不同手术切口设计的SMILE术后角膜知觉的变化
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摘要
目的:探讨不同手术切口设计的SMILE术后角膜知觉的变化。方法:选取2016-05-12/2018-01-18于我院行SMILE手术的近视及近视伴散光患者30例60眼,所有患者右眼手术切口设计在颞上方135°位置,左眼手术切口设计在正上方90°位置。分别于术前和术后1、7d,1、3mo采用角膜知觉计检测距角膜中央3mm位置3∶00、6∶00、9∶00、12∶00位及角膜中央的角膜知觉,并采用眼表疾病指数量表(OSDI)进行干眼症状评分。结果:手术前后,本组患者左右眼之间5个位置的角膜知觉无明显差异(P>0.05)。术后1d,双眼5个位置的角膜知觉均较术前和术后1、3mo显著降低(P<0.05),但术后1、3mo双眼5个位置的角膜知觉均与术前无明显差异(P>0.05)。术前和术后1、7d,1、3mo本组患者OSDI分值分别为10.739±7.576、15.003±11.296、16.357±14.467、14.020±10.128、11.968±7.586分,无明显差异(F=1.583,P=0.204)。结论:不同手术切口设计的SMILE术后角膜知觉无明显差异,均在术后1d明显下降,至术后1mo基本恢复至术前水平。
?AIM: To study the recovery of cornea sensitivity after small incision lenticule extraction(SMILE) surgery by different incision sites.?METHODS: Totally 30 SMILE patients(60 eyes) were selected from 05/12/2016-01/18/2018. The incision in the right eye was designed at 135° while that in the left eye was designed at 90°. Cornea sensitivity were examined and noted by an experienced examiner preoperative, 1 d, 7 d,1 mo and 3 mo 3 mm from central cornea postoperative at 3, 6, 9,12 o'clock and the central cornea. The eye surface disease index(ocular surface disease index, OSDI) was also noted at the same time.?RESULTS: The comparison of corneal sensitivity results from different eyes showed that there was no significant difference on all time points at different position(P>0.05). After further comparison, cornea sensitivity of both eyes was found to be lower on 1 d postoperative than that preoperative, 1 mo postoperative and 3 mo postoperative(P<0.05), while restored to the level of preoperative at 1 mo and 3 mo(P>0.05). The OSDI scores on different time points are 10.739±7.576, 15.003±11.296, 16.357±14.467, 14.020±10.128, 11.968±7.586 respectively. The comparison showed no significant difference(F=1.583, P=0.204).?CONCLUSION: There is no significant difference on cornea sensitivity between two eyes after SMILE surgeries. The corneal sensitivity declined at 1 d postoperative and the recovery was faster at about 1 mo.
?AIM: To study the recovery of cornea sensitivity after small incision lenticule extraction(SMILE) surgery by different incision sites.?METHODS: Totally 30 SMILE patients(60 eyes) were selected from 05/12/2016-01/18/2018. The incision in the right eye was designed at 135° while that in the left eye was designed at 90°. Cornea sensitivity were examined and noted by an experienced examiner preoperative, 1 d, 7 d,1 mo and 3 mo 3 mm from central cornea postoperative at 3, 6, 9,12 o'clock and the central cornea. The eye surface disease index(ocular surface disease index, OSDI) was also noted at the same time.?RESULTS: The comparison of corneal sensitivity results from different eyes showed that there was no significant difference on all time points at different position(P>0.05). After further comparison, cornea sensitivity of both eyes was found to be lower on 1 d postoperative than that preoperative, 1 mo postoperative and 3 mo postoperative(P<0.05), while restored to the level of preoperative at 1 mo and 3 mo(P>0.05). The OSDI scores on different time points are 10.739±7.576, 15.003±11.296, 16.357±14.467, 14.020±10.128, 11.968±7.586 respectively. The comparison showed no significant difference(F=1.583, P=0.204).?CONCLUSION: There is no significant difference on cornea sensitivity between two eyes after SMILE surgeries. The corneal sensitivity declined at 1 d postoperative and the recovery was faster at about 1 mo.
