华西医学

华西医学

全飞秒激光小切口角膜基质透镜取出术、飞秒激光制瓣联合准分子激光角膜原位磨镶术及前弹力层下激光角膜磨镶术对术后干眼及角膜知觉的影响研究

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目的 比较目前主流的 3 种角膜屈光手术方式对术后干眼及角膜知觉的影响,探讨最佳角膜屈光术式。 方法 回顾性分析 2015 年 3 月—2016 年 1 月于四川大学华西医院行全飞秒激光小切口角膜基质透镜取出术(small incision lamellar extraction,SMILE)(40 例,80 只眼)、飞秒激光制瓣联合准分子激光角膜原位磨镶术(femtosecond-laserin situ keratomileusis,FS-LASIK)(36 例,72 只眼)、前弹力层下激光角膜磨镶术(sub-Bowman keratomileusis,SBK)(42 例,84 只眼)的 118 例患者(236 只眼)的病历资料,分别在术前、术后 1 周和术后 1 个月 3 个时间点采用眼表分析仪测定泪膜破裂时间、泪河高度和眼红指数;进行 SchimerⅠ试验检测泪液分泌;采用角膜知觉测量仪测量中央角膜知觉。观察分析 3 种手术方式组各观察时间点测量指标差异。 结果 3 组患者术后 1 周泪膜破裂时间均下降(P<0.05),SMILE 组[9.643±4.751)s]较其他 2 组[FS-LASIK 组(8.172±4.300)s、SBK 组(7.612±3.691)s]更长(P<0.05),SMILE 组术后 1 个月泪膜破裂时间和术前差异无统计学意义(P>0.05),其余 2 组较术前仍下降(P<0.05)。术后 1 周和 1 个月,3 组泪河高度均较术前下降(P<0.05),但 FS-LASIK 组术后 1 周时除外(P>0.05),SBK 组术后 1 周下降最明显。3 组各观察时间点眼红指数差异无统计学意义(P>0.05)。3 组术后 1 周和 1 个月中央角膜知觉均下降(P<0.05),SBK 组下降最为显著。3 组各观察时间点泪液分泌无变化(P>0.05)。 结论 SMILE 手术对术后干眼及角膜知觉的影响最小,其次为 FS-LASIK,最大为 SBK。

Objection To compare the effects of three mainstream surgical methods on the ocular surface and investigate the optimal corneal myopia correction surgery. Methods We selected 118 patients (236 eyes) undergoing small incision lamellar extraction (SMILE) (40 patients, 80 eyes), femtosecond-laser in situ keratomileusis (FS-LASIK) (36 patients, 72 eyes) or sub-Bowman keratomileusis (SBK) (42 patients, 84 eyes) surgery for corneal myopia correction from March 2015 to January 2016. Before surgery, one week and one month after surgery, tear film rupture time, tear river height and eye red index were measured using ocular surface analyzer. The Schimer Ⅰ test was used to detect tear secretion. Corneal sensory gauge was used to measure corneal sensation. Analysis of variance was used to analyze the measurements of the three surgical methods at various time points. Results The tear film rupture time of the three groups decreased after one week (P<0.05), but the time in the SMILE group [(9.643±4.751) seconds] was longer than those in the other two groups [FS-LASIK (8.172±4.300) seconds, SBK (7.612±3.691) seconds,P<0.05]. The time in the SMILE group at one month after surgery was not different from that before surgery (P>0.05). At one month after surgery, the rupture times of the other two groups were still shortened (P<0.05). The tear river heights in the three groups were decreased at one week and one month after surgery (P<0.05), except FS-LASIK group (P>0.05). In the SBK group, at one week after surgery, the decrease of the height was the most obvious (P<0.05). There was no difference in eye red index among the three groups at the time of observation (P>0.05). Corneal sensation decreased in the three groups at one week and one month after surgery. In the SBK group, that was the most obvious decline (P<0.05). In the three groups, the tear secretion did not change at each observation time point (P>0.05). Conclusion In the three surgical methods, SMILE has the minimal impact on the ocular surface, followed by FS-LASIK, and SBK has the greatest impact.

关键词: 全飞秒激光小切口角膜基质透镜取出术; 飞秒激光制瓣联合准分子激光角膜原位磨镶术; 前弹力层下激光角膜磨镶术; 干眼; 角膜知觉

Key words: Small incision lamellar extraction; Femtosecond-laser in situ keratomileusis; Sub-Bowman keratomileusis; Dry eye; Corneal sensation

引用本文: 张颖, 邱乐梅, 王顺清, 张小兰, 孙成淑, 马可. 全飞秒激光小切口角膜基质透镜取出术、飞秒激光制瓣联合准分子激光角膜原位磨镶术及前弹力层下激光角膜磨镶术对术后干眼及角膜知觉的影响研究. 华西医学, 2018, 33(11): 1371-1375. doi: 10.7507/1002-0179.201709122 复制

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