山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (2): 22-31.doi: 10.6040/j.issn.1673-3770.1.2020.005

• 临床研究 • 上一篇    下一篇

SMILE术中角膜帽下地塞米松平衡液冲洗与否的早期临床观察

梁刚1,马蓉1,张丰菊2   

  1. 1.云南省第二人民医院 眼科, 云南 昆明 650021;
    2.首都医科大学附属北京同仁医院 北京同仁眼科中心/北京市眼科学与视觉科学重点实验室, 北京 100730
  • 发布日期:2020-04-07
  • 通讯作者: 张丰菊. E-mail:wxw93@hotmail.com
  • 基金资助:
    云南省基础研究计划(昆医联合专项)项目[2018FE001(-263)];北京市卫生系统高层次卫生技术人才基金(2013-2-023)

Early clinical observations of intraoperative corneal stromal pocket irrigation with dexamethasone in small incision lenticule extraction

LIANG Gang1.2, MA Rong1, ZHANG Fengju2   

  1. 1. Department of Ophthalmology, The Second Hospital of Yunnan Province, Kunming 650021, Yunnan, China;
    2. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing 100730, China
  • Published:2020-04-07

摘要: 目的 观察飞秒激光小切口角膜基质透镜取出术(SMILE)中角膜帽下地塞米松平衡液冲洗与否对术后视觉质量及角膜组织结构形态的影响。 方法 选择拟进行双眼SMILE手术的24例(48眼)纳入研究,每例患者随机选取一眼透镜取出后,行地塞米松平衡液冲洗角膜帽下基质腔隙(实验组),对侧眼不冲洗(对照组)。分别于术后第1天、第7天及1个月对比观察两组的裸眼视力、屈光状态、角膜中央厚度(CCT)、眼压(NCT);同时利用共焦显微镜及前段光学相干断层扫描(OCT)检查对比观察两组角膜上皮细胞、神经纤维、基质细胞、内皮细胞形态结构。采用配对t检验比较两组的裸眼视力、屈光状态等各指标有无差异。 结果 术后第1天、第7天及1个月两组间裸眼视力比较:实验组为4.99±0.07、5.06±0.08、5.05±0.06;对照组为5.01±0.07、5.05±0.08、5.06±0.09;3个时间点两组间裸眼视力均无统计学差异(P>0.05);术后第1天、第7天及1个月的屈光度(SE,D):实验组为0.03±0.49、0.1±0.37、0.02±0.4;对照组为0.09±0.54、0.19±0.48、0±0.52,3个时间点两组间SE比较均无统计学差异(P>0.05)。共焦镜检查不同时间点比较:角膜上皮层细胞密度[术前(4 578.73±268.40,4 539.57±329.25)个/mm2,术后第1天(4 565.21±247.31,4 627.23±271.03)个/mm2,术后第7天(4 640.01±246.79,4 517.71±281.43)个/mm2];角膜内皮细胞密度[术前(2 541.50±259.59,2 443.52±305.58)个/mm2,术后第1天(2 387.01±248.55,2 495.27±238.52 )个/mm2,术后第7天(2 484.49±223.71,2 482.53±323.82)个/mm2],术前术后两组间均无统计学差异(P>0.05);角膜上皮下神经纤维丛术前术后两组间比较无明显变化;切削界面高反光物两组间比较没有明显差异;角膜前基质细胞密度[术前(789.51±67.17,802.03±67.94)个/mm2,术后第1天(889.37±60.62,912.27±95.87)个/mm2,术后第7天(796.67±75.03,818.39±59.65)个/mm2]在术后第1天、第7天较术前均有增加,但两组之间没有统计学差异(P>0.05),术后1 d两组前基质细胞较术前增加,有统计学差异(P<0.05);角膜后基质细胞术后各时间点两组间比较无统计学差异(P>0.05)。角膜OCT在术后1 d、7 d两组在角膜帽下均未出现明显层间间隙和积液,两组间角膜中央厚度无统计学差异(P>0.05)。 结论 SMILE术中地塞米松平衡液角膜帽下冲洗对术后裸眼视力、屈光度及角膜组织结构形态无明显影响。

