SMILE术后角膜后表面高度变化及其影响因素  

Posterior Corneal Elevation changes after Small Incision Lenticule Extraction

作　　者：宋文婷 刘铭 潘红飙 张勇 罗丹 石磊 Song Wenting;Liu Ming;Pan Hongbiao;Lei Shi(Provincial Hospital Affiliated to Anhui Medical University,Hefei,Anhui,230000;Anhui No.2 Provincial People's Hospital,Hefei,Anhui,23000,PR.China)

机构地区：[1]安徽医科大学附属省立医院眼科,安徽合肥230000 [2]安徽省第二人民医院(安徽省眼科医院)眼科

出　　处：《实用防盲技术》2024年第3期114-121,F0004,共9页Journal of Practical Preventing Blind

摘　　要：目的研究飞秒激光小切口角膜基质透镜取出术(SMILE)后角膜后表面高度的变化及其影响因素。方法回顾分析SMILE近视矫正患者285例(559眼)。比较术前、术后1天、术后1周、术后1月顶点及以顶点为圆心2mm、4mm、6mm直径范围上0°、90°、180°、270°角膜后表面高度的变化。计算术后与术前的差值,分析变化量与年龄、术前等效球镜度数、角膜厚度、透镜厚度、角膜帽厚度、透镜直径、残余角膜厚度、角膜帽厚度/角膜厚度、透镜厚度/角膜厚度及后表面曲率的相关性。结果术后1天、术后1周、术后1月时角膜顶点、2mm环、4mm环、6mm环处的后表面高度较术前差异均有统计学意义(F=52.01,P<0.0001;F=44.63,P<0.0001;F=32.15,P<0.0001;F=30.27,P<0.0001),术后1天与术后1周、术后1月角膜后表面高度变化无统计学意义(P>0.05)。术后1天、术后1周、术后1月在顶点和2mm环处表面高度变化为后移,与术前角膜后表面K1、K2、Km值呈正相关(r>0,P<0.05);在4mm环和6mm环处,后表面高度变化为前移,与术前角膜后表面K1、K2、Km值呈负相关(r<0,P<0.05);余研究因素与角膜后表面高度改变相关性无统计学意义。结论角膜后表面高度在术后第一天显著变化,后趋于稳定。在切削深度安全范围内,SMILE术后发生后表面扩张的可能性小。对于角膜后表面曲率过大或过小的患者选择手术时应慎重。Objective To investigate the changes of posterior corneal surface(PCS)elevation and its influencing factors after femtosecond laser small incision lenticule extraction(SMILE).Methods A total of 285 patients(559 eyes)with myopia corrected by SMILE were retrospectively analyzed.Compared the changes of the PCS elevation before operation,1 day after operation,1 week after operation,and 1 month after operation at the central cornea and 0°,90°,180°,270°of the 2mm,4mm,and 6mm circle with the corneal center.Then calculated the difference between the postoperative and preoperative values.Analyzed the correlation between the changes with age,preoperative equivalent spherical refraction,corneal thickness,the thickness of the lens,corneal cap thickness,lenticule diameter,residual corneal thickness,corneal cap thickness/corneal thickness,lenticule thickness/corneal thickness and PCS curvature.Results There were significant differences in the PCS elevation of corneal center,2mm,4mm,6mm circle at 1 day,1 week and 1 month post-operation(F=52.01,P<0.0001;F=44.63,P<0.0001;F=32.15,P<0.0001;F=30.27,P<0.0001).There was no significant difference in the PCS elevation at 1 day,1 week and 1 month post-operation(P>0.05).At the center and 2mm circle of cornea,the PCS moved backward at 1 day,1 week and 1 month after operation,which were positively correlated with preoperative values of K1,K2 and Km on the PCS(r>0,P<0.05).At the 4mm and 6mm circle,the PCS moved forward at 1 day,1 week and 1 month after operation,while were negatively correlated with the preoperative K1,K2 and Km of the PCS(r<0,P<0.05).There was no significant correlation between the changes of PCS elevation and the rest of the study factors.Conclusion The posterior corneal surface elevation changed significantly on the first day after SMILE surgery,and then stayed stable.Within the safe range of ablation depth,the possibility of posterior surface expansion after SMILE is rare.SMILE surgery should be carefully selected for patients with excessive or too small posterior co

关 键 词：SMILE 角膜后表面高度 角膜后表面曲率 

分 类 号：R779.63[医药卫生—眼科]