飞秒激光角膜微小切口基质透镜取出术矫正近视及近视散光的早期临床研究  

Clinical study of femtosecond laser corneal small incision lenticule extraction for correction of myopia and myopic astigmatism

作　　者：王雁[1] 鲍锡柳[1] 汤欣[1] 左彤[1] 耿维莉[1] 金颖[1] 

机构地区：[1]天津市眼科医院天津市眼科学与视觉科学重点实验室天津市眼科研究所天津医科大学眼科临床学院,300020

出　　处：《中华眼科杂志》2013年第4期292-298,共7页Chinese Journal of Ophthalmology

基　　金：国家自然科学基金（81178073）

摘　　要：目的探讨飞秒激光角膜微小切口基质透镜取出术（SMILE）矫正近视及近视散光的安全性、有效性、可预测性、稳定性及手术相关并发症等。方法前瞻性研究。对人选的50例（88只眼）近视及近视散光患者，常规术前检查及围手术期处理，均施行飞秒激光SMILE手术。术后1d、1周、1个月、3个月随诊，复查裸眼视力（UCVA）、最佳矫正视力（BCVA）、电脑验光、显然验光和检影、眼压及角膜地形图等。失吸眼、有不透明气泡层的眼与其余眼各参数间比较应用独立样本t检验，手术前后眼压比较应用配对t检验，术后不同随访时间预矫等效球镜度数（SE）与实际矫正度数之间应用线性回归分析。结果SMILE手术末次随访所有患者均获得1．0以上UCVA，均达到术前BCVA，残余等效球镜度数为（-0．11±0．29）D，散光度数仅为（0．01±0．33）D。术后患者的实际sE与预矫SE呈线性关系（R2=0．943，P〈0．05）。手术过程中3例（3只眼，3．4％）患者发生失吸，14例（26只眼，29．5％）患者发生不透明气泡层（OBL）。术后无BCVA下降。术后弥漫性板层角膜炎及角膜上皮下雾状混浊的发生率低，未出现其他严重并发症，角膜愈合良好。患者术前、术后1个月、术后3个月的平均眼压分别为（15．03±2．92）、（12．974-3．12）、（13．33±2．34）mmHg（1mmHg=0．133kPa），较术前相比，1个月时眼压略有降低（t=6．238，P〈0．05），3个月时无明显变化（t=0．053，P〉0．05）。结论SMILE手术用于矫正近视及近视散光具有较好的安全性、有效性、可预测性及稳定性，但需扩大样本量及延长随访时间远期观察。Objective To evaluate the safety, efficacy, predictability, stability and complications of femtosecond laser corneal small incision lenticule extraction （SMILE） procedure for the correction of myopia and myopic astigmatism. Methods In this prospective study, 50 patients （88 eyes） with myopia and myopic astigmatism were chosen to be performed SMILE procedure randomly. These patients were followed up at 1 day, 1 week, 1 month and 3 months postoperatively and were examined for uncorrected visual acuity （UCVA）, best corrected visual acuity （BCVA）, manifest refraction, intraocular pressure （lOP） and corneal topography. The results were analyzed with paired-t test, independent-samples t test and regression analysis. Results SMILE procedure was performed well in all patients, only 3 cases （3 eyes, 3.4% ） suffered from the suction loss, 14 cases （26 eyes, 29. 5% ） developed opaque bubble layer. All patients gained perfect UCVA （20/20）, no eye had decrease of BCVA. The residual spherical equivalent was （ -0. 11 ＋0.29） D, the astigmatism was （0.01±0. 33 ） 13 3 months postoperatively. The incidence of diffuse lamellar keratitis and haze was low, and no other complications were observed. The IOP was decreased slightly after 1 month （ t = 6. 238, P 〈 0. 05 ）, but no changes after 3 months （ t = 0. 053, P 〈 0. 05）. Conclusion The SMILE procedure is good at the safety, efficacy, predictability and stability for the correction of myopia and myopic astigmatism.

关 键 词：近视 散光 屈光外科手术 激光 飞秒 角膜基质 

分 类 号：R779.63[医药卫生—眼科]