关键词: SMILE手术, 冲洗, 地塞米松, 共焦显微镜, 眼前节光学相干断层扫描

Abstract: Objective This study aimed to evaluate the postoperative vision recovery and corneal morphological changes after corneal stroma pocket irrigation with dexamethasone during Small Incision Lenticule Extraction(SMILE). Methods This was a prospective case-control study, which included 48 eyes from 24 patients who underwent SMILE. One eye from each case was randomly selected to have corneal pocket irrigation with dexamethasone(experimental group, EG), while the other eye did not undergo irrigation(control group, CG). The morphological changes of the cornea were observed using in vivo confocal microscopy and anterior segment optical coherence tomography(OCT), 1 day and 7 days after surgery. The uncorrected visual acuity(UCVA), spherical equivalent(SE), corneal center thickness(CCT), and non-contact tension(NCT)values between the groups were compared 1 day, 7 days, and 1 month after surgery. Results No significant differences were observed in the UCVA(EG: 4.99±0.07,5.06±0.08, 5.05±0.06; CG:5.01±0.07, 5.05±0.08, 5.06±0.09, P>0.05)and SE between the two groups(EG: 0.03±0.49, 0.1±0.37, 0.02±0.4; CG: 0.09±0.54, 0.19±0.48, 0±0.52)the same day as the procedure, and 1 day, 7 days, and 1 month after surgery, p>0.05. The two groups were compared at the same time, 1 day and 7 days before and after SMILE using confocal microscopy and anterior segment OCT. The cell shape, density, cell size and arrangement of the corneal epithelium[pre-operation(4 578.73±268.40, 4 539.57±329.25)cell/mm2, post-1d(4 565.21±247.31, 4 627.23±271.03)cell/mm2, post-7d(4 640.01±246.79, 4 517.71±281.43)cell/mm2] and endothelium [pre-(2541.50±259.59, 2 443.52±305.58)cell/mm2, post-1d(2 387.01±248.55, 2 495.27±238.52)cell/mm2, post-7d(2 484.49±223.71, 2 482.53±323.82)cell/mm2] were not significantly different (P>0.05). There were no significant differences observed in the corneal sub-epithelial nerve fibers. The degree of active corneal stromal cells near the cutting interface was similar between the groups, without any significant differences. Regarding the density of the corneal superficial-stromal cells [pre-(789.51±67.17, 802.03±6 794)cell/mm2, post- 1d(889.37±60.62, 912.27±95.87)cell/mm2, post-7d(96.67±75.03, 818.39±59.65)cell/mm2 ], both groups revealed no significant difference pre- or post-operation. However, a significant difference (P<0.05) was observed after SMILE in both groups between the day immediately before and after the procedure. Both groups revealed no significant differences regarding the density of the deep stromal cells. Comparisons of the preoperative and postoperative anterior segment OCT show no obvious inter-lamellar space and effusion in the corneal stromal pocket in the two groups. There was no significant difference in the CCT between the groups (P>0.05). Conclusion Irrigation with dexamethasone in the corneal stromal pocket during SMILE did not have a significant effect on postoperative UCVA, SE, and corneal morphological changes after surgery.

Key words: SMILE surgery, Irrigation, Dexamethasone, Confocal microscope, Anterior segment optical coherence tomography(OCT)

中图分类号: 

