FS-LASIK和SMILE术后角膜生物力学变化研究  

Comparison of corneal biomechanical changes after FS-LASIK and SMILE

作　　者：曹雪倩 王林农[1] 王晶[1] 马君鑫 张荟[1] Cao Xueqian;Wang Linnong;Wang Jing;Ma Junxin;Zhang Hui(Department of Ophthalmology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院),南京210006

出　　处：《临床眼科杂志》2025年第1期17-23,共7页Journal of Clinical Ophthalmology

基　　金：南京市医学科技发展重点项目(ZKX17023)。

摘　　要：目的研究飞秒激光辅助准分子激光角膜原位磨镶术(FS-LASIK)和飞秒激光小切口角膜基质透镜取出术(SMILE)手术前后的角膜生物力学变化。方法前瞻性病例对照研究。分析2022年4~6月于南京医科大学附属南京医院和江苏省中医院行角膜屈光手术的患者52例(101只眼)。根据手术方式不同分为FS-LASIK组和SMILE组,其中FS-LASIK组23例(44只眼)和SMILE组29例(57只眼)。观察两组患者手术前、术后1d、1周、6个月的可视化角膜生物力学分析仪(CST)测量结果。结果两组患者手术均顺利完成。两组患者术后角膜生物力学都发生了且相似的变化趋势,第一压平时间(A_(r1))、中央角膜厚度(CCT)、最大压陷曲率半径(HC-radius)、眼压(IOP)均降低(均P<0.05),第二压平时间(A_(r2))、第二压平速度(V_(out))最大压陷幅度(DA)均增加(均P<0.05),第一压平速度(V.)降低(P<0.05)后恢复术前状态。高度近视组术后6个月时,A_(T1)、CCT、IOP变比中度近视组明显。术后1d,中度近视患者中FS-LASIK组和SMILE组的患者测量值差异无统计学意义(P>0.05)。术后1周,SMILE组的CCT小于FS-LASIK组(P<0.05),DA值大于FS-LASIK组(P<0.05)。术后6个月,SMILE组的CCT、A_(T1)、HC-radius和IOP明显小于FS-LASIK组(均P<0.05),DA值大于FS-LASIK组(P<0.05)。在高度近视组中,两组在术后1d和术后1周测量的生物力学参数差异均无统计学意义(均P>0.05)。术后6个月,SMILE组的HC-radius和IOP小于FS-LASIK组(均P<0.05)。结论两种手术都能在术后达到较为稳定的角膜生物力学状态,有良好的安全性和可预测性,SMILE手术设计相较于FS-LASIK需切削更多角膜基质。从术后角膜生物力学稳定性来说,中度近视的患者可以优选FS-LASIK手术,高度近视的患者两种术式无明显优劣。Objective To study the changes in corneal biomechanics before and after femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK)and small incision lenticule extraction(SMILE).Methods The prospective case-control study.was performed on 101 eyes of 52 patients who underwent corneal refractive surgery in Nanjing Hospital Affili-ated to Nanjing Medical University and Jiangsu Provincial Hospital of Traditional Chinese Medicine from April 2022 to June According to the different surgical methods,they were divided into FS-LASIK group and SMILE group,44 eyes of 23 patients in the FS-LASIK group and 57 eyes of 29 patients in the SMILE group.The corneal visualization scheimpflug tech-nology(CST)measurement results of the two groups of patients before the surgery,at 1 day,1 week after surgery,and 6 months after the surgery were observed.ResultsThe surgery was successfully completed in both groups.Corneal biome-chanics in both groups showed similar trends after the surgery.The first applanation time(A_(r1)),central corneal thickness(CCT),central curvature radius at highest concavity(HC-radius),and intraocular pressure(IOP)all decreased(all P<0.05).The second applanation length(A_(r2)),corneal velocity during the second applanation moment(V.),and deforma-tion amplitude(DA)increased(all P<0.05),and corneal velocity during the first applanation moment(V.)decreased(P<0.05).At 6 months after the surgery in the high myopia group,the ratio of Ari,CCT,and IOP to the moderate myo-pia group was obvious.At 1 day after the surgery,there was no significant difference in the measured values between the FS-LASIK group and the SMILE group in patients with moderate myopia(P>0.05).At 1 week postoperatively,the CCT of the SMILE group was smaller than that of FS-LASIK group(P<0.05),and the DA value was greater than that of FS-LASIK group(P<0.05).At 6 months after the surgery,the CCT,Ar,HC-radius,and IOP in the SMILE group were sig-nificantly smaller than those in the FS-LASIK group(all P<0.05),DA value was greater than the FS-LASIK grou

关 键 词：飞秒激光小切口角膜基质透镜取出术 飞秒激光辅助准分子激光角膜原位磨镶术 可视化角膜生物力学分析仪 近视 

分 类 号：R779.63[医药卫生—眼科]