引文
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3 Ivarsen A,Asp S,Hjortdal J.Safety and complications of more than 1500 small-incision lenticule extraction procedures.Ophthalmology 2014;121(4):822-828
4 Sekundo W,Kunert KS,Blum M.Small-incision corneal refractive surgery using the small-incision lenticule extraction(SMILE) procedure for the correction of myopia and myopic astigmatism:results of a 6-month prospective study.Br J Ophthalmol 2011;95(3):335-339
5 Schiffman RM,Christianson MD,Jacobsen G,et al.Reliability and validity of the Ocular Surface Disease Index.Arch Ophthalmol 2000;118(5):615-621
6 Battat L,Macri A,Dursun D,et al.Effects of laser in situ keratomileusis on tear production,clearance and ocular surface.Ophthalmology 2001;108(7):1230-1235
7 Rodiguez AE,Hamdi IM.Comparison of goblet cell density after femtosecond laser and mechanical microkeratome in LASIK.Invest Ophthal Vis Sci 2007;48(6):2570-2575
8 Kumano Y,Matsui H,Zushi I,et al.Recovery of corneal sensation after myopic correction bylaser in situ keratomileusis with a nasal or superior hinge.J CataractRefract Surg 2003;29(4):757-761
9 Xu Y,Yang Y.Dry eye after small incision lenticule extraction and LASIK for myopia.J Refract Surg 2014;30(3):186-190
10 Li M,Zhao J,Shen Y,et al.Comparison ofdry eye and corneal sensitivity between small incision lenticule extraction and femtosecond LASIK for myopia.PLoS One 2013;8(10):e77797
11 Demirok A,Ozgurhan EB,Agca A,et al.Corneal sensation after corneal refractive surgery with small incision lenticule extraction.Optom Vis Sci 2013;90(10):1040-1047
12魏升升,王雁,耿维莉,等.飞秒激光小切口基质透镜取出术和飞秒激光基质透镜取出术后早期角膜知觉变化的对比研究.中华眼科杂志2013;49(4):299-304
13杨颖,左晶,张传伟,等.不同角膜屈光手术对基底膜下神经的影响.国际眼科杂志2015;15(8):1429-1431
14张梅,刘祖国,陈家祺,等.正常人角膜神经的共焦显微镜观察.中华眼科杂志2004;40(9):632-634
15金玉梅,钟勇,王忠海,等.不同角膜瓣位置对准分子激光原位角膜磨镶术后角膜知觉恢复的影响.眼视光学杂志2008;10(2):123-125
16 Qiu PJ,Yang YB.Early changes to dry eye and ocular surface after small-incision lenticule extraction for myopia.Int J Ophthalmol 2016;9(4):575-579
17 Wei S,Wang Y.Comparison of corneal sensitivity between FS-LASIK and femtosecond lenticule extraction (ReLEx flex) or small-incision lenticule extraction (ReLEx smile) for myopic eyes.Graefes Arch Clin Exp Ophthalmol 2013;251(6):1645-1654
18 Chan TC,Ng AL,Cheng GP,et al.Effect of location of opening incision on astigmatic correction after small-incision lenticule extraction.Sci Rep 2016;6:35881
19 Elmohamady MN,Abdelghaffar W,Daifalla A,et al.Evaluation of femtosecond laser in flap and cap creation in corneal refractive surgery for myopia:a 3-year follow-up.Clin Ophthalmol 2018;12:935-942
2 Levinson BA,Rapuano CJ,Cohen EJ,et al.Referrals to the Wills Eye Institute Cornea Service after laser in situ keratomileusis:reasons for patient dissatisfaction.J Cataract Refract Surg 2008;34(1):32-39
3 Ivarsen A,Asp S,Hjortdal J.Safety and complications of more than 1500 small-incision lenticule extraction procedures.Ophthalmology 2014;121(4):822-828
4 Sekundo W,Kunert KS,Blum M.Small-incision corneal refractive surgery using the small-incision lenticule extraction(SMILE) procedure for the correction of myopia and myopic astigmatism:results of a 6-month prospective study.Br J Ophthalmol 2011;95(3):335-339
5 Schiffman RM,Christianson MD,Jacobsen G,et al.Reliability and validity of the Ocular Surface Disease Index.Arch Ophthalmol 2000;118(5):615-621
6 Battat L,Macri A,Dursun D,et al.Effects of laser in situ keratomileusis on tear production,clearance and ocular surface.Ophthalmology 2001;108(7):1230-1235
7 Rodiguez AE,Hamdi IM.Comparison of goblet cell density after femtosecond laser and mechanical microkeratome in LASIK.Invest Ophthal Vis Sci 2007;48(6):2570-2575
8 Kumano Y,Matsui H,Zushi I,et al.Recovery of corneal sensation after myopic correction bylaser in situ keratomileusis with a nasal or superior hinge.J CataractRefract Surg 2003;29(4):757-761
9 Xu Y,Yang Y.Dry eye after small incision lenticule extraction and LASIK for myopia.J Refract Surg 2014;30(3):186-190
10 Li M,Zhao J,Shen Y,et al.Comparison ofdry eye and corneal sensitivity between small incision lenticule extraction and femtosecond LASIK for myopia.PLoS One 2013;8(10):e77797
11 Demirok A,Ozgurhan EB,Agca A,et al.Corneal sensation after corneal refractive surgery with small incision lenticule extraction.Optom Vis Sci 2013;90(10):1040-1047
12魏升升,王雁,耿维莉,等.飞秒激光小切口基质透镜取出术和飞秒激光基质透镜取出术后早期角膜知觉变化的对比研究.中华眼科杂志2013;49(4):299-304
13杨颖,左晶,张传伟,等.不同角膜屈光手术对基底膜下神经的影响.国际眼科杂志2015;15(8):1429-1431
14张梅,刘祖国,陈家祺,等.正常人角膜神经的共焦显微镜观察.中华眼科杂志2004;40(9):632-634
15金玉梅,钟勇,王忠海,等.不同角膜瓣位置对准分子激光原位角膜磨镶术后角膜知觉恢复的影响.眼视光学杂志2008;10(2):123-125
16 Qiu PJ,Yang YB.Early changes to dry eye and ocular surface after small-incision lenticule extraction for myopia.Int J Ophthalmol 2016;9(4):575-579
17 Wei S,Wang Y.Comparison of corneal sensitivity between FS-LASIK and femtosecond lenticule extraction (ReLEx flex) or small-incision lenticule extraction (ReLEx smile) for myopic eyes.Graefes Arch Clin Exp Ophthalmol 2013;251(6):1645-1654
18 Chan TC,Ng AL,Cheng GP,et al.Effect of location of opening incision on astigmatic correction after small-incision lenticule extraction.Sci Rep 2016;6:35881
19 Elmohamady MN,Abdelghaffar W,Daifalla A,et al.Evaluation of femtosecond laser in flap and cap creation in corneal refractive surgery for myopia:a 3-year follow-up.Clin Ophthalmol 2018;12:935-942