SMILE术中角膜帽下地塞米松平衡液冲洗与否的早期临床观察  

Early clinical observations of intraoperative corneal stromal pocket irrigation with dexamethasone in small incision lenticule extraction

作　　者：梁刚[1] 马蓉[1] 张丰菊 LIANG Gang;MA Rong;ZHANG Fengju(Department of Ophthalmology,The Second Hospital of Yunnan Province,Kunming 650021,Yunnan,China;Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Ophthalmology&Visual Sciences Key Lab,Beijing 100730,China)

机构地区：[1]云南省第二人民医院眼科,云南昆明650021 [2]首都医科大学附属北京同仁医院北京同仁眼科中心/北京市眼科学与视觉科学重点实验室,北京100730

出　　处：《山东大学耳鼻喉眼学报》2020年第2期22-31,共10页Journal of Otolaryngology and Ophthalmology of Shandong University

基　　金：云南省基础研究计划(昆医联合专项)项目[2018FE001(-263)];北京市卫生系统高层次卫生技术人才基金(2013-2-023)。

摘　　要：目的观察飞秒激光小切口角膜基质透镜取出术(SMILE)中角膜帽下地塞米松平衡液冲洗与否对术后视觉质量及角膜组织结构形态的影响。方法选择拟进行双眼SMILE手术的24例(48眼)纳入研究,每例患者随机选取一眼透镜取出后,行地塞米松平衡液冲洗角膜帽下基质腔隙(实验组),对侧眼不冲洗(对照组)。分别于术后第1天、第7天及1个月对比观察两组的裸眼视力、屈光状态、角膜中央厚度(CCT)、眼压(NCT);同时利用共焦显微镜及前段光学相干断层扫描(OCT)检查对比观察两组角膜上皮细胞、神经纤维、基质细胞、内皮细胞形态结构。采用配对t检验比较两组的裸眼视力、屈光状态等各指标有无差异。结果术后第1天、第7天及1个月两组间裸眼视力比较:实验组为4.99±0.07、5.06±0.08、5.05±0.06;对照组为5.01±0.07、5.05±0.08、5.06±0.09;3个时间点两组间裸眼视力均无统计学差异(P均>0.05);术后第1天、第7天及1个月的屈光度(SE,D):实验组为0.03±0.49、0.1±0.37、0.02±0.4;对照组为0.09±0.54、0.19±0.48、0±0.52,3个时间点两组间SE比较均无统计学差异(P均>0.05)。共焦镜检查不同时间点比较:角膜上皮层细胞密度[术前(4578.73±268.40,4539.57±329.25)个/mm^2,术后第1天(4565.21±247.31,4627.23±271.03)个/mm^2,术后第7天(4640.01±246.79,4517.71±281.43)个/mm^2];角膜内皮细胞密度[术前(2541.50±259.59,2443.52±305.58)个/mm^2,术后第1天(2387.01±248.55,2495.27±238.52)个/mm^2,术后第7天(2484.49±223.71,2482.53±323.82)个/mm^2],术前术后两组间均无统计学差异(P>0.05);角膜上皮下神经纤维丛术前术后两组间比较无明显变化;切削界面高反光物两组间比较没有明显差异;角膜前基质细胞密度[术前(789.51±67.17,802.03±67.94)个/mm^2,术后第1天(889.37±60.62,912.27±95.87)个/mm^2,术后第7天(796.67±75.03,818.39±59.65)个/mm^2]在术后第1天、第7天较术前均有增加,但两组之间没有�Objective This study aimed to evaluate the postoperative vision recovery and corneal morphological changes after corneal stroma pocket irrigation with dexamethasone during Small Incision Lenticule Extraction(SMILE). Methods This was a prospective case-control study, which included 48 eyes from 24 patients who underwent SMILE. One eye from each case was randomly selected to have corneal pocket irrigation with dexamethasone(experimental group, EG), while the other eye did not undergo irrigation(control group, CG). The morphological changes of the cornea were observed using in vivo confocal microscopy and anterior segment optical coherence tomography(OCT), 1 day and 7 days after surgery. The uncorrected visual acuity(UCVA), spherical equivalent(SE), corneal center thickness(CCT), and non-contact tension(NCT) values between the groups were compared 1 day, 7 days, and 1 month after surgery. Results No significant differences were observed in the UCVA(EG: 4.99±0.07,5.06±0.08, 5.05±0.06;CG:5.01±0.07, 5.05±0.08, 5.06±0.09, P>0.05) and SE between the two groups(EG: 0.03±0.49, 0.1±0.37, 0.02±0.4;CG: 0.09±0.54, 0.19±0.48, 0±0.52) the same day as the procedure, and 1 day, 7 days, and 1 month after surgery, p>0.05. The two groups were compared at the same time, 1 day and 7 days before and after SMILE using confocal microscopy and anterior segment OCT. The cell shape, density, cell size and arrangement of the corneal epithelium[pre-operation(4 578.73±268.40, 4 539.57±329.25)cell/mm^2, post-1 d(4 565.21±247.31, 4 627.23±271.03)cell/mm^2, post-7 d(4 640.01±246.79, 4 517.71±281.43)cell/mm^2] and endothelium [pre-(2541.50±259.59, 2 443.52±305.58)cell/mm^2, post-1 d(2 387.01±248.55, 2 495.27±238.52) cell/mm^2, post-7 d(2 484.49±223.71, 2 482.53±323.82)cell/mm^2] were not significantly different(P>0.05). There were no significant differences observed in the corneal sub-epithelial nerve fibers. The degree of active corneal stromal cells near the cutting interface was similar between the groups, without any sig

关 键 词：SMILE手术 冲洗 地塞米松 共焦显微镜 眼前节光学相干断层扫描 

分 类 号：R778.1[医药卫生—眼科]