飞秒激光小切口角膜基质透镜取出术矫正中高度近视眼术后早期角膜后表面高度变化及影响因素的临床研究
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摘要
目的探讨飞秒激光小切口角膜基质透镜取出术(SMILE)矫正中高度近视眼术后角膜后表面高度的变化情况及其可能的影响因素。方法本研究为回顾性研究。收集2017年9月至2018年5月在广西医科大学第一附属医院眼科接受SMILE手术的63例(110只眼)中高度近视眼患者的病例资料,提取术前术后1 d、1周、1个月及3个月Pentacam眼前节分析系统的检查结果,包括角膜顶点及以顶点为圆心2 mm与4 mm直径范围上45°、135°、225°、315°角膜后表面高度,以此9点处角膜后表面高度的平均值作为角膜中央后表面高度。采用单因素重复测量方差分析比较不同时间点角膜顶点后表面高度及角膜中央后表面的高度,采用Pearson相关系数评价角膜顶点后表面高度的变化量和角膜中央后表面高度的变化量与年龄、术前等效球镜度数、角膜中央厚度、平均手术切削深度、平均剩余角膜厚度及角膜切削比之间的相关性。结果角膜顶点后表面高度及角膜中央后表面高度在术后1个月内呈下降趋势并在术后1个月时开始恢复,术前术后1 d、1周、1个月及3个月角膜顶点后表面高度分别为(0.52±2.46) mm、(0.39±2.21) mm、(0.33±2.33) mm、(-0.06±2.18) mm及(0.00±2.72) mm,角膜中央后表面高度分别为(1.18±0.90) mm、(1.16±0.76) mm、(1.06±0.76) mm、(1.04±0.74) mm及(1.09±0.89) mm,差异均无统计学意义(F=1.24,0.62;P>0.05)。术后1 d、1周、1个月及3个月角膜顶点后表面高度平均变化量分别为(-0.13±1.43) mm、(-0.19±1.74) mm、(-0.58±1.65) mm及(-0.52±1.96) mm,角膜中央后表面高度平均变化量分别为(-0.02±0.68) mm、(-0.12±0.74) mm、(-0.14±0.78) mm及(-0.09±0.95) mm,差异均无统计学意义(F=1.98,0.47;P>0.05)。各时间点角膜顶点后表面高度的变化量及角膜中央后表面高度的变化量与患者年龄、术前等效球镜度数、角膜中央厚度、平均手术切削深度、平均剩余角膜厚度及角膜切削比均无明显相关性(P>0.05)。结论 SMILE矫正中高度近视眼术后角膜后表面高度无明显变化,并在术后早期恢复,对角膜后表面形态的影响小,安全性和稳定性良好。
Objective The aim of this study was to investigate the early changes of posterior corneal elevation and possible influencing factors in moderate and high myopia after small incision lenticule extraction(SMILE). Methods This was a retrospective study. From Sep. 2017 to May 2018, case data of 63 patients(110 eyes) with moderate and high myopia who received SMILE in The First Affiliated Hospital of Guangxi Medical University were collected; parameters obtained by Pentacam Scheimpflug system of preoperation and postoperative 1 d, 1 week, 1 month and 3 months were selected, including the posterior corneal elevation at corneal apex and 45°, 135°, 225°, 315° points of two zones(centered on corneal apex 2 mm, 4 mm diameter), the mean of the 9 points above was taken as the central posterior corneal elevation. One-way repeated measures ANOVA was used to analysis the posterior corneal elevation at corneal apex and central corneal of different time pints, and Pearson product moment coefficient was used to analysis the correlation of the change of posterior corneal elevation at corneal apex and central corneal and the age of patients,preoperative spherical equivalent,central corneal thickness,corneal cutting depth,residual corneal thickness or corneal cutting ratio. Results The posterior corneal elevation at corneal apex and central corneal declined within postoperative 1 month and turn back after postoperation for 1 month. After preoperation for 1 day,1 week,1 month and 3 months,the posterior corneal elevation at corneal apex were( 0. 52 ± 2. 46) mm,( 0. 39 ± 2. 21) mm,( 0. 33 ± 2. 33) mm,(-0. 06 ± 2. 18) mm and( 0. 00 ±2. 72) mm,respectively; the posterior corneal elevation at central corneal were( 1. 18 ± 0. 90) mm,( 1. 16± 0. 76) mm,( 1. 06 ± 0. 76) mm,( 1. 04 ± 0. 74) mm,( 1. 09 ± 0. 89) mm at postoperative for 1 day,1 week,1 month and 3 months,respectively; the difference was no significant among them( F = 1. 24,0. 62;P > 0. 05). At postoperative 1 day,1 week,1 and 3 months,the average changes of posterior corneal elevation at corneal apex(-0. 13 ± 1. 43) mm,(-0. 19 ± 1. 74) mm,(-0. 58 ± 1. 65) mm,(-0. 52± 1. 96) mm,respectively; and the average changes of posterior corneal elevation at central corneal(-0. 02 ± 0. 68) mm,(-0. 12 ± 0. 74) mm,(-0. 14 ± 0. 78) mm,(-0. 09 ± 0. 95) mm,respectively; the difference was also no significant among them( F = 1. 98,0. 47; P > 0. 05). There was no correlation between the change of posterior corneal elevation at corneal apex and central corneal and the age of patients,preoperative spherical equivalent,central corneal thickness,corneal cutting depth,residual corneal thickness or corneal cutting ratio at each time point( P > 0. 05). Conclusion There was no obvious change in the posterior corneal elevation which recovered in the early postoperative period. SMILE has little effect on the posterior corneal morphology,which is safe and stable for patients with moderate and high myopia.
