飞秒激光小切口角膜基质透镜取出术不同直径光学区术后角膜后表面稳定性的比较  

Comparison of posterior corneal surface stability after small incision lenticule extraction with different optical zones diameters

作　　者：程雪莹 赵宇 厉青青 于志强 周行涛 高颖 Cheng Xueying;Zhao Yu;Li Qingqing;Yu Zhiqiang;Zhou Xingtao;Gao Ying(Department of Ophthalmology,Affiliated Jinhua Hospital,Zhejiang University School of Medicine,Jinhua Municipal Central Hospital,Jinhua 321000,China;Department of Ophthalmology,Eye and ENT Hospital of Fudan University,NHC Key Laboratory of Myopia,Fudan University,Laboratory of Myopia,Chinese Academy of Medical Sciences,Shanghai Research Center of Ophthalmology and Optometry,Shanghai 200031,China)

机构地区：[1]浙江大学医学院附属金华医院眼科,金华市中心医院,金华321000 [2]复旦大学附属眼耳鼻喉科医院眼科,国家卫生健康委近视眼及相关眼病重点实验室,中国医学科学院近视眼及相关眼病重点实验室,上海市眼视光学研究中心,上海200031

出　　处：《中华眼外伤职业眼病杂志》2024年第11期801-806,共6页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：金华市科技计划项目公益类项目(2023-4-069)。

摘　　要：目的比较飞秒激光小切口角膜基质透镜取出术(SMILE)不同直径光学区的术后角膜厚度(CT)及角膜后表面高度(PCE)。方法回顾性队列研究。纳入2019年1月至2019年12月于复旦大学附属眼耳鼻喉科医院接受SMILE的近视者56例(56只眼),根据手术不同光学区直径分为两组:光学区直径≤6.2 mm者为A组(26只眼);光学区直径≥6.5 mm者为B组(30只眼)。随访3年,检查两组人群术前及术后裸眼视力(UCVA),应用Pentacam眼前节分析系统记录CT的变化量(ΔCT):SMILE术后3年最薄CT-(术前最薄CT-切削深度),收集两组人群术后3年角膜顶点及以顶点为圆心2、4和6 mm直径范围上45°、135°、225°及315°各4个点,共13个点的PCE变化(ΔPCE)。SMILE术后随访3年。结果术后3年,B组术后UCVA(logMAR)为-0.02±0.06,优于A组(0.01±0.06)(t=2.20,P=0.032)。A组ΔCT[(33.81±14.16)μm]与B组[(29.73±10.06)μm]相比,两组间差异无统计学意义(t=1.25,P=0.215)。两组间顶点ΔPCE、ΔPCE-2 mm、ΔPCE-4 mm、ΔPCE-6 mm差异均无统计学意义(t=-0.27、0.40、-0.41、-0.23,P=0.791、0.694、0.681、0.832)。所有角膜均稳定,无医源性角膜膨隆的并发症发生。结论不同直径光学区SMILE术后角膜均较稳定,光学区直径≥6.5 mm者术后视力优于光学直径≤6.2 mm者。Objective To compare the corneal thickness(CT)and posterior corneal elevation(PCE)after small incision lenticule extraction(SMILE)with different optical zones diameters.Methods This was a retrospective cohort study.A total of 56 eyes of 56 patients who underwent SMILE in the Eye and ENT Hospital of Fudan University from Jan.to Dec.2019 were recruited.All cases were divided into two groups depending on the diameters of the optical zone:group A,26 eyes,optical zone diameter≤6.2 mm;and group B,30 eyes,optical zone diameter≥6.5 mm.The follow-up time was 3 years after surgery.Uncorrected visual acuity(UCVA,logMAR)was assessed preoperatively and postoperatively for both groups.The change of CT(ΔCT)was calculated by Pentacam as the difference between the minimum CT before and at 3 years after SMILE.The changes of PCE(ΔPCE)were measured at a total of 13 points,including the corneal apex and four points each at 45°,135°,225°,and 315°along diameters of 2 mm,4 mm,and 6 mm centered on the apex.Results At 3 years after surgery,postoperative UCVA of group B was-0.02±0.06,which was better than the 0.01±0.06 of group A(t=2.20,P=0.032).ΔCT of group A[(33.81±14.16)μm]and group B[(29.73±10.06)μm]demonstrated no statistically significant difference(t=1.25,P=0.215).ΔPCE at the corneal apex,ΔPCE-2 mm,ΔPCE-4 mm,andΔPCE-6 mm between these 2 groups all demonstrated no statistically significant differences(t=-0.27,0.40,-0.41,-0.23;P=0.791,0.694,0.681,0.832).All corneas were stable and there were no complications of iatrogenic corneal dilation.Conclusion The cornea after SMILE with different optical zone diameters are relatively stable,and those with an optical zone diameter≥6.5 mm have better postoperative visual acuity than those with an optical zone diameter≤6.2 mm.

关 键 词：激光 飞秒 角膜 角膜基质 角膜外科手术 激光 

分 类 号：R47[医药卫生—护理学]