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目的探讨准分子激光原位角膜磨镶术(LASIK)后弥漫性板层角膜炎(DLK)的临床病理学特征及发病机制。方法LASIK术后DLK患者30例(39只眼)(Ⅰ~Ⅳ期),术后1、3、5、7 d及1个月进行裂隙灯显微镜检查,术后3、7 d及1个月进行共焦显微镜检查。结果Ⅰ期及Ⅱ期DLK的典型表现出现在术后3 d,共焦显微镜观察所见:角膜板层切口前基质及层间可见大量直径12~20μm的圆形或卵圆形细胞,反光较强,散在分布或排列成行,细胞内可见偏心的高反光的核和低反光的细胞内结构。层间还可见大量直径8~12μm的圆形细胞,强反光,多聚集成簇或排列成行,细胞核形态不规则。术后7 d上述细胞几乎消失。Ⅲ期DLK出现于术后3~5 d,表现为前基质中的细胞浸润更浓密,层间无定形的高反光物质较明显。Ⅳ期DLK在术后5~7 d出现明显的前基质结构模糊,高反光,角膜瓣全层皱褶,晚期形成大量高反光的瘢痕组织。结论LASIK术后弥漫性板层角膜炎是角膜瓣层间的炎性反应,主要病理学特征为角膜瓣层间的炎性细胞浸润,其发病是多种因素通过内源性途径和外源性途径共同作用的结果
Objective To investigate the clinicopathological features and pathogenesis of diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK). Methods Thirty patients (39 eyes) with DLK after LASIK were examined by slit lamp microscopy at 1, 3, 5, 7 d and 1 month after operation. At 3, 7 d and 1 month after operation Confocal microscopy was performed. Results The typical appearances of stage Ⅰ and stage Ⅱ DLK appeared on the 3rd postoperative day. Confocal microscopy showed that a large number of round or oval cells with a diameter of 12 ~ 20 μm were seen between the stroma and the anterior layer of the corneal incision, Strong, scattered or arranged in rows, the cells can be seen eccentric high reflective nucleus and low reflective intracellular structure. Between the layers can also see a large number of 8 ~ 12μm diameter circular cells, strong reflective, clustered or arranged in rows, irregular nuclear morphology. After 7 days, the above cells almost disappeared. Stage Ⅲ DLK appeared in 3 ~ 5 days postoperatively, showing a more dense infiltration of cells in the anterior stroma and a more pronounced presence of amorphous hyperreflective striae. Stage IV DLK appeared obvious anterior stromal structure fuzzy, hyperreflective, corneal flap full-thickness folds 5 to 7 days after operation, and formed a large number of highly reflective scar tissue late. Conclusions Diffuse lamellar keratitis after LASIK is an inflammatory reaction between the corneal flap and the main pathological feature is the infiltration of inflammatory cells between the corneal flap layers. The pathogenesis of diffuse lamellar keratitis is caused by many factors, including endogenous and exogenous Way to work together