  • R778.1
[1] 王雁. “全飞秒激光技术”的最新发展及其在SMILE手术中的应用[J]. 中华眼视光学与视觉科学杂志, 2014, 16(7): 388-393. doi:10.3760/cma.j.issn.1674-845X.2014.07.002. WANG Yan. Latest developments of the all-in-one femtosecond laser and its applications in SMILE surgery[J]. Chinese Journal of Optometry Ophthalmology and Visual Science, 2014, 16(7): 388-393. doi:10.3760/cma.j.issn.1674-845X.2014.07.002.
[2] Moshirfar M, Shah TJ, Masud M, et al. Surgical options for retreatment after small-incision lenticule extraction: Advantages and disadvantages[J]. J Cataract Refract Surg, 2018, 44(11): 1384-1389. doi:10.1016/j.jcrs.2018.07.047.
[3] 张国伟, 陈开建, 白继, 等. 水浸润分离法在SMILE手术角膜基质透镜分离中的应用[J]. 中华眼视光学与视觉科学杂志, 2014, 16(7): 412-415. doi:10.3760/cma.j.issn.1674-845X.2014.07.007. ZHANG Guowei, CHEN Kaijian, BAI Ji, et al. Liquid infiltration method to separate lenticule in small incision lenticule extraction[J]. Chinese Journal of Optometry Ophthalmology and Visual Science, 2014, 16(7): 412-415. doi:10.3760/cma.j.issn.1674-845X.2014.07.007.
[4] Ganesh S, Brar S,Gupta R, et al. A Comparative Study of Patients Undergoing ReLEX® Smile with One Eye Interface Wash and the Contralateral Eye without Interface Wash[J]. EC Ophthalmology,2017: 3-10.
[5] 张丰菊, 宋彦铮. 倡导角膜屈光手术的规范化和个性化[J]. 中华眼科杂志, 2016, 52(7): 481-485. doi:10.3760/cma.j.issn.0412-4081.2016.07.001. ZHANG Fengju, SONG Yanzheng. Advocating standardization and customization of corneal refractive surgery in Chinese domestic situation[J]. Chinese Journal of Ophthalmology, 2016, 52(7): 481-485. doi:10.3760/cma.j.issn.0412-4081.2016.07.001.
[6] 赵向阳, 刘军, 李卫平, 等. LASIK术中应用糖皮质激素瓣下冲洗预防弥漫性板层角膜炎[J]. 眼科新进展, 2009, 29(11): 846-848. doi:10.13389/j.cnki.rao.2009.11.013. ZHAO Xiangyang, LIU Jun, LI Weiping, et al. Rinsing with glucocorticoid under valve to prevent diffuse lamellar keratitis during LASIK[J]. Recent Advances in Ophthalmology, 2009, 29(11): 846-848. doi:10.13389/j.cnki.rao.2009.11.013.
[7] 梁刚, 张丰菊. 飞秒激光小切口角膜基质透镜取出术在眼科临床应用的新进展[J]. 中华眼科杂志, 2016, 52(1): 68-72. doi:10.3760/cma.j.issn.0412-4081.2016.01.018. LIANG Gang, ZHANG Fengju. Advance of femtosecond small incision lenticule extraction(SMILE)in clinic application[J]. Chinese Journal of Ophthalmology, 2016, 52(1): 68-72. doi:10.3760/cma.j.issn.0412-4081.2016.01.018.
[8] 张丰菊, 孙明甡. 飞秒激光辅助LASIK与飞秒激光小切口角膜基质透镜取出术孰优孰劣[J]. 中华眼科杂志, 2018, 54(1): 7-10. doi:10.3760/cma.j.issn.0412-4081.2018.01.003. ZHANG Fengju, SUN Mingshen. Advantages and disadvantages of femtosecond laser assisted LASIK and SMILE[J]. Chinese Journal of Ophthalmology, 2018, 54(1): 7-10. doi:10.3760/cma.j.issn.0412-4081.2018.01.003.
