传统和飞秒激光辅助的LASIK术后角膜神经再生及干眼情况比较  

Comparison of corneal nerve regeneration and dry eye condition after conventional LASIK and femtosecond-assisted LASIK

作　　者：余晨颖[1] 李莹[1] 王忠海[1] 姜洋[1] 金玉梅[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院眼科,100730

出　　处：《中华眼科杂志》2015年第3期188-192,共5页Chinese Journal of Ophthalmology

基　　金：国家自然科学基金（81170826）;教育部博士点基金（20111106110045）

摘　　要：目的 比较传统LASIK与飞秒激光辅助的LASIK术后1年患者角膜中央基底层下上皮神经丛的再生及干眼情况.方法 横断面研究.入选在北京协和医院眼科行LASIK手术的患者30例（60只眼）.根据术式将患者分为传统LASIK组和飞秒激光辅助的LASIK组.对患者进行干眼相关检查,并采用共聚焦显微镜观察角膜中央基底层下上皮神经丛的再生情况.使用ACCMetrics软件对共焦图像进行神经数量及形态参数的统计.数据采用独立样本t检验的方法来比较两种LASIK术后患者神经参数与干眼指标的差异.结果 飞秒激光辅助的LASIK组患者术后1年基础泪液分泌试验检查结果、泪膜劈裂时间值及眼表疾病指数评分分别为（12.65 ±8.73） mm/5min、（7.85±2.81）s、（7.25 ±6.35）分,与传统LASIK组[（16.73±10.55） mm/5min、（8.77±3.04）s、（4.46±5.37）分]相比,差异均无统计学意义（t=1.399,-1.050,-1.613;P＞O.05）;飞秒激光辅助的LASIK组患者角膜神经主干密度、主干分支密度、神经长度、总分支节点密度、神经宽度及弯曲度分别为（16.46 ±6.65）条/mm2、（19.27±9.56）条/mm2、（10.88±4.70） mm/mm2、（65.10±38.43）个/mm2、（4.76±0.34） μm、（2.30 ±0.34）级],传统LASIK组则分别为（15.99 ±7.14）条/mm2、（19.39 ±7.07）条/mm2、（11.30±3.17）mm/mm2、（68.43±34.94）个/mm 2、（4.73±0.24） μm、（2.14±0.34）级,两组相比差异均有统计学意义（t=-0.229,0.049,0.365,0.306,-0.394,-1.629;P＞0.05）.结论 传统LASIK与飞秒激光辅助的LASIK相比,其对术后1年患者的干眼指标和神经再生所产生的影响无明显差异.Objective To compare the regeneration of subbasal epithelial nerve plexus in the central cornea and dry eye condition between patients undergoing conventional LASIK surgery and femtosecond-assisted LASIK surgery Methods It was across-sectional study.Thirty patients （60 eyes） who had LASIK at our hospital from October 2011 to September 2012 were included in this study.Patients were divided into conventional LASIK group and femtosecond-assisted LASIK group based on the method used for corneal flap creation.Subjective and objective dry eye tests were carried out at 1 year after surgery.HRT Ⅲ confocal microscopy was used to observe the regeneration of subbasal epithelial nerve plexus,and the images were analyzed by ACCMetrics software using quantitative parameters to determine the density and morphology of corneal nerve fibers.The data of corneal nerve fibers and dry eye condition in the two groups undergoing different LASIK procedures was compared using an independent sample t test.Results During the one-year postoperative follow-up,the Schirmer test result,tear film break-up time value,and ocular surface disease index score in the F-LASIK group [（12.65 ± 8.73） mm/5min,（7.85 ± 2.81） s,（7.25 ± 6.35） points] were not significantly different from that in the C-LASIK group [（16.73 ± 10.55） mm/5min,（8.77 ± 3.04） s,（4.46 ± 5.37） points] （t =1.399,-1.050,-1.613,P ＞ 0.05）.Regarding the nerve fiber measurements,which included corneal nerve fiber density,corneal nerve branch density,corneal nerve fiber length,corneal total branch node,corneal nerve fiber width,and corneal nerve fiber tortuosit,there was no statistically significant difference in their results between patients who had femtosecond-assisted LASIK surgery [（16.46 ± 6.65） /mm2,（19.27 ± 9.56） /mm2,（10.88 ± 4.70） mm/mm2,（65.10 ±38.43） /mm2,（4.76 ±0.34） μm,（2.30 ±0.34） grades] and those who had conventional LASIK surgery [（15.99 ±7.14） /mm2,（19.39 ±7.07） /mm2,（11.30 ±3.17） mm/mm2,

关 键 词：角膜磨镶术 激光原位 激光 飞秒 角膜 神经再生 干眼综合征 显微镜检查 共焦 

分 类 号：R779.63[医药卫生—眼科]