Objective The aim of this study was to investigate the early changes of posterior corneal elevation and possible influencing factors in moderate and high myopia after small incision lenticule extraction(SMILE). Methods This was a retrospective study. From Sep. 2017 to May 2018, case data of 63 patients(110 eyes) with moderate and high myopia who received SMILE in The First Affiliated Hospital of Guangxi Medical University were collected; parameters obtained by Pentacam Scheimpflug system of preoperation and postoperative 1 d, 1 week, 1 month and 3 months were selected, including the posterior corneal elevation at corneal apex and 45°, 135°, 225°, 315° points of two zones(centered on corneal apex 2 mm, 4 mm diameter), the mean of the 9 points above was taken as the central posterior corneal elevation. One-way repeated measures ANOVA was used to analysis the posterior corneal elevation at corneal apex and central corneal of different time pints, and Pearson product moment coefficient was used to analysis the correlation of the change of posterior corneal elevation at corneal apex and central corneal and the age of patients,preoperative spherical equivalent,central corneal thickness,corneal cutting depth,residual corneal thickness or corneal cutting ratio. Results The posterior corneal elevation at corneal apex and central corneal declined within postoperative 1 month and turn back after postoperation for 1 month. After preoperation for 1 day,1 week,1 month and 3 months,the posterior corneal elevation at corneal apex were( 0. 52 ± 2. 46) mm,( 0. 39 ± 2. 21) mm,( 0. 33 ± 2. 33) mm,(-0. 06 ± 2. 18) mm and( 0. 00 ±2. 72) mm,respectively; the posterior corneal elevation at central corneal were( 1. 18 ± 0. 90) mm,( 1. 16± 0. 76) mm,( 1. 06 ± 0. 76) mm,( 1. 04 ± 0. 74) mm,( 1. 09 ± 0. 89) mm at postoperative for 1 day,1 week,1 month and 3 months,respectively; the difference was no significant among them( F = 1. 24,0. 62;P > 0. 05). At postoperative 1 day,1 week,1 and 3 months,the average changes of posterior corneal elevation at corneal apex(-0. 13 ± 1. 43) mm,(-0. 19 ± 1. 74) mm,(-0. 58 ± 1. 65) mm,(-0. 52± 1. 96) mm,respectively; and the average changes of posterior corneal elevation at central corneal(-0. 02 ± 0. 68) mm,(-0. 12 ± 0. 74) mm,(-0. 14 ± 0. 78) mm,(-0. 09 ± 0. 95) mm,respectively; the difference was also no significant among them( F = 1. 98,0. 47; P > 0. 05). There was no correlation between the change of posterior corneal elevation at corneal apex and central corneal and the age of patients,preoperative spherical equivalent,central corneal thickness,corneal cutting depth,residual corneal thickness or corneal cutting ratio at each time point( P > 0. 05). Conclusion There was no obvious change in the posterior corneal elevation which recovered in the early postoperative period. SMILE has little effect on the posterior corneal morphology,which is safe and stable for patients with moderate and high myopia.
引文
[1] Marcus A,Henrietta H,Eva Fenwick,et al.Vision-related quality of life and visual outcomes after small-incision lenticule extraction and laser in situ keratomileusis[J].J Cataract Refract Surg,2015,41(10):2136-2144.
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[5] Foster PJ,Jiang Y.Epidemiology of myopia[J].Eye,2014,28(2):202-208.
