三种不同设备行屈光手术时的角膜切削误差比较  

Investigation of central corneal cutting error in corneal refractive surgery using three different devices

作　　者：刘才远[1] 汤勇[2] 蒋瑜[1] 潘秀珍[1] 汤元昕 陈萍[1] 虞燕[1] 

机构地区：[1]中国科学技术大学医院,合肥230026 [2]中国科学技术大学生命科学学院,合肥230027

出　　处：《中华眼视光学与视觉科学杂志》2013年第11期680-683,共4页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的调查2种不同的准分子激光设备和1种全飞秒激光手术设备用于准分子激光原位角膜磨镶术（LASIK）时对中央角膜厚度切削误差的影响，探索角膜切削误差的变化规律。方法前瞻性病例对照研究。使用A型超声角膜测厚仪测量分别应用3种不同设备行手术治疗的138例（274眼）患者术前及术后1个月的中央角膜厚度。其中51例（100眼）使用Esiris机器行LASIK手术（Esiris—LASIK），50例（100眼）使用VisxS4-IR机器行LASIK手术（Visx—LASIK组），37例（74眼）使用VisuMax机器行SMILE手术（VisuMax—SMILE组）。所有眼按屈光度分为低、中、高度3组，分别计算中央角膜厚度及角膜切削误差，并分析切削误差与不同设备、近视程度、散光程度、角膜切削直径及手术前角膜厚度的关系。采用单样本t检验、双因素方差分析及Pearson相关进行数据分析。结果3组病例中，近视程度、术前中央角膜厚度及术前散光度对角膜切削误差均没有显著影响，设备或手术方式对角膜切削误差有显著的影响。在Esiris—LASIK组中，角膜的实际切削厚度小于预期切削厚度，差异有统计学意义（低度近视组，t=4．672，P〈0．01；中度近视组，t=10．629，P〈0．01；高度近视组，t=11．021，P〈0．01）；Visx—LASIK组中，角膜的实际切削厚度大于预期切削厚度，差异有统计学意义（低度近视组，t=3．910，P〈O．01；中度近视组，t=4．922，P〈0．01；高度近视组，t=4．807，P〈0．01）；在VisuMax—SMILE组中，角膜的实际切削厚度与预期切削厚度差异无统计学意义（中度近视组，t=1．158，P〉O．05；高度近视组，t=0．836，P〉0．05）。结论不同的手术设备会显著影响屈光手术中中央角膜厚度的切削误差。Objective To evaluate the precision of laser in situ keratomileusis （LASIK） using two different devices, the Esiris excimer and Visx S4-IR laser systems, and small incision lentieule extraction （SMILE） surgery with the VisuMax femtosecond laser system. Methods This was a prospective case control study. Central corneal thickness was measured by using ultrasonic pachymetry before and 1 month after surgery in 274 consecutive eyes of 138 patients with no previous history of surgery. Corneal refractive surgery was then performed on all patients. Among all eyes, 100（51 patients） underwent LASIK with the Esiris excimer laser system; 100（50 patients） underwent LASIK with the Visx S4-IR exeimer laser system; and 74（37 patients） underwent SMILE with the VisuMax femtosecond laser system. The changes in central corneal thickness before and after surgery were compared with their theoretically expected between them were defined as the central corneal values calculated before surgery. The differences cutting error, the index of the surgical precision, and were compared for different types of surgery and different magnitudes of refractive errors. An independent sample t test, two-way analysis of variance and Pearson correlation were used for data analysis. Results The extent of myopia, the extent of astigmatism and the central corneal thickness before surgery had no significant effects on the central corneal cutting error. In contrast, the cutting error showed significant differences between groups, suggesting a strong effect based on the equipment and procedure used in the refractive surgery. In the Esiris-LASIK group, there were significant differences （low myopia, t=4.672, P〈0.01; moderate myopia, t=10.629, P〈0.01; high myopia, t=11.021, P〈0.01） between the changes in central corneal thickness and their expected values. Similarly, there were significant differences （low myopia, t=3.910, P〈0.01; moderate myopia, t=4.922, P〈0.01; high myopia, t=4.807, P〈0.01） between the changes in centra

关 键 词：近视 屈光外科手术 中央角膜厚度 

分 类 号：R779.63[医药卫生—眼科]