[9] Liu YC, Jayasinghe L, Ang HP, et al. Effect of intraoperative corneal stromal pocket irrigation in small incision lenticule extraction[J]. Biomed Res Int, 2015, 2015: 928608. doi:10.1155/2015/928608.
[10] Luft N, Ring MH, Dirisamer M, et al. Semiautomated SD-OCT measurements of corneal sublayer thickness in normal and post-SMILE eyes[J]. Cornea, 2016, 35(7): 972-979. doi:10.1097/ICO.0000000000000799.
[11] 侯杰, 雷玉琳, 郑秀云. 近视眼角膜上皮厚度分布特点及其与角膜生物力学性能的关系[J]. 中华眼视光学与视觉科学杂志, 2014, 16(5): 291-296. doi:10.3760/cma.j.issn.1674-845X.2014.05.008. HOU Jie, LEI Yulin, ZHENG Xiuyun. Corneal epithelial thickness in myopic eyes and its relationship with the corneal biomechanical properties[J]. Chinese Journal of Optometry Ophthalmology and Visual Science, 2014, 16(5): 291-296. doi:10.3760/cma.j.issn.1674-845X.2014.05.008.
[12] Li MY, Zhou ZM, Shen Y, et al. Comparison of corneal sensation between small incision lenticule extraction(SMILE)and femtosecond laser-assisted LASIK for myopia[J]. J Refract Surg, 2014, 30(2): 94-100. doi:10.3928/1081597X-20140120-04.
[13] 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[J]. 中华眼科杂志, 2013, 49(4): 299-304. doi:10.3760/cma.j.issn.0412-4081.2013.04.003. WEI Shengsheng, WANG Yan, GENG Weili, et al. Early outcomes of corneal sensitivity changes after small incision lenticule extraction and femtosecond lenticule extraction[J]. Chinese Journal of Ophthalmology, 2013, 49(4): 299-304. doi:10.3760/cma.j.issn.0412-4081.2013.04.003.
[14] Zhang FJ, Deng SJ, Guo N, et al. Confocal comparison of corneal nerve regeneration and keratocyte reaction between FS-LASIK, OUP-SBK, and conventional LASIK[J]. Invest Ophthalmol Vis Sci, 2012, 53(9): 5536-5544. doi:10.1167/iovs.11-8786.
[15] 许烨, 周行涛, 牛凌凌, 等. Visumax飞秒激光准分子激光角膜原位磨镶术术后角膜反应的共焦显微镜观察[J]. 眼科研究, 2010, 28(7): 661-665. doi:10.3969/j.issn.1003-0808.2010.07.024. XU Ye, ZHOU Xingtao, NIU Lingling, et al. Corneal tissue responses under confocal microscopy after VisuMumax femtosecond laser assisted LASIK[J]. Chinese Ophthalmic Research, 2010, 28(7): 661-665. doi:10.3969/j.issn.1003-0808.2010.07.024
[16] 刘慧颖, 周行涛. 飞秒激光辅助准分子激光原位角膜磨镶术后角膜内皮细胞密度的临床研究[J]. 中国眼耳鼻喉科杂志, 2012, 12(4): 234-236. doi:10.3969/j.issn.1671-2420.2012.04.012. LIU Huiying, ZHOU Xingtao. Clinic study of corneal endothelial cell density of femtosecond laser assisted in situ keratomileusis[J]. Chinese Journal of Ophthalmology and Otorhinolaryngology, 2012, 12(4): 234-236. doi:10.3969/j.issn.1671-2420.2012.04.012.[万方]
[17] 刘洋辰, 王雁, 解士勇. VisuMumax飞秒激光制作角膜瓣的OCT临床观察[J]. 中国实用眼科杂志, 2012, 30(4): 421-427. doi:10.3760/cma.j.issn.1006-4443.2012.04.015. LIU Yangchen, WANG Yan, XIE Shiyong. Preliminary study on clinical outcomes of Visumax femtosecond laser flap thickness measured by optical coherence tomography[J]. Chinese Journal of Practical Ophthalmology(CJPO), 2012, 30(4): 421-427. doi:10.3760/cma.j.issn.1006-4443.2012.04.015.