[6] 董彦会,王政和,杨招庚,等.2005年2014年中国7～18岁儿童青少年营养不良流行现状及趋势变化分析[J].北京大学学报(医学版),2017,49(3):424-432.
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[9] 马兴爱,王莉,石倩,等.太原市中小学生视力保健相关知识现况[J].中国学校卫生,2014,35(2):193-195.
[10] 亓德云,谭晖,林可,等.上海市某区小学生视力保健行为与视力的关联性分析[J].中国学校卫生,2015,36(1):94-96.
[11] Liu M,Zhang T,Zhou Y,et al.Corneal regeneration after femtosecond laser small-incision lenticule extraction:a prospective study[J].Graefes Arch Clin Exp Ophthalmol,2015,253(7):1035-1042.
[12] Ganesh S,Patel U,Brar S.Posterior corneal curvature changes following Refractive Small Incision Lenticule Extraction[J].Clin Ophthalmol,2015,9:1359-1364.
[13] Ishii R,Shimizu K,Igarashi A,et al.Influence of femtosecond lenticule extraction and small incision lenticule extraction on corneal nerve density and ocular surface:a 1-year prospective,confocal,microscopic study[J].J Refract Surg,2015,31(1):10-15.
[14] Medeiros FW,Stapleton WM,Hammel J,et al.Wavefront analysis comparison of LASIK outcomes with the femtosecond laser and mechanical microkeratomes[J].J Refract Surg,2007,23(9):880-887.
[15] Zhang ZH,Jin HY,Suo Y,et al.Femtosecond laser versus mechanical microkeratome laser in situ keratomileusis for myopia:metaanalysis of randomized controlled trials[J].J Cataract Refract Surg,2011,37(12):2151-2159.
[16] Hyojin K,Hyun JK,Choun-Ki J.Comparison of forward shift of posterior corneal surface after operation between LASIK and LASEK[J].Ophthalmologica,2006,220(1):37-42.
[17] 朱冉,刘庆淮.LASIK和LASEK术后角膜后表面高度和前房变化的临床研究[J].徐州医学院学报,2010,30(9):584-588.
[18] 李莹,李悦,罗岩,等.Pentacam前节分析系统测量角膜厚度、地形图及屈光手术后角膜后表面的研究[J].山东大学耳鼻喉眼学报,2011,25(5):82-88.
[19] Seitz B,Torres F,Langenbucher A,et al.Posterior corneal curvature changes after myopic laser in situ keratomileusis[J].Ophthalmology,2001,108(4):666-673.
[20] 龙克利,朱冉,程蕾,等.应用Pentacam分析3种近视激光矫正术后角膜后表面高度和曲率的变化[J].眼科新进展,2015,35(1):67-70.
[21] Zhang Y,Xu W,Tian L,et al.Analysis of anterior segment of age-related cataract after phacoemulsification combinded with intraocular lens implantation by Pentacam[J].Inter J Ophthalmol,2011,11(2):235-239.
[22] Gilda CD,Raimondo FD,Bernardino AC,et al.Computerized Scheimpflug densitometry as a measure of average CD values after excimer laser refractive surgery in myopic eyes[J].J Cataract Refract Surg,2011,37(8):1502-1506.
[23] 杨丹,谷天瀑,李颖,等.圆锥角膜的光密度分析[J].眼科新进展,2017,37(5):450-454.
[24] 熊世红,王薇,陆平.LASIK术后角膜后表面高度变化及影响因素[J].中华眼视光学与视觉科学杂志,2013,15(2):112-115.
[25] 薛超,王雁,左彤,等.飞秒激光与常规刀片准分子激光术后角膜后表面高度早期变化的对照研究[J].中华实验眼科杂志,2014,32(3):235-240.
[26] 郑燕,周跃华,柳静.准分子激光角膜原位磨镶术后角膜后表面的高度变化[J].中华实验眼科杂志,2013,31(12):1155-1158.
[27] 刘俐利,陈辉,程新梁.飞秒激光小切口基质透镜取出术术后角膜后表面的高度变化[J].临床眼科杂志,2016,24(6):531-534.
[28] Roy AS,Dupps WJ,Roberts CJ.Comparison of biomechanical effects of small-incisionlenticule extraction and laser in situ keratomileusis:finite-element analysis[J].J Cataract Refract Surg,2014,40(6):971-980.
[29] Dou R,Wang Y,Xu L,et al.Comparison of corneal biomechanical characteristics after surface ablation refractive surgery and novel lamellar refractive surgery[J].Cornea,2015,34(11):1441-1446.
