飞秒激光小切口透镜取出术中角膜上皮损伤的临床研究  

Clinical Study on Intraoperative Corneal Epithelial Injuries of Femtosecond Laser Small Incision Lens Extraction

作　　者：叶进 李康 谢汉平 刘飞 YE Jin;LI Kang;XIE Hanping;LIU Fei(Refractive Surgery Center,Chongqing Bright Eye Hospital,Chongqing 400013,China)

机构地区：[1]重庆普瑞眼科医院屈光中心,重庆市400013

出　　处：《中国激光医学杂志》2023年第5期261-266,共6页Chinese Journal of Laser Medicine & Surgery

摘　　要：目的探讨飞秒激光小切口透镜取出术(femtosecond laser small incision lenticule extraction,SMILE)中角膜上皮损伤的危险因素和预防措施。方法回顾性分析2020年8月至2023年3月,屈光不正患者103例103只眼,均行SMILE手术治疗,激光波长1053 nm,能量140 nJ,透镜下层及角膜帽点间距和线间距为4.5μm;透镜边切及切口点间距和线间距为2.0μm。根据术中是否出现角膜上皮损伤分为两组,观察组为出现角膜上皮损伤的患者48例48只眼;对照组为未出现角膜上皮损伤患者55例55只眼。记录两组患者表面麻醉药物滴眼频次、手术前等效球镜、角膜帽厚度、切削光区大小、激光扫描质量异常(包括不透明气泡和黑区)以及重复吸引的病例数等相关因素,并运用二元Logistic回归分析影响患者术中角膜上皮损伤的独立危险因素。结果观察组激光扫描异常8只眼,角膜帽厚度(117.0±4.0)μm、切削光区(6.49±0.1)mm、重复吸引13只眼、表面麻醉药物滴眼频次(3.0±0.6)次。对照组激光扫描异常2只眼,角膜帽厚度(122.7±4.0)μm、切削光区(6.49±0.1)mm,重复吸引2只眼,表面麻醉药物滴眼频次(2.6±0.5)次。将单因素分析结果中有统计学差异的指标纳入二元logistic回归分析,结果显示年龄、滴表面麻醉药物次数、重复吸引次数、角膜帽厚度、激光扫描异常是导致患者术中角膜上皮损伤的独立危险因素。结论年龄、滴表面麻醉药物次数、重复吸引次数和激光扫描异常例数与角膜上皮损伤呈正相关,说明年龄越大、滴表面麻醉药物次数越多、重复吸引例数和激光扫描异常例数越多,可能导致SMILE术中角膜上皮损伤概率增大;角膜帽厚度与角膜上皮损伤呈负相关,说明角膜帽厚度越薄,可能导致SMILE术中角膜上皮损伤概率增大;通过合理控制上述相关危险因素有可能在一定程度上减少SMILE术中角膜上皮损伤发生的概率。Objective To investigate the risk factors and preventive measures for corneal epithelial injuries due to femtosecond laser small incision lenticule extraction(SMILE).Method A retrospective study was conducted.Totally 103 patients(103 eyes)with refractive errors given SMILE surgeries between Aug.2020 and Mar.2023 were selected,for which the wavelength of the laser used was 1053 nm,energy 140 nJ,the dot and line spacing between the lower lens and the corneal cap 4.5μm and the lens edge cutting and incision point spacing and line spacing 2.0μm.The patients were divided into two groups:the observation group with 48 patients(48 eyes)suffered corneal epithelial injuries during the surgery and the control group with 55 patients(55 eyes)escaped corneal epithelial injuries during the surgery.The frequency of surface anesthesia drug eye drops,equivalent spherical mirror before and after surgery,corneal cap thickness,cutting light area size as well as related factors such as abnormal laser scanning quality(including opaque bubbles and black areas)and number of cases of repeated attraction were recorded for the patients of each group.Binary logistic regression analysis was used to analyze independent risk factors causing intraoperative corneal epithelial injuries.Results There were 48 patients(48 eyes)in the observation group:25 males,age 28.5±4.3 y,preoperative equivalent spherical mirror-4.59±0.94 D,abnormal laser scanning in 8 eyes,corneal cap thickness 117.0±4.0μm,cutting light area 6.49±0.08 mm,repeated suction in 13 eyes and surface anesthesia drug drop frequency 3.0±0.6 times.The data of the 55 patients in the control group was given as below:31 males,age 24.1±3.5 y,preoperative equivalent spherical mirror-4.52±1.10 D,abnormal laser scanning in 2 eyes,corneal cap thickness 122.7±4.0μm,cutting light area 6.49±0.08 mm,repeated suction in 2 eyes and surface anesthesia drug drop frequency 2.6±0.5 times.The indicators with significant differences in the univariate analysis results were included in the binary

关 键 词：飞秒激光小切口透镜取出术 角膜上皮损伤 危险因素 预防 

分 类 号：R779.63[医药卫生—眼科] R778.11[医药卫生—临床医学]