SMILE手术前后全眼高阶像差与角膜生物力学变化  

Change of Total Ocular High Order Aberrations and Corneal Biomechanical Effects by Small Incision Lenticule Extraction

作　　者：李康寯 王姗姗 李青云 余晴 宋小翠 李雅心 Kangjun Li;Shanshan Wang;Qingyun Li;Qing Yu;Xiaocui Song;Yaxin Li(The Aier Eye Institute of Central South University,Changsha 410083,China;The Xi'an Aier Eye Hospital,Xi'an 710000,China)

机构地区：[1]中南大学爱尔眼科学院,长沙410083 [2]西安爱尔眼科医院,西安710000

出　　处：《中华眼视光学与视觉科学杂志》2022年第5期351-357,共7页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：湖南省自然科学基金面上项目(2021JJ30048);爱尔眼科集团自由探索项目(AF1909D4,AF2009D8);爱尔眼科集团临床研究所科研基金(AR2109D3)。

摘　　要：目的:探讨飞秒激光小切口角膜基质透镜取出术(SMILE)前后全眼高阶像差和角膜生物力学参数的变化,并分析角膜生物力学对全眼高阶像差的影响。方法:前瞻性临床研究。选择2019年3月至2020年3月在西安爱尔眼科医院行SMILE的屈光不正患者160例,术后随访6个月。手术前、后使用iTrace视觉功能分析仪测量角膜及全眼球差、彗差、三叶草、总高阶像差(HOA);使用Corvis-ST生物力学分析仪测量角膜硬度参数(SP-A1)和最大形变幅度(DA)。采用配对t检验、单因素方差分析、Pearson线性相关分析等对高阶像差变化量(角膜ΔHOA、全眼ΔHOA)及生物力学改变量(ΔSP-A1、ΔDA)进行分析。结果:SMILE术后6个月,150例(295眼)(随访率为94%)角膜HOA为(0.37±0.01)μm,全眼HOA为(0.24±0.01)μm,角膜HOA较术前增加15.63%,全眼HOA较术前减少35.14%,角膜HOA、全眼HOA的手术前后差异均有统计学意义(t=3.76,P=0.002;t=10.04,P=0.001);SP-A1为(77.29±11.86)mmHg/mm,较术前下降29.6%,DA为(1.19±0.68)mm,较术前增加10.4%,手术前、后SP-A1、DA差异均有统计学意义(t=32.98、20.62,P<0.001)。ΔSP-A1、ΔDA与全眼ΔHOA均呈正相关(r=0.19,P<0.001;r=0.17,P=0.002)。结论:SMILE术后6个月的全眼HOA减小,角膜生物力学改变与全眼HOA的变化具有相关性。Objective:To investigate the change of high order aberration of total eye and corneal biomechanics in patients undergoing small incision lenticule extraction(SMILE)and to examine the higher order aberrations(HOA)in relation to corneal biomechanical changes.Methods:Prospective clinical study.A total of 160 patients underwent SMILE in Xi'an Aier Eye Hospital were selected from March 2019 to March 2020.The cornea and total spherical aberration,coma,trefoil and total HOA were measured by iTrace.Corvis-ST was used to measure the corneal stiffness parameters at the first applanation(SP-A1)and deformation amplitude(DA).Paired t-test,One-way ANOVA and Pearson correlation analysis were used for changes of HOA(CornealΔHOA,Total ocularΔHOA)and corneal biomechanical parameters(ΔSP-A1,ΔDA).Results:Six months later,150 patients(295 eyes)were in follow-up team(follow-up rate,94%)and the corneal HOA was 0.37±0.01μm and the total ocular HOA was 0.24±0.01μm.The corneal HOA was increased by 15.63%and the total ocular HOA was decreased by 35.14%with statistically significant differences(t=3.76,P=0.002;t=10.04,P=0.001).SP-A1(77.29±11.86)mmHg/mm was decreased by 29.6%and DA(1.19±0.68)mm was increased by 10.4%with statistically significant differences(t=32.98,20.62,P<0.001).ΔSP-A1,ΔDA and total ocularΔHOA were significantly correlated(r=0.19,P<0.001;r=0.17,P=0.002).Conclusions:The total ocular HOA decreased after SMILE and the alterations in corneal morphology caused by biomechanics may affect HOA.

关 键 词：飞秒激光小切口角膜基质透镜取出术 高阶像差 角膜生物力学 

分 类 号：R779.63[医药卫生—眼科]