[30] Randleman JB,Woodward M,Lynn MJ,et al.Risk assessment for ectasia after corneal refractive surgery(Article)[J].Ophthalmology,2008,115(1):37-50.
[31] Yao P,Zhao J,Li M,et al.Microdistortions in Bowman's layer following femtosecond laser small incision lenticule extraction observed by Fourier-Domain OCT[J].J Refract Surg,2013,29(10):668-674.
[32] Dong ZX,Zhou XT,Wu JH,et al.Small incision lenticule extraction (SMILE) and femtosecond laser LASIK:comparison of corneal wound healing and inflammation[J].Br J Ophthalmol,2014,98(2):263-269.
[33] Zhang L,Wang Y.The shape of posterior corneal surface in normal,Post-LASIK,and post-epi-LASIK eyes[J].Invest Ophthalmol Vis Sci,2010,51(7):3468-3475.
[34] 于长江,王雁,苏小连,等.飞秒激光小切口角膜基质透镜取出术后角膜后表面高度变化及其影响因素的研究[J].中华眼科杂志,2016,52(7):494-498.
[35] 王亚茹,周艳峰.两种不同LASIK手术对角膜后表面高度影响的临床研究[J].临床眼科杂志,2018,26(2):116-120.
[36] Tatar MG,Aylin Kantarci F,Yildirim A,et al.Risk factors in post-LASIK corneal ectasia[J].J Ophthalmol,2014,2014:204191.
[37] Spadea L,Cantera E,Cortes M,et al.Corneal ectasia after myopic laser in situ keratomileusis:a long-term study[J].Clin Ophthalmol,2012,6:1801-1813.
[38] Cagini C,Messina M,Lupidi M,et al.Posterior corneal surface stability after femtosecond laser-assisted keratomileusis[J].J Ophthalmol,2015,2015:184850.
[2] Messerschmidt-Roth A,Sekundo W,Lazaridis A,et al.Three years follow-up study after refractive small incision lenticule extraction (SMILE) using 500 kHz Femtosecond laser in"Fast Mode"[J].Klin Monatsbl Augenheilkd,2017,234(1):102-108.
[3] Kunert KS,Melle J,Sekundo W,et al.One-year results of small incision lenticule extraction (SMILE) in Myopia[J].Klin Monbl Augenheilkd,2015,232(1):67-71.
[4] Choo V.A look at slowing progression of myopia[J].Lancet,2003,361(9369):1622-1623.
[5] Foster PJ,Jiang Y.Epidemiology of myopia[J].Eye,2014,28(2):202-208.
[6] 董彦会,王政和,杨招庚,等.2005年2014年中国7～18岁儿童青少年营养不良流行现状及趋势变化分析[J].北京大学学报(医学版),2017,49(3):424-432.
[7] 杨妙玲,任杰,郑波.双生子屈光状态与遗传的关系[J].眼视光学杂志,2000,2(3):151-152.
[8] 周丽,侯万里,谢思柔,等.中小学生视力保健行为及影响因素分析[J].中国公共卫生,2014,30(7):896-898.
[9] 马兴爱,王莉,石倩,等.太原市中小学生视力保健相关知识现况[J].中国学校卫生,2014,35(2):193-195.
[10] 亓德云,谭晖,林可,等.上海市某区小学生视力保健行为与视力的关联性分析[J].中国学校卫生,2015,36(1):94-96.
[11] Liu M,Zhang T,Zhou Y,et al.Corneal regeneration after femtosecond laser small-incision lenticule extraction:a prospective study[J].Graefes Arch Clin Exp Ophthalmol,2015,253(7):1035-1042.
[12] Ganesh S,Patel U,Brar S.Posterior corneal curvature changes following Refractive Small Incision Lenticule Extraction[J].Clin Ophthalmol,2015,9:1359-1364.
[13] Ishii R,Shimizu K,Igarashi A,et al.Influence of femtosecond lenticule extraction and small incision lenticule extraction on corneal nerve density and ocular surface:a 1-year prospective,confocal,microscopic study[J].J Refract Surg,2015,31(1):10-15.
[14] Medeiros FW,Stapleton WM,Hammel J,et al.Wavefront analysis comparison of LASIK outcomes with the femtosecond laser and mechanical microkeratomes[J].J Refract Surg,2007,23(9):880-887.
[15] Zhang ZH,Jin HY,Suo Y,et al.Femtosecond laser versus mechanical microkeratome laser in situ keratomileusis for myopia:metaanalysis of randomized controlled trials[J].J Cataract Refract Surg,2011,37(12):2151-2159.
