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目的 探讨角膜新生血管对大鼠角膜损伤神经再生的影响.设计实验研究.研究对象SD大鼠.方法 采用随机数字表法将18只SD大鼠分为3组,每组6只.A组行缝线铲针角膜基质层间切开及缝线诱导新生血管术,术后0、3、7天给予结膜下注射贝伐单抗;B组行缝线铲针角膜基质层间切开及缝线诱导新生血管术;C组0、3、7天行结膜下注射贝伐单抗操作.分别在术后1天、1周、2周、4周,采用裂隙灯照相法观察记录角膜新生血管面积;角膜共聚焦显微镜记录神经长度.采用Cochet-Bonnet知觉仪测量缝线区的角膜知觉,采用Schirmer试验泪液线测量右眼的泪液分泌量.术后4周角膜全层铺片免疫荧光染色,记录上皮下神经密度.主要指标角膜新生血管面积比、神经长度、上皮下神经密度、角膜知觉、泪液分泌量.结果 A、B组术后1、2周有角膜新生血管生长,术后4周消退闭锁,C组无角膜新生血管生长.A组术后1、2周新生血管面积比为(10.86±1.57)％和(1.87±0.69)％,分别小于B组的(25.42±2.65)％和(6.48±1.10)％(P均=0.000).术后1天A、B组神经长度分别为(151.02±4.74) μm、(149.69±4.32) μm(P=0.306);术后1、2、4周,A组神经长度均长于B组,分别为(193.84±2.25)μm与(155.73±2.98)μm、(217.15±2.08)μm与(166.21±2.41)μm、(220.70± 1.41)μm与(203.76± 1.74) μm(P均=0.000).术后A、B组神经长度均有减少并有恢复趋势,C组无明显变化.术后4周A组损伤区上皮下神经密度(22.60％±2.02％)明显高于B组(9.41％±2.01％)(P=0.000).A、B组上皮下神经短小稀疏、密度低,C组形态正常.A、B组术后1、2、4周时角膜知觉及泪液分泌量均无统计学差异(P均＞0.05).A、B组均有下降并恢复趋势,C组无明显变化.结论 角膜新生血管可能抑制角膜损伤神经再生,抑制角膜新生血管有利于神经再生.","Objective To investigate the effect of coeal neovascularization on nerve regeneration in the injured coea.Design Experimental study.Participants Sprague Dawley (SD) rats.Methods Eighteen SD rats were randomly allocated into 3 groups.Suture method inducing angiogenesis,coea injury and subconjunctival injection of bevacizumab ware performed in Group A;Suture method inducing angiogenesis and coea injury ware performed in Group B;Subconjunctival injection of bevacizumab was performed in Group C.At postoperative 1-day,1-,2-,4-weeks,the slit lamp photographic method was used to observe surface area of coeal neovascularization;and confocal microscope was used to investigate coeal stromal nerve length.Coeal subepithelial nerves were stained with β tubulin antibody and pictures of subepithelial nerve plexus were taken at postoperative 4 weeks.The coeal sensation of suture zone was examined using the Cochet-Bonnet perception instrument.The Schirmer tests tears line was used to measure the tear secretion in the right eye.Main Outcome Measures Coeal neovascularization surface area,coeal stromal nerve length,subepithelial nerve plexus density,coeal sensitivity,tear secretion.Results Coeal neovascularization grew in group A and B at 1-and 2-weeks and regressed at 4-weeks,and the coea of group C was normal.There were significant difference of the coeal neovascularization area ratio between 1-and 2-weeks of group A and 1-and 2-weeks of group B[(10.86±1.57)％ versus(25.42±2.65)％,(1.87±0.69)％ versus(6.48±1.10)％,all P=0.000].The length of injured coea nerve decreased after experimental surgery in group A and B,and was normal in group C.There was no significant difference between group A and group B at 1-day after surgery[(151.02±4.74)μm versus(149.69±4.32)μm,P=0.306],and there was significant difference among 1-,2-,4-weeks of group A and l-,2-,4-weeks of group B[(193.84±2.25)μm versus(155.73±2.98)μm,(217.15±2.08)μm versus(166.21 ±2.41)μm,(220.70±1.41)μm versus(203.76±1.74)μm,all P=0.000].The subepithelial nerve of injured coea in the group C was normal and the subepithelial nerve plexus density was significantly higher in the group A than that in the group B[22.60±2.02)％ versus(9.41±2.01)％,P=0.000].The coeal sensitivity and tear secretion decreased after experimental surgery in group A and B,and were normal in group C,and there were no significant difference among 1-,2-,4-weeks of group A and 1-,2-,4-weeks of group B (all P＞0.05).Conclusions Coeal neovascularization may retard nerve regeneration of damaged coea,and inhibition of coeal neovascularization is helpful for nerve regeneration.