression of TGF-β 1 in the corneal stroma after operation showed a descending trend with time(P<0.01). Conclusion Paclitaxel may inhibit corneal cell proliferation and collagen fiber formation in rabbit eyes after LASEK, and significantly reduce the expression of TGF-β1 in the corneal stromal layer of rabbit eyes in early stage, thereby inhibiting the formation of corneal Haze remarkably.
引文
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