SMILE联合快速角膜交联术后角膜光密度的早期临床观察

doi:10.6040/j.issn.1673-3770.0.2021.110

摘要/Abstract

摘要： 目的观察飞秒激光小切口角膜基质透镜取出术联合快速角膜胶原交联术(SMILE Xtra)对角膜光密度的影响。方法收集2017年3月至2019年7月在济南明水眼科医院矫正近视及近视散光的患者78例,纳入右眼数据(78眼)进行分析,根据手术方式分为SMILE Xtra组和SMILE组,其中SMILE Xtra组39例(39眼),SMILE组39例(39眼),分别在术前和术后3个月对两组患者的角膜光密度值进行随访。应用Pentacam三维眼前节分析系统测量角膜光密度值,根据软件分析,以角膜顶点为中心,获取0~2 mm、2~6 mm及6~10 mm直径范围角膜光密度平均值,同时获取角膜前120 μm、中间基质层及后60 μm的光密度平均值。结果 SMILE Xtra组和SMILE组在术后3个月时78眼(100%)UCVA均达到术前预期矫正视力。SMILE Xtra组术后整体角膜及角膜0~2 mm、2~6 mm直径范围的光密度值均较手术前显著增高,且变化有统计学意义(P<0.001)。逐层分析显示术后前120 μm的数值均显著高于中部及后部角膜。SMILE组术后角膜各个直径范围的光密度值与术前差异有统计学意义(P<0.05)。角膜中部角膜组织及后60 μm的光密度值在手术前后变化有统计学意义(P<0.05)。SMILE Xtra组手术后3个月角膜光密度在0~2 mm、3~6 mm、7~10 mm和前120 μm的数值均高于SMILE组,差异有统计学意义(P<0.05)。两组角膜光密度值的变化量与等效球镜度、角膜中央厚度、角膜曲率及角膜上皮厚度变化量均无明显相关性(P>0.05),与年龄呈负相关(r=-0.542, P=0.01)。结论 SMILE Xtra组术后早期角膜光密度增加,透明度下降,但只在手术操作区域内发生变化。

关键词: 飞秒激光, 透镜, 胶原交联, 角膜光密度, 近视

Abstract: Objective To study the effect of small incision lenticule extraction combined with rapid corneal collagen crosslinking(SMILE Xtra)on corneal densitometry(CD). Methods Seventy-eight patients with myopia and myopic astigmatism were collected during March 2017 and July 2019 in Jinan Mingshui Eye Hospital. The right eye data(78 eyes)were included for analysis.They were divided into two groups: SMILE Xtra(39 patients,39 eyes)and SMILE alone(39 patients,39eyes). CD data of two groups were measured by the pentacam system preoperatively and postperatively at 3 months. According to the software analysis, the average CD data of three concentric radial zones centered on the apex of the cornea(0-2 mm, 2-6 mm, 6-10 mm diameters)were applied, and three layers were defined according to different corneal depths(the anterior 120 μm as the 1st layer, the posterior 60 μm as the 3rd layer, and the center part between them as the 2nd layer). Results UCVA of 78 eyes(100%)in both groups achieved the expected corrected visual acuity postperatively at 3 months. The overall CD data of SMILE Xtra in the central two zones(0-2 mm and 2-6 mm diameter of cornea)were significantly higher than that before surgery(P<0.001). The value of the first 120μm layer was increased more than that of the other two layers.There was a significant difference in the CD data of SMILE between the preoperative and postoperative(P<0.05). There was a significant difference in the CD data of central corneal tissue and posterior 60 μm before and after operation(P< 0.05). In SMILE Xtra group, the CD data of the three zones(0-2 mm, 2-6 mm, 6-10 mm)and the anterior 120μm were higher than that of SMILE group postperatively at 3 months.The difference was statistically significant(P<0.05).There was no significant correlation between the change of CD data and the change of spherical equivalent, central corneal thickness, corneal curvature and corneal epithelial thickness(P>0.05), but negative correlation was found with age(r=-0.542, P=0.01). Conclusion In the early postoperative period, CD data increased and the corneal transparency decreased after SMILE Xtra, but only changed within the surgical area.

Key words: Femtosecond laser, Lenses, Collagen crosslinking, Corneal densitometry, Myopia

中图分类号:

R779

张颖,雷玉琳,马志兴,杨星花,张静,侯杰. SMILE联合快速角膜交联术后角膜光密度的早期临床观察[J]. 山东大学耳鼻喉眼学报, 2021, 35(6): 52-58.

ZHANG Ying, LEI Yulin, MA Zhixing, YANG Xinghua, ZHANG Jing, HOU Jie. Early clinical observation of corneal densitometry after SMILE combined with rapid corneal cross-linking[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(6): 52-58.

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