Abstract：
UNASSIGNED: To review the atypical development of Salzmann\'s nodular degeneration (SND) after two cases of laser in situ keratomileusis (LASIK) and one case of photorefractive keratomileusis (PRK), and to highlight the pathophysiology of SND and its treatment.
UNASSIGNED: Three cases of SND (two following LASIK performed with microkeratomes and one following PRK) were reviewed and Pubmed.gov and internet searches were performed.
UNASSIGNED: SND is myofibroblast-generated fibrosis in the subepithelial space between the epithelium and Bowman\'s layer that develops years or decades after traumatic, surgical, infectious, or inflammatory injuries to the cornea in which the epithelial basement membrane is damaged in one or more locations and does not fully regenerate. It is hypothesized based on these cases, and the previous immunohistochemistry of other investigators, that myofibroblast precursors, such as fibrocytes or corneal fibroblasts, that enter the subepithelial space are driven to develop into myofibroblasts, which slowly proliferate and extend the fibrosis, by transforming growth factor-beta from epithelium and tears that passes through the defective epithelial basement membrane. These myofibroblasts and the disordered collagens, and other extracellular matrix components they produce, make up the subepithelial opacity characteristic of SND. Nodules are larger accumulations of myofibroblasts and disordered extracellular matrix. If the injury is associated with damage to the underlying Bowman\'s layer and stroma, as in LASIK flap generation, then the myofibroblasts and fibrosis can extend into Bowman\'s layer and the underlying anterior stroma.
UNASSIGNED: SND fibrosis often extends into Bowman\'s layer and the anterior stroma if there are associated Bowman\'s defects, such as incisions or lacerations. In the latter cases, SND frequently cannot be removed by simple scrape and peel, as typically performed for most common SND cases, but can be trimmed to remove the offending tissue. This condition is more accurately termed Salzmann\'s subepithelial fibrosis. [J Refract Surg. 2024;40(5):e279-e290.].
UNASSIGNED: Three cases of SND (two following LASIK performed with microkeratomes and one following PRK) were reviewed and Pubmed.gov and internet searches were performed.
UNASSIGNED: SND is myofibroblast-generated fibrosis in the subepithelial space between the epithelium and Bowman\'s layer that develops years or decades after traumatic, surgical, infectious, or inflammatory injuries to the cornea in which the epithelial basement membrane is damaged in one or more locations and does not fully regenerate. It is hypothesized based on these cases, and the previous immunohistochemistry of other investigators, that myofibroblast precursors, such as fibrocytes or corneal fibroblasts, that enter the subepithelial space are driven to develop into myofibroblasts, which slowly proliferate and extend the fibrosis, by transforming growth factor-beta from epithelium and tears that passes through the defective epithelial basement membrane. These myofibroblasts and the disordered collagens, and other extracellular matrix components they produce, make up the subepithelial opacity characteristic of SND. Nodules are larger accumulations of myofibroblasts and disordered extracellular matrix. If the injury is associated with damage to the underlying Bowman\'s layer and stroma, as in LASIK flap generation, then the myofibroblasts and fibrosis can extend into Bowman\'s layer and the underlying anterior stroma.
UNASSIGNED: SND fibrosis often extends into Bowman\'s layer and the anterior stroma if there are associated Bowman\'s defects, such as incisions or lacerations. In the latter cases, SND frequently cannot be removed by simple scrape and peel, as typically performed for most common SND cases, but can be trimmed to remove the offending tissue. This condition is more accurately termed Salzmann\'s subepithelial fibrosis. [J Refract Surg. 2024;40(5):e279-e290.].
摘要：
■回顾2例激光原位角膜磨镶术（LASIK）和1例屈光性角膜磨镶术（PRK）后Salzmann结节变性（SND）的非典型发展，并强调SND的病理生理学及其治疗。
■回顾了3例SND（2例LASIK术后进行微角膜磨和1例PRK术后），并进行了Pubmed.gov和互联网搜索。
■SND是在上皮组织和Bowman层之间的上皮下空间中由肌成纤维细胞产生的纤维化，在创伤后数年或数十年发展，外科,传染性,或角膜的炎症损伤，其中上皮基底膜在一个或多个位置受损且未完全再生。它是基于这些案例假设的，和其他研究者以前的免疫组织化学，肌成纤维细胞前体，如纤维细胞或角膜成纤维细胞，进入上皮下空间的人被驱使发展成肌成纤维细胞，缓慢增殖并扩展纤维化，通过从上皮中转化生长因子-β和通过有缺陷的上皮基底膜的眼泪。这些肌成纤维细胞和无序的胶原，以及它们产生的其他细胞外基质成分，构成SND的上皮下混浊特征。结节是肌成纤维细胞和无序的细胞外基质的较大积聚。如果损伤与下面的Bowman层和基质的损伤有关,如LASIK皮瓣一代,然后肌成纤维细胞和纤维化可以延伸到Bowman层和下面的前间质。
■如果存在相关的Bowman缺损，SND纤维化通常会延伸到Bowman层和前基质，如切口或撕裂。在后一种情况下，SND通常不能通过简单的刮擦和剥离来去除，通常在最常见的SND案例中执行，但可以修剪去除有问题的组织。这种情况更准确地称为萨尔茨曼上皮下纤维化。[JRefractSurg.2024；40（5）：e279-e290。].
■回顾了3例SND（2例LASIK术后进行微角膜磨和1例PRK术后），并进行了Pubmed.gov和互联网搜索。
■SND是在上皮组织和Bowman层之间的上皮下空间中由肌成纤维细胞产生的纤维化，在创伤后数年或数十年发展，外科,传染性,或角膜的炎症损伤，其中上皮基底膜在一个或多个位置受损且未完全再生。它是基于这些案例假设的，和其他研究者以前的免疫组织化学，肌成纤维细胞前体，如纤维细胞或角膜成纤维细胞，进入上皮下空间的人被驱使发展成肌成纤维细胞，缓慢增殖并扩展纤维化，通过从上皮中转化生长因子-β和通过有缺陷的上皮基底膜的眼泪。这些肌成纤维细胞和无序的胶原，以及它们产生的其他细胞外基质成分，构成SND的上皮下混浊特征。结节是肌成纤维细胞和无序的细胞外基质的较大积聚。如果损伤与下面的Bowman层和基质的损伤有关,如LASIK皮瓣一代,然后肌成纤维细胞和纤维化可以延伸到Bowman层和下面的前间质。
■如果存在相关的Bowman缺损，SND纤维化通常会延伸到Bowman层和前基质，如切口或撕裂。在后一种情况下，SND通常不能通过简单的刮擦和剥离来去除，通常在最常见的SND案例中执行，但可以修剪去除有问题的组织。这种情况更准确地称为萨尔茨曼上皮下纤维化。[JRefractSurg.2024；40（5）：e279-e290。].
