角膜屈光手术后早期角膜生物力学特性变化研究  

Short-term influence of different refractive surgery on corneal biomechanical properties

作　　者：祖培培[1] 王雁[1] 吴迪[1] 魏升升[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,天津300020

出　　处：《中国实用眼科杂志》2013年第7期866-871,共6页Chinese Journal of Practical Ophthalmology

基　　金：国家自然科学基金资助项目（81170873）

摘　　要：目的探讨不同角膜屈光手术方式术后早期角膜生物力学变化的特点及各术式间的生物力学对比情况。方法前瞻性病例研究。对49只眼行准分子激光屈光手术患者术前术后角膜生物力学参数进行分析，其中行FS—LASIK手术29只眼，SBK手术8只眼，LASEK手术12只眼。术前和术后3个月应用角膜生物力学眼压计（CorvisST）对患者的第一次压平时间（1stA—time）、角膜长度（1stAlength）、速度（Vin），第二次压平时间（2ndA—time）、角膜长度（2ndAlength）、速度（Vout），以及最高点时间（HC—time）、两峰间距（W—Dist）、曲率半径（HC—radius），位移（HC—DA）及非接触式眼内压（intraocularpressure，IOP）等进行测量和分析。采用Pearson线性相关分析患者术后生物力学各参数变化值与年龄，术前等效球镜（MRSE）、中央角膜厚度（CCT）等一般参数及术中角膜切削量（AD）、术后角膜残余基质床厚度（RST）等重要手术参数之间的相关关系；应用配对f检验对手术前后各生物力学参数及眼压变化进行对比分析，观察三种手术方式（FS—LASIK，SBK，LASEK）手术前后变化规律；并研究不同术式之间术后角膜生物力学变化的对比情况。结果三组组内各生物力学参数与等效球镜（MRSE）、术中角膜切削量（AD）、术后角膜残余基质床厚度（RST）、中央角膜厚度（CCT）等有不同程度相关性（P〈0．05），且术前术后差异明显具有统计学意义（P〈0．01）；组间术后SBK组与LASEK组△1stA—time、△HC—radius，AIOP差异有统计学意义（P〈0．05），FS—LASIK组与LASEK组的AVout差异有统计学意义（P〈0．05）。结论不同角膜屈光手术方式会对角膜生物力学产生不同影响，使其动态学特性发生一系列变化，与术前患者等效球镜度和激光对角膜组织的切削量等有一定的相关性。Objective To evaluate the influence of different refractive surgery on corneal biome- chanical properties. Methods Forty-nine myopic eyes were enrolled in this prospective case series study. There were 29 eyes underwent FS-LASIK, 8 eyes underwent SBK and 12 eyes underwent LASEK. The lstA-time, lstA length, Vin, 2ndA-time, 2ndA length, Vout, HC-time, W-Dist, HC-radi- us, HC-DA and lOP were obtained with Corvis ST preoperatively and 3 months postoperatively. A Pearson correlation was used to investigate correlations between changing values and age, MRSE, CCT, AD, RST and so on. The values were analyzed before and after surgery using a paired t test and investigated between 3 groups with One-Way ANOVA. Results There was varying significanceof correlation between changing biomechanical values and age, MRSE, CCT, AD, RST （P 〈0.05）. The difference between preoperative and 3 months postoperative status were statistically significant in 3 groups respectively （P 〈0.01）. Significance of AlstA-time, AHC-radius and AIOP between SBK and LASEK group were found （P 〈0.05）, as well as AVout between FS-LASIK and LASEK group （P 〈0.05）. Conclusions There are different influences on corneal biomechanical properties between different refractive surgery, which are related to MRSE, AD and so on.

关 键 词：角膜生物力学 FS—LASIK手术 SBK手术 LASEK手术 角膜瓣 

分 类 号：R318.01[医药卫生—生物医学工程]