角膜基质透镜植入矫正远视的6个月效果及其对角膜后表面高度变化的影响  

The six months efficacy of corneal intrastromal lenticule implantation for hyperopia and its influence on the change of corneal posterior surface elevation

作　　者：杨士睿 侯杰 张静 雷玉琳 唐敏 Yang Shirui;Hou Jie;Zhang Jing;Lei Yulin;Tang Min(Binzhou Medical University,Binzhou Shandong 256603,China;Jinan Mingshui Eye Hospital,Jinan 250200,China)

机构地区：[1]滨州医学院,山东滨州256603 [2]济南明水眼科医院,250200

出　　处：《眼科》2022年第6期435-439,共5页Ophthalmology in China

基　　金：山东省医药卫生科技发展计划项目(202107020525);济南市卫生健康委员会科技计划项目(2022-2-191)。

摘　　要：目的探讨角膜基质透镜植入矫正远视的效果及其对角膜高阶像差和角膜后表面高度的影响。设计回顾性病例系列。研究对象2020-2021年在济南明水眼科医院接受角膜基质透镜植入术的远视患者25例(31眼),年龄18~45岁。方法术前及术后1周、1个月、3个月、6个月进行视力、屈光度、OCT及Pentacam眼前节检查。在Pentacam上获取角膜高阶像差值、角膜顶点后表面高度以及1 mm、2 mm半径圆环的后表面高度平均值,并比较手术前后的变化。主要指标视力、屈光度、角膜曲率、高阶像差、角膜后表面高度。结果术后裸眼视力和最佳矫正视力较术前明显提高(P均<0.001)。术后6个月时裸眼视力达到或高于术前最佳矫正视力者26/31眼,最佳矫正视力优于术前者14/31眼。术后各时间点的等效球镜度较术前均明显下降(P均<0.001),术后6个月时等效球镜度为(+0.36±0.93)D。术后角膜前表面曲率较术前明显增加,后表面曲率未发现明显变化。术后全角膜的总高阶像差和球差(0.98±0.34μm、-0.13±0.25μm)较术前(0.41±0.09μm、0.17±0.11μm)均有显著差异(P均<0.001)。手术前后除了角膜顶点处的后表面高度变化无统计学意义外,以1 mm和2 mm为半径的圆环后表面高度在术后1周时(2.76±3.30μm、-2.29±2.11μm)相比术前(3.86±2.57μm、-1.63±1.88μm)下降明显(P均<0.05);而术后6个月时的后表面高度(3.69±3.28μm、-1.69±1.93μm)近似恢复至术前(P均>0.05)。结论6个月的随访结果显示,角膜基质透镜植入矫正远视可获得良好的视觉效果,未发现明显的屈光回退。术后角膜高阶像差增加,角膜后表面高度先下降后恢复至术前水平。(眼科,2022,31:435-439)Objective To investigate the efficacy of corneal intrastromal lenticule implantation for hyperopia and its influence on higher order corneal aberrations and posterior corneal elevation.Design Retrospective case series.Participants Thirty-one hyperopic eyes of 25 patients who underwent corneal intrastromal lenticule implantation with 18 to 45 years old were enrolled in Jinan Mingshui Eye Hospital from 2020 to 2021.Methods Uncorrected distance visual acuity(UDVA),best corrected distance visual acuity(BCDVA),spherical equivalent(SE),anterior segment OCT,and Pentacam corneal topography were performed preoperatively and 1 week,1 month,3 months,and 6 months postoperatively.Corneal higher order aberrations(HOA)and posterior corneal elevation from different concentric radial zones were obtained and compared using Pentacam before and after surgery.Main Outcome Measures UDVA,BCDVA,SE,corneal curvature,HOA,posterior corneal surface elevation.Results The UDVA and the BCDVA were significantly improved after surgery(all P<0.001).Six months after surgery,the UDVA of 26 eyes was equal or better than the preoperative BCDVA.The BCDVA of 14 eyes was better than the preoperation.The SE was significantly decreased at each time point after surgery than before surgery(all P<0.001).The SE was(+0.36±0.93)D 6 months after surgery.The anterior surface of corneal curvature increased obviously after surgery,but no change was found in the corneal curvature of posterior surface.The total HOA and spherical aberrations of the whole cornea after surgery(0.98±0.34μm,-0.13±0.25μm)were significantly different from those before surgery(0.41±0.09μm,0.17±0.11μm)(all P<0.001).No significant difference was found in the posterior corneal elevationat the corneal apex before and after surgery(P>0.05).The elevation at 1 mm and 2 mm radius reduced significantly at one week(2.76±3.30μm,-2.29±2.11μm)compared with baseline(3.86±2.57μm,-1.63±1.88μm)(all P<0.05).However,there was no significant difference in posterior corneal elevation before and

关 键 词：远视 角膜基质透镜植入 角膜高阶像差 后表面高度 

分 类 号：R778.12[医药卫生—眼科]