SMILE矫正中度和高度近视散光6个月疗效分析  

Six months effects on SMILE for moderate and high myopia with astigmatism

作　　者：许多[1] 阚秋霞[1] 张国伟[1] 陈开建[1] 刘丽娜[1] 郎敏[1] 白继[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所眼科,重庆400042

出　　处：《眼科》2014年第5期295-300,共6页Ophthalmology in China

摘　　要：目的分析SMILE手术矫正中、高度近视散光临床疗效,探讨SMILE手术矫正中、高度近视散光的技术特点。设计前瞻性病例系列。研究对象-1.00^-5.50 D的中、高度近视散光患者47例92眼。方法对中、高度近视散光患者47例92眼完成SMILE手术矫正,术前等效球镜屈光度为-3.25^-5.50 D,近视散光-1.00^-4.50 D,其中中度散光-1.00^-3.00 D者54眼为A组,高度散光-3.00^-4.50 D者38眼为B组。应用Visu Max全飞秒激光系统,采用SMILE术式,微透镜直径为6.0~6.5 mm,角膜帽直径6.8~7.5 mm,帽厚120~130μm,边切2 mm,按照SMILE术式常规操作流程完成手术,并引入角膜微透镜中心精确定位以及水浸润分离微透镜技术。术后常规抗菌、抗炎药物治疗。主要指标术前最佳矫正视力(BCVA),术后裸眼视力(UCVA)、屈光状态、残留散光度数、视觉对比敏感度。结果 92眼均按设计完成手术,其中1眼术中负压环锥脱失,再次吸附完成手术,角膜透镜层间出现较为明显不透明气泡层(OBL)3眼,角膜帽边切区上皮脱落大于1 mm×1 mm者2眼,激光扫描区域黑斑导致分离较为困难1眼。术后第1天,术眼角膜透明,无上皮缺损及干燥斑。术眼UCVA大于或等于术前BCVA眼数:术后1天89眼、1周90眼、1个月92眼、6个月79眼(复查眼数79眼),其中术后1天、1周、1个月、6个月超过术前BCVA 2行的眼数分别为14眼、18眼、22眼、16眼。术后无1级以上的弥漫性板层角膜炎(DLK)、无上皮植入以及明显干眼症状的病例。中、高度散光组间对比,术后UCVA差异无统计学意义,术后明视下视觉对比敏感度的差异无统计学意义。结论 SMILE手术矫正中、高度近视散光可获得较好的临床疗效,并有较高的安全性及预测性,术中角膜微透镜中心"精确定位"及水浸润分离技术可提高手术的准确性。Objective To analyze the therapeutic effect of astigmatism with moderate and high myopia by small incision lenticule extraction （SMILE） and investigate the characteristics of SMILE. Design Prospective case series. Participants A total of 47 patients （92 eyes） with moderate and high myopic astigmatism （-1.00 D～-5.50 D）. Methods A total of 47 patients （92 eyes） with moderate and high myopic astigmatism （astigmatism≥-1.00 D） were treated by SMILE, which were divided into two groups. Group A included 54 eyes with moderate astigmatism （-1.00 D～-3.00 D）, group B 38 eyes with high astigmatism （-3.00 D～-4.50 D）. The operation were carried with the VisuMax femtosecond laser. Intended flap diameters were 6.8-7.5 mm, cap with 120～130 μm, side cutting 2 mm, according to the normal operation of SMILE. Main Outcome Measures Preoperative best corrected visual acuity（BCVA）, uncorrected visual acuity （UCVA）, refraction, keratometry, residual astigmatism and visual contrast sensitivity at 1 day, 1 week, 1 month and 6 months after surgery. Results There were 92 eyes completed the procedure as designed, including 1 eye with negative pressure cone ring detached during the procedure, then absorbed again to complete the surgery. In three cases, air bubble was found between corneal lens layers. Corneal cap edge （epithelium loss was greater than 1 mm × 1 mm in 2 eyes. Laser scanning area shading resulted in difficult separation in 1 eye. No other complications were encountered. No microperforations were observed, and neither graft rejection nor failure occurred. Cornea was transparent and no epithelial defect and dry spot were observed in patients 1 day after surgery. Postoperative UCVA was greater than or equal to the preoperative BCVA in 89, 90, 92, 79 eyes respectively at 1 d, 1 wk, 1 mo and 6 mo as after surgery （only 79 eyes were followed at 6 mo）. Furthermore post operation visual acuity improved more than 2 rows than preoperative BCVA was found in 14, 18, 22, 16 eyes at 1 d, 1

关 键 词：全飞秒微透镜摘除术 近视散光 水分离 中心定位 

分 类 号：R779.6[医药卫生—眼科]