高度近视SMILE、FS-LASIK及LASEK术后角膜后表面高度变化的比较  

Comparison of the Change in Posterior Corneal Elevation after SMILE,FS-LASIK and LASEK for High Myopia Correction

作　　者：李娜 刘明娜 高华 陈彤 田歌 Na Li;Mingna Liu;Hua Gao;Tong Chen;Ge Tian(Eye Institute of Shandong First Medical University,Eye Hospital of Shandong First Medical University(Shandong Eye Hospital),State Key Laboratory Cultivation Base,Shandong Provincial Key Laboratory of Ophthalmology,School of Ophthalmology,Shandong First Medical University,Jinan 250021,China)

机构地区：[1]山东第一医科大学附属眼科研究所,山东第一医科大学附属眼科医院(山东省眼科医院),山东省眼科学重点实验室-省部共建国家重点实验室培育基地,山东第一医科大学眼科学院,济南25002

出　　处：《中华眼视光学与视觉科学杂志》2022年第5期343-350,共8页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：国家自然科学基金面上项目(81870639);山东省自然科学基金面上项目(ZR2020MH171)。

摘　　要：目的:对比和分析飞秒激光小切口角膜基质透镜取出术(SMILE)、飞秒激光制瓣准分子激光原位角膜磨镶术(FS-LASIK)和准分子激光上皮瓣下角膜磨镶术(LASEK)矫正高度近视术后角膜后表面高度(PCE)的变化。方法:回顾性病例对照研究。纳入2017年1月至2019年12月就诊于山东第一医科大学附属眼科医院的高度近视患者共144例(144眼),分为3组,每组各48例(48眼),分别行SMILE、FS-LASIK及LASEK。采用Pentacam三维眼前节分析系统分析术前及术后1、3、6个月角膜顶点PCE及2 mm、4 mm直径平均PCE。角膜后表面高度变化量(△PCE)为术后PCE与术前PCE差值。采用重复测量方差分析对组内及3组间PCE和△PCE进行比较。术后6个月采用Pearson相关分析对3组△PCE与中央角膜厚度(CCT)、透镜厚度/切削深度(LT/AD)及剩余基质床厚度(RBT)进行分析。结果:3组PCE仅在角膜4 mm直径处差异有统计学意义(F=7.79,P<0.001),术后6个月,SMILE及FS-LASIK组PCE小于LASEK组(F=9.75,P<0.001)。3组△PCE在角膜各区域均差异无统计学意义。LASEK组角膜中央后表面术后1个月较术前轻微后移(P=0.001),至术后6个月时回弹至术前高度。SMILE组及LASEK组术后1个月4 mm直径角膜后表面较术前均有轻微前移(P<0.05),至术后6个月维持稳定。FS-LASIK组PCE在角膜各区域及手术前后各时间点差异均无统计学意义。FS-LASIK组2 mm环及4 mm环△PCE与AD呈轻度正相关(r=0.31,P=0.029;r=0.30,P=0.039),其余参数间均无相关性。结论:SMILE、FS-LASIK及LASEK矫正高度近视后,角膜后表面高度变化无差异;3种方式矫正高度近视后角膜后表面高度均有较好的稳定性。Objective:To compare the change in posterior corneal elevation(PCE)after small incision lenticule extraction(SMILE),femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK)and laser-assisted subepithelial keratomileusis(LASEK)for high myopia correction.Methods:Retrospective case series study.144 patients(144 eyes)of high myopia who visited Eye Hospital of Shandong First Medical University(Shandong Eye Hospital)from January 2017 to December 2019 were divided into 3 groups,including SMILE,FS-LASIK and LASEK,with 48 patients(48 eyes)in each group.The PCE at the corneal apex and the average PCE of the 2 mm and 4 mm diameter were analyzed by Pentacam preoperatively,1 month,3 months and 6 months postoperatively.The change of PCE(ΔPCE)is the difference between postoperative and preoperative PCE.Repeated measurements analysis of variance was used to compare PCE andΔPCE within and among the three groups.The impact of central corneal thickness(CCT),lenticule thickness/ablation depth(LT/AD)and residual bed thickness(RBT)toΔPCE was evaluated in each group at 6 months after surgery.Results:The difference of PCE among the three groups was statistically significant only at the 4 mm diameter(F=7.79,P<0.001).PCE in SMILE and FS-LASIK group was lower than that in LASEK group at 6 months after surgery(F=9.75,P<0.001).There was no significant difference ofΔPCE in each area of the cornea among the three groups.The posterior corneal surface was slightly forward in the 4 mm circle in SMILE and LASEK group at 1 month after surgery(P<0.05),and remained stable 6 months after surgery.The central posterior surface was slightly backward in the LASEK group at 1 month after surgery(P=0.001),and recovered to preoperative level at 6 months after surgery.There was no significant difference of PCE in each corneal area and at each time point before and after FS-LASIK.In the FS-LASIK group,ΔPCE and AD showed a slight positive correlation in the 2 mm(r=0.31,P=0.029)and 4 mm circle(r=0.30,P=0.039).Conclusion:SMILE,FS-LASIK and LASEK pres

关 键 词：飞秒激光小切口角膜基质透镜取出术 飞秒激光制瓣准分子激光原位角膜磨镶术 准分子激光上皮瓣下角膜磨镶术 高度近视 角膜后表面高度 

分 类 号：R779.63[医药卫生—眼科]