TransPRK与SMILE术后早期角膜生物力学对比研究  

Comparison of corneal biomechanics in the early postoperative period between TransPRK and SMILE

作　　者：宁吉良 方石峰 靳琳 闫春晓 孙思宇 陈若语 邢泽群 于涛瑞 张立军 Ning Jiliang;Fang Shifeng;Jin Lin;Yan Chunxiao;Sun Siyu;Chen Ruoyu;Xing Zequn;Yu Taorui;Zhang Lijun(Department of Ophthalmic Refractive Center,Dalian Medical University Affiliated Dalian Third People's Hospital,Dalian 116033,China)

机构地区：[1]大连医科大学附属大连市第三人民医院眼科屈光中心,大连116033

出　　处：《中华实验眼科杂志》2023年第11期1098-1104,共7页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金面上项目(82171032);辽宁省应用基础研究计划项目(2022JH2/101300036);大连市医学科学研究计划项目(2111008、1911032);大连市高层次人才创新支持计划项目(2021RQ033)。

摘　　要：目的探讨经上皮准分子激光角膜切削术(TransPRK)与飞秒激光小切口角膜基质透镜取出术(SMILE)对术后早期角膜生物力学的影响。方法采用队列研究,连续纳入2020年11月至2021年6月于大连医科大学附属大连市第三人民医院自愿行TransPRK的患者56例56眼和SMILE患者52例52眼,均纳入右眼数据进行分析。术后随访3个月,收集术眼术后1个月、术后3个月中央角膜厚度(CCT)和角膜曲率(Km),收集术前、术后1个月、术后3个月眼反应分析仪测量的角膜补偿眼压值(IOPcc)、角膜阻力系数(CRF)、角膜滞后量(CH)及19个重复性较好的力学红外信号波形参数。比较各组不同时间点各测量指标的差异。结果2个组术后1个月、3个月术眼CCT、Km及IOPcc比较,差异均无统计学意义(均P>0.05)。2个组术后1个月CRF、CH、p1area、p2area、p1area1、p2area1、w1、w2、w11、w21、h1、h2、h11、h21、dive1、dive2、mslew1较术前下降,path1、path2、path11、aplhf较术前升高,差异均有统计学意义(均P<0.05)。2个组术后3个月CRF、CH、p1area、p2area、p1area1、p2area1、w1、w2、w11、w21、h1、h2、h11、h21、dive1较术前下降,path1、path2、path11、aplhf较术前升高,差异均有统计学意义(均P<0.05);SMILE组术后3个月dive2较术前下降,差异有统计学意义(P<0.01)。术后1个月,TransPRK组p1area、p2area、p1area1、p2area1、w1、w2、w11、w21、dive1、dive2大于SMILE组,CH、path1、path2、path11小于SMILE组,差异均有统计学意义(均P<0.05)。术后3个月,TransPRK组p1area、p2area、p1area1、p2area1、w1、w2、w11、w21、h2、h21、dive1、dive2大于SMILE组,path1、path2、path11小于SMILE组,差异均有统计学意义(均P<0.05)。结论TransPRK和SMILE术后角膜生物力学均减弱,术后早期TransPRK眼反应分析仪红外波形力学参数优于SMILE。Objective To investigate the effects of transepithelial photorefractive keratectomy(TransPRK)and femtosecond small incision lenticule extraction(SMILE)on corneal biomechanics measured by the Ocular Response Analyzer in the early postoperative period.Methods A cohort study was conducted.The right eyes of 56 patients who underwent TransPRK and 52 patients who underwent SMILE in Dalian Medical University Affiliated Dalian Third People's Hospital from November 2020 to June 2021 were continuously included.The postoperative follow-up was 3 months.The central corneal thickness(CCT)and keratometry(Km)were measured 1 month and 3 months after surgery.The corneal-compensated intraocular pressure(IOPcc),corneal resistance factor(CRF),corneal hysteresis(CH),and 19 repeatable mechanical infrared signal waveform parameters measured by the Ocular Response Analyzer were recorded before the surgery,1 month and 3 months after the surgery,respectively.The measurement indexs at different time points between two groups were compared.This study adhered to the Declaration of Helsinki and the study protocol was approved by the Ethics Committee of Dalian Medical University Affiliated Dalian Third People's Hospital(No.2019-KT-010).Written informed consent was obtained from each patient before surgery.Results There was no significant difference in CCT,Km,and IOPcc between the two groups at 1 month and 3 months after the surgery(all at P>0.05).In both groups,CRF,CH,p1area,p2area,p1area1,p2area1,w1,w2,w11,w21,h1,h2,h11,h21,dive1,dive2 and mslew1 were decreased,while path1,path2,path11,and aplhf were increased at 1 month after the surgery compared with before surgery,showing statistically significant differences(all at P<0.05).In both groups,CRF,CH,p1area,p2area,p1area1,p2area1,w1,w2,w11,w21,h1,h2,h11,h21,dive1 decreased,while path1,path2,path11,and aplhf were increased at 3 months after the surgery in comparison with before surgery,showing statistically significant differences(all at P<0.05).In SMILE group,the dive2 were decreased at 3 months

关 键 词：角膜外科手术 激光 经上皮准分子激光角膜切削术 飞秒激光小切口角膜基质透镜取出术 角膜生物力学 

分 类 号：R779.6[医药卫生—眼科]