[16] Hyojin K,Hyun JK,Choun-Ki J.Comparison of forward shift of posterior corneal surface after operation between LASIK and LASEK[J].Ophthalmologica,2006,220(1):37-42.
[17] 朱冉,刘庆淮.LASIK和LASEK术后角膜后表面高度和前房变化的临床研究[J].徐州医学院学报,2010,30(9):584-588.
[18] 李莹,李悦,罗岩,等.Pentacam前节分析系统测量角膜厚度、地形图及屈光手术后角膜后表面的研究[J].山东大学耳鼻喉眼学报,2011,25(5):82-88.
[19] Seitz B,Torres F,Langenbucher A,et al.Posterior corneal curvature changes after myopic laser in situ keratomileusis[J].Ophthalmology,2001,108(4):666-673.
[20] 龙克利,朱冉,程蕾,等.应用Pentacam分析3种近视激光矫正术后角膜后表面高度和曲率的变化[J].眼科新进展,2015,35(1):67-70.
[21] Zhang Y,Xu W,Tian L,et al.Analysis of anterior segment of age-related cataract after phacoemulsification combinded with intraocular lens implantation by Pentacam[J].Inter J Ophthalmol,2011,11(2):235-239.
[22] Gilda CD,Raimondo FD,Bernardino AC,et al.Computerized Scheimpflug densitometry as a measure of average CD values after excimer laser refractive surgery in myopic eyes[J].J Cataract Refract Surg,2011,37(8):1502-1506.
[23] 杨丹,谷天瀑,李颖,等.圆锥角膜的光密度分析[J].眼科新进展,2017,37(5):450-454.
[24] 熊世红,王薇,陆平.LASIK术后角膜后表面高度变化及影响因素[J].中华眼视光学与视觉科学杂志,2013,15(2):112-115.
[25] 薛超,王雁,左彤,等.飞秒激光与常规刀片准分子激光术后角膜后表面高度早期变化的对照研究[J].中华实验眼科杂志,2014,32(3):235-240.
[26] 郑燕,周跃华,柳静.准分子激光角膜原位磨镶术后角膜后表面的高度变化[J].中华实验眼科杂志,2013,31(12):1155-1158.
[27] 刘俐利,陈辉,程新梁.飞秒激光小切口基质透镜取出术术后角膜后表面的高度变化[J].临床眼科杂志,2016,24(6):531-534.
[28] Roy AS,Dupps WJ,Roberts CJ.Comparison of biomechanical effects of small-incisionlenticule extraction and laser in situ keratomileusis:finite-element analysis[J].J Cataract Refract Surg,2014,40(6):971-980.
[29] Dou R,Wang Y,Xu L,et al.Comparison of corneal biomechanical characteristics after surface ablation refractive surgery and novel lamellar refractive surgery[J].Cornea,2015,34(11):1441-1446.
[30] Randleman JB,Woodward M,Lynn MJ,et al.Risk assessment for ectasia after corneal refractive surgery(Article)[J].Ophthalmology,2008,115(1):37-50.
[31] Yao P,Zhao J,Li M,et al.Microdistortions in Bowman's layer following femtosecond laser small incision lenticule extraction observed by Fourier-Domain OCT[J].J Refract Surg,2013,29(10):668-674.
[32] Dong ZX,Zhou XT,Wu JH,et al.Small incision lenticule extraction (SMILE) and femtosecond laser LASIK:comparison of corneal wound healing and inflammation[J].Br J Ophthalmol,2014,98(2):263-269.
[33] Zhang L,Wang Y.The shape of posterior corneal surface in normal,Post-LASIK,and post-epi-LASIK eyes[J].Invest Ophthalmol Vis Sci,2010,51(7):3468-3475.
[34] 于长江,王雁,苏小连,等.飞秒激光小切口角膜基质透镜取出术后角膜后表面高度变化及其影响因素的研究[J].中华眼科杂志,2016,52(7):494-498.
[35] 王亚茹,周艳峰.两种不同LASIK手术对角膜后表面高度影响的临床研究[J].临床眼科杂志,2018,26(2):116-120.
[36] Tatar MG,Aylin Kantarci F,Yildirim A,et al.Risk factors in post-LASIK corneal ectasia[J].J Ophthalmol,2014,2014:204191.
[37] Spadea L,Cantera E,Cortes M,et al.Corneal ectasia after myopic laser in situ keratomileusis:a long-term study[J].Clin Ophthalmol,2012,6:1801-1813.
[38] Cagini C,Messina M,Lupidi M,et al.Posterior corneal surface stability after femtosecond laser-assisted keratomileusis[J].J Ophthalmol,2015,2015:184850.