SMILE术后角膜厚度变化及影响因素  

Changes in Corneal Thickness and Relevant Factors after Small Incision Lenticule Extraction

作　　者：张雪梅[1] 徐新花 刘勤[1] 宋新志 杨君[1] Xuemei Zhang;Xinhua Xu;Qin Liu;Xinzhi Song;Jun Yang(Department of Ophthalmology,Gansu Provincial People's Hospital,Lanzhou 730000,China;The Gansu University of Traditional Chinese Medicine,Lanzhou 730000,China)

机构地区：[1]甘肃省人民医院眼科,兰州730000 [2]甘肃中医药大学,兰州730000

出　　处：《中华眼视光学与视觉科学杂志》2021年第1期27-33,共7页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：甘肃省卫生行业科研计划项目(GSWSKY-2018-32)。

摘　　要：目的:探讨飞秒激光小切口角膜基质透镜取出术(SMILE)后角膜厚度的改变及可能的影响因素。方法:回顾性系列病例研究。收集甘肃省人民医院眼视光学中心120例(240眼)行SMILE且完成1年随访的低、中、高度近视患者,采用Pentacam三维眼前节分析系统记录术后1 d、1周、1个月、3个月、6个月及1年角膜顶点和直径2 mm、6 mm同心圆上的角膜厚度,比较术后相邻时间点同一区域及同一时间点不同区域角膜厚度的变化(△CT)。组内比较采用配对t检验,3组间比较采用重复测量方差分析,组间两两比较采用LSD-t检验。结果:3组患者术后1 d至1周角膜不同区域△CT均增加,差异均有统计学意义(均P<0.05);术后1周至1个月角膜变薄(P<0.05);术后1个月至3个月角膜各个区域均有不同程度的增厚(P<0.05);术后3个月至1年,不同区域△CT均为正值且逐渐减小,差异无统计学意义。术后1个月至1年角膜增厚均呈现递减趋势,且中央增厚较周边明显。3组之间比较,顶点、2 mm同心圆差异有统计学意义(均P<0.05),6 mm同心圆差异无统计学意义。角膜中央区厚度(顶点、2 mm圆)增加量与等效球镜度(SE)、切削深度(AD)呈正相关(r=0.73,P<0.001;r=0.38,P<0.001),与剩余角膜基质床厚度(RBT)呈负相关(r=-0.27,P=0.01)。高度近视组中央区厚度(顶点和2 mm圆)增加量与眼压(IOP)呈正相关(r=0.69,P<0.001)。结论:SMILE术后角膜厚度逐渐增加,3个月时基本稳定,且中央增厚较周边明显,近视度数越高增厚越明显。Objective:To study the changes in corneal thickness and relevant factors after small incision lenticule extraction(SMILE).Methods:This was a retrospective case series study.A total of 120 patients(240 eyes)with low to high myopia who had undergone SMILE surgery and completed a 1-year follow-up were enrolled from the Optometry Center of Gansu Provincial People's Hospital.Corneal thickness of the apex and concentric circles of the diameter at 2 mm and 6 mm locations were examined by Pentacam at 1 day,1 week,1 month,3 months,6 months and 1 year after surgery.The changes in corneal thickness(△CT)in the same area at the adjacent time points and the different areas at the same time were compared.Paired samples t-test was used for intra-group comparison,repeated measurement of variance was used for inter-group comparison,and LSD-t test was used for pairwise comparison between groups.Results:In the three groups,the△CT of the different areas all increased from 1 day to 1 week after surgery,and the results were statistically significant(P<0.05).From 1 week to 1 month,corneal thickness became thinner;from 1 month to 3 months after the operation,all the corneal areas had thickened by different degrees(P<0.05).From 3 months to 1 year,the△CT of the different areas were positive and the growth of corneal thickness decreased slowly,and the difference was not statistically significant.The thickness from the center to the periphery decreased from 1 month to 1 year after surgery,and the thickening in the center was more obvious than that in the periphery.There were statistically significant differences at the apex and concentric circles of the diameter at 2 mm among the three groups(P<0.05),while there were no statistically significant differences at 6 mm circles.The changes in corneal thickness had a positive correlation with spherical equivalence(SE)and ablation depth(AD)(r=0.73,P<0.001;r=0.38,P<0.001),but a negative correlation with residual bed thickness(RBT)(r=-0.27,P=0.01).There was a positive correlation between IOP(r=

关 键 词：飞秒激光小切口角膜基质透镜取出术 角膜厚度 近视 

分 类 号：R779.6[医药卫生—眼科]