基于Corvis ST分析飞秒LASIK联合快速交联矫正高度近视术后角膜生物力学变化  

Analysis of corneal biomechanical changes after femtosecond laser-assisted in situ keratomileusis combined with accelerated corneal cross-linking for correction of high myopia based on Corvis ST

作　　者：王庆宝 毕宏生[2,3] 范华 祖培培[2] 李莉 季鹏[2] WANG Qingbao;BI Hongsheng;FAN Hua;ZU Peipei;LI Li;JI Peng(Shandong University of Traditional Chinese Medicine,Jinan 250014,Shandong Province,China;Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250002,Shandong Province,China;Shandong Clinical Medicine Research Center,Shandong Academy of Eye Disease Prevention and Therapy,Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases,Jinan 250002,Shandong Province,China)

机构地区：[1]山东中医药大学,山东省济南市250014 [2]山东中医药大学附属眼科医院,山东省济南市250002 [3]山东省临床医学研究中心,山东省眼病防治研究院,山东省中西医结合眼病防治重点实验室,山东省济南市250002

出　　处：《眼科新进展》2024年第8期632-636,共5页Recent Advances in Ophthalmology

基　　金：山东省医务职工科技创新计划项目(编号:SDYWZGKCJH2022021);山东省中医药科技项目(重点项目)(编号:Z-2023053)。

摘　　要：目的应用Corvis ST评估飞秒激光辅助准分子激光原位角膜磨镶术(LASIK)联合快速角膜交联术(FS-LASIK Xtra)矫正高度近视术后角膜生物力学的变化。方法前瞻性病例对照研究。选取2020年7月至2022年7月在山东中医药大学附属眼科医院行手术矫正高度近视的患者185例(185眼)为研究对象,所有患者均将右眼纳入研究,其中行FS-LASIK Xtra者93例为FS-LASIK Xtra组,行FS-LASIK者92例为FS-LASIK组,术后随访6个月,记录患者的裸眼视力、等效球镜度、平均角膜曲率(Km)、最薄点角膜厚度(TCT)、角膜生物力学参数[2 mm处变形幅度比(DAR 2 mm)、综合半径(IR)、第一次压平刚度系数(SP-A1)、应力应变指数(SSI)]和手术前后角膜生物力学参数变化量(术后6个月与术前的差值,即ΔDAR 2 mm、ΔIR、ΔSP-A1、ΔSSI)。采用独立样本t检验和Mann-Whitney U检验对组间数据进行比较。结果术后3个月等效球镜度FS-LASIK组和FS-LASIK Xtra组患者分别为(-0.21±0.31)D和(-0.04±0.36)D,差异有统计学意义(t=3.49,P=0.001);术后6个月两组分别为(-0.33±0.31)D、(-0.14±0.37)D,差异均有统计学意义(t=4.00,P<0.001)。术后6个月时FS-LASIK组与FS-LASIK Xtra组患者手术的有效性指数和安全性指数差异均无统计学意义(均为P>0.05)。术前两组患者DAR 2 mm、IR、SP-A1、SSI等角膜生物力学参数比较差异均无统计学意义(均为P>0.05);术后6个月,FS-LASIK组与FS-LASIK Xtra组患者角膜生物力学参数变化量ΔIR分别为3.03±0.78、2.67±0.80,ΔSP-A1为-35.93±12.04、-30.43±12.44,ΔSSI为-0.09±0.10、-0.03±0.06,两组相比差异均有统计学意义(均为P<0.05)。结论FS-LASIK Xtra矫正高度近视术后患者视力、等效球镜度稳定,具有良好的安全性和有效性,角膜生物力学稳定性较术前降低,但优于常规FS-LASIK,长期效果需要进一步观察。Objective To evaluate the corneal biomechanical changes after femtosecond laser-assisted in situ keratomileusis(FS-LASIK)combined with accelerated corneal cross-linking(FS-LASIK Xtra)for the correction of high myopia using Corvis ST.Methods In this prospective case-control study,185 patients(185 eyes)who underwent surgical correction of high myopia in the Affiliated Eye Hospital of Shandong University of Chinese Medicine from July 2020 to July 2022 were selected,including 93 patients receiving FS-LASIK Xtra in the FS-LASIK Xtra group and 92 patients receiving FS-LASIK in the FS-LASIK group.All patients had their right eyes included in the study.During the 6-month follow-up,the uncorrected visual acuity,spherical equivalent(SE),mean corneal curvature,thinnest corneal thickness,corneal biomechanical parameters[deformation amplitude ratio at 2 mm(DAR 2 mm),integrated radius(IR),stiffness parameter at the first applanation(SP-A1),stress-strain index(SSI)],and changes in corneal biomechanical parameters before and after surgery(difference between 6 months after surgery and before surgery,namelyΔDAR 2 mm,ΔIR,ΔSP-A1,andΔSSI)were recorded.Independent sample t test and Mann-Whitney U test were used to compare the data between groups.Results Three months after surgery,the SE in the FS-LASIK group and the FS-LASIK Xtra group was(-0.21±0.31)D and(-0.04±0.36)D,respectively,and the difference was statistically significant(t=3.49,P=0.001).Six months after surgery,the SE in the FS-LASIK group and the FS-LASIK Xtra group was(-0.33±0.31)D and(-0.14±0.37)D,respectively,and the difference was statistically significant(t=4.00,P<0.001).There was no significant difference in efficacy index and safety index between the FS-LASIK group and the FS-LASIK Xtra group at 6 months after operation(both P>0.05).There were no significant differences in DAR 2 mm,IR,SP-A1,SSI and other biomechanical parameters between the two groups before surgery(all P>0.05).At 6 months postoperatively,ΔIR in the FS-LASIK group and the FS-LASIK Xtra group

关 键 词：高度近视 快速角膜交联 准分子激光原位角膜磨镶术 角膜生物力学 屈光手术 

分 类 号：R778.1[医药卫生—眼科]