板层角膜刀制作前弹力层下角膜磨镶术中角膜瓣的临床评估  

Clinical evaluation of corneal flap created by mechanical microkeratome in sub bowman's keratomileusis

作　　者：邓德勇[1] 谢美娜[1] 王泽[1] 彭涛[1] 于丹丹[1] 彭亚军 

机构地区：[1]武警浙江省总队嘉兴医院眼科,中国浙江省嘉兴市314000 [2]长海医院眼科,中国上海市200433

出　　处：《国际眼科杂志》2013年第10期2096-2098,共3页International Eye Science

摘　　要：目的:观察前弹力层下角膜磨镶术(sub-Bowman's keratomileusis,SBK)术中应用板层角膜刀制作的角膜瓣特点及相关影响因素。方法:用Moria One Use-Plus SBK板层角膜刀对98例196眼进行手术,预设角膜瓣厚度为100μm,术中用A型超声测量角膜瓣厚度,分析角膜瓣的均匀性、稳定性及相应的瓣并发症,并与预设角膜瓣厚度进行差异性分析,与术前等效球镜、角膜直径、角膜厚度、角膜中央最大K值等进行相关性分析。结果:实际角膜瓣平均厚度为100.96±5.35μm,先做眼(左眼)平均角膜瓣厚度103.56±5.22μm,后做眼(右眼)平均角膜瓣厚度98.12±5.50μm,两组差异有统计学意义(t=2.36,P<0.05)。角膜瓣的均匀性良好,各眼角膜中心、鼻侧、颞侧和上下方距中心3mm处角膜厚度无统计学差异(F=0.438,P>0.05)。实际角膜瓣厚度与患者术前中央角膜厚度(r=0.312,P<0.05)、角膜中央最大K值(r=0.452,P<0.01)呈正相关,与术前等效球镜、角膜直径等无明显相关性。常见制瓣并发症为上方瓣缘出血(34眼)、根部瓣缘粗糙(38眼)以及微小皱褶(25眼),未见其他严重并发症。结论:SBK术中机械板层角膜刀制作角膜瓣厚度均匀,预测性好,瓣相关并发症少,角膜瓣厚度与术前中央角膜厚度及角膜中央最大K值呈正相关。AIM ： To observe the flap characteristics and the factors correlated to the thickness of the cornea flap created with mechanical microkeratome in sub bowman＇s keratomileusis （SBK）. METHODS： One hundred and ninety-six consecutive eyes of 98 patients were treated with Moria One Use Plus SBK microkeratome. The intended flap thickness was 100μm. The flap thickness was measured by A type ultrasound. The flap complications were recorded and single variable correlations of the flap thickness and preoperative MRSE, corneal diameter, corneal thickness, corneal keratometric value K were determined. RESULTS： The mean flap thickness was 100. 96±5. 35μm, mean flap thickness was 103.56±5. 22μ m in the left eyes and 98. 12 ± 5. 50tJm in the right eyes, the difference between right and left eyes was statistically significant（t= 2.36, P〈0.05）. The uniformity of corneal flap was good. There were no statistical differences on corneal thickness at cornea center, nasal side, temporal side and 3ram from the center at the top and bottom （ F= 0. 438, P〉 0. 05）. Corneal flap thickness was positively correlated with preoperative corneal keratometric value K（r= 0. 452, P〈 0. 01 ） and preoperative central corneal thickness（ r= 0. 312, P〈0.05 ）, but was not dependent on preoperative MRSE and corneal diameter. The common complications were top flap edge bleeding （34 eyes）, root flap edge roughness （38 eyes） and tiny folds （25 eyes）, with no other complications. CONCLUSION： The corneal flaps created by mechanical microkeratome in SBK have even thickness, good predictability and fewer complications, and are positively correlated with preoperative corneal keratometric value K and preoperative central corneal thickness.

关 键 词：角膜瓣 前弹力层下角膜磨镶术 相关因素 

分 类 号：R779.63[医药卫生—眼科]