[1] 朱晶,张睿,赵媛,李炀,赵昱. 新生儿咽旁间隙卡梅现象1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 55-59.
[2] 秦铭,孙占伟,王卫卫,李世超,武天义,王广科. 咽喉反流症状或体征评分阳性的慢性鼻窦炎患者鼻内镜术后碱性等渗盐水冲洗的疗效观察[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 147-153.
[3] 林曼青,周敏,陈腾宇,李丹,方彩珊,王睿智,朱锦祥,阮岩,徐慧贤,王培源. 中药鼻腔冲洗治疗慢性鼻窦炎术后有效性和安全性的Meta分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 209-225.
[4] 王俊,邢奋丽,朱萍,孙亚萍,汤翠菊. 鼻咽癌放疗期间两种鼻腔冲洗方法的应用效果比较[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 60-63.
[5] 杜经纬,冯俊,马鹏,李志勇,李红光. 鼻腔冲洗联合鼻用糖皮质激素对AR患者FeNO、肺功能及生活质量的影响[J]. 山东大学耳鼻喉眼学报, 2019, 33(1): 124-127.
[6] 郑雅霓, 刘鹤, 马亮, 张明生, 孙中武. 布地奈德联合生理盐水鼻腔冲洗对慢性鼻-鼻窦炎的疗效及对鼻腔分泌物IL-6、IL-8、TNF-α的影响[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 58-62.
[7] 关凯,李丽莎. 鼻腔冲洗在变应性鼻炎防治中的应用[J]. 山东大学耳鼻喉眼学报, 2017, 31(3): 22-27.
[8] 江朝勇, 蔡永明, 殷亚磊. 耳后药物注射治疗突发性聋32例[J]. 山东大学耳鼻喉眼学报, 2014, 28(6): 18-20.
[9] 周慧, 黄雪琴, 胡俊丽, 姚俊, 张月飞, 江枫. 黄芩苷对鼻咽癌化疗期间激素使用影响的实验研究[J]. 山东大学耳鼻喉眼学报, 2014, 28(4): 30-32.
[10] 王荃1,2,李凯军2,高东鸿2,路晖2. 角膜共焦显微镜在真菌性角膜炎诊断中的优势[J]. 山东大学耳鼻喉眼学报, 2014, 28(2): 90-91.
[11] 韩时超1,崔传波2,李艳1,郝发香1,申红静1,肖俊杰1 . 共焦显微镜观察飞秒激光和机械刀制瓣LASIK术后角膜神经再生[J]. 山东大学耳鼻喉眼学报, 2013, 27(2): 71-74.
[12] 刘冬梅1,徐开伦1,罗晓1,贾全凡1,任贤灵1,袁龙1,罗通勇1,刘军2,马殿伟2, 岳胜清1,文晓蛟1,付誉颖2. 鼓室联合静脉地塞米松+传统方法治疗突发性耳聋的近期疗效[J]. 山东大学耳鼻喉眼学报, 2013, 27(1): 26-30.
[13] 乔岗,姜世怀,代艳,王晓莉,曾健,余敏. 微创技术在Ⅳ级前房积血(黑眼球)中的应用[J]. 山东大学耳鼻喉眼学报, 2012, 26(4): 61-63.
[14] 吴允刚,李晓瑜,庞太忠,高福平,李珊,王彩华,张永红,张辉,黄萌萌. 鼻内镜下经咽鼓管鼓室内注入地塞米松辅助治疗难治性突发性耳聋[J]. 山东大学耳鼻喉眼学报, 2012, 26(1): 29-30.
[15] 李建房. 吊瓶式鼻内镜冲洗器[J]. 山东大学耳鼻喉眼学报, 2012, 26(1): 92-92.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 张晗,黄一飞 . 抗角膜移植排斥的研究进展[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 84 -87 .
[2] 牛善利,柴茂文,李振秀 . 鼻内镜下鼻甲成形术治疗慢性肥厚性鼻炎60例[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 16 -18 .
[3] 孟庆国,卢永田,范献良 . 杀伤细胞免疫球蛋白样受体基因多态性与鼻咽癌的关联性[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 196 -199 .
[4] 马玉起,孔祥春 . 先天性双侧下唇窦道1例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 199 -199 .
[5] 万俐佳,鲁海涛,姜义道,刘 辉,李 琴,佘腊枝 . 改良腭咽成形术治疗阻塞性睡眠呼吸暂停综合征41例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 204 -205 .
[6] 于青青 ,王跃建 . 硬质耳内镜的临床应用进展[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 222 -224 .
[7] 吉晓滨,邓家德,臧林泉,王 磊,谢 军 . 豚鼠变应性鼻炎模型血清组胺的测定[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 228 -230 .
[8] 向登,卢永田,孙焕吉 . 鼻内镜下修补脑脊液鼻漏19例并文献复习[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 234 -236 .
[9] 邱恩惠,李志春,方文旭 . 嗅觉障碍的中西医治疗[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 253 -257 .
[10] 殷国华,钟 笑 . 激光减容术治疗舌扁桃体肥大的远期疗效[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 280 -282 .