OCT导航的飞秒激光制作角膜瓣的优势分析

doi:10.6040/j.issn.1673-3770.1.2020.002

摘要/Abstract

摘要： 目的比较OCT导航的飞秒激光与其他三种飞秒激光制作角膜瓣的特点。方法近视及近视散光患者107例(200眼),分别行4种飞秒激光LASIK手术,其中A组:FEMTO LDV Z8飞秒激光,B组: Ziemer Crystalline飞秒激光,C组:Wavelight FS200飞秒激光,D组:Zeiss VisuMax飞秒激光,每组各50 眼。术后应用RTVue OCT分别测量角膜瓣厚度并分析。结果术后1周,A组角膜瓣厚度与预计值接近,组内变异范围小;B组角膜瓣厚度与预计值接近,但是变异范围大;C组和D组变异范围较小,但C组角膜瓣厚度偏薄,D组角膜瓣厚度与预计值接近。4种飞秒激光制作的角膜瓣形态规整、均一,中央厚度与周边厚度没有统计学差异(P>0.05)。4组间比较角膜瓣厚度值与预计值110 μm差值有明显差异,A组(3.43±2.81)μm和D组(3.13±2.89)μm明显好于B组(6.88±4.13)μm和C组(5.44±3.62)μm(F=2.397, P=0.018)。结论 OCT导航的飞秒激光与Zeiss VisuMax飞秒激光比Ziemer Crystalline和Wavelight FS200飞秒激光制作的角膜瓣更精确,可预测性更好。

关键词: 准分子激光原位角膜磨镶术, 飞秒激光, 角膜瓣厚度, 光学相干断层扫描

Abstract: Objective To compare the features of corneal flaps created by using an optical coherence tomography(OCT)-guided femtosecond laser and those created by three other femtosecond lasers. Methods Four types of femtosecond laser laser-assisted in situ keratomileusis procedures were performed on 107 patients(200 eyes)with myopia and myopic astigmatism. Patients were divided into four groups of 50: group A, FEMTO LDV Z8 femtosecond laser; group B, Ziemer Crystalline femtosecond laser; group C, Wavelight FS200 femtosecond laser; and group D, Zeiss VisuMax femtosecond laser. Corneal flap thickness was measured and analyzed by RTVue OCT. Results At 1 week postoperatively, the corneal flap thickness in group A was close to the expected value and the variation range was small. The corneal flap thickness in group B was close to the expected value, but the variation range was large. The corneal flap thickness in group C was thin, that of group D was close to the expected value, and the variation ranges of both groups were small. The corneal flaps created by the four femtosecond lasers were regular and uniform in shape, and there was no statistically significant difference between central and peripheral thicknesses(P>0.05). The differences between the corneal flap thickness value and the predicted value of 110 μm among the four groups were obviously different. The results of groups A(3.43±2.81)μm and D(3.13±2.89)μm were obviously better than those of groups B(6.88±4.13)μm and C(5.44±3.62)μm(F=2.397; P=0.018). Conclusion Compared with the Ziemer Crystalline and Wavelight FS200 femtosecond lasers, the OCT-guided femtosecond laser and the Zeiss VisuMax femtosecond laser featured higher accuracy and better predictability.

Key words: Femtosecond laser, Flap thickness, Laser in situ keratomileusis, Optical coherence tomography

中图分类号:

R772.2

张晶,陶冶,李福生,王燊,曲冬懿,李莹,周跃华. OCT导航的飞秒激光制作角膜瓣的优势分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(2): 17-21.

ZHANG Jing, TAO Ye, LI Fusheng, WANG Shen, QU Dongyi, LI Ying, ZHOU Yuehua. Analysis of the advantages of flaps created with an optical coherence tomography-guided femtosecond laser[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(2): 17-21.

参考文献

[1] Parafita-Fernández A, Teus M. Femtosecond laser in situ keratomileusis flap creation[J]. J Cataract Refract Surg, 2018, 44(10): 1297. doi:10.1016/j.jcrs.2018.07.020.
[2] Parafita-Fernández A, García-Gonzalez M, Katsanos A, et al. Two femtosecond laser LASIK platforms: comparison of evolution of visual acuity, flap thickness, and stromal optical density[J]. Cornea, 2019, 38(1): 98-104. doi:10.1097/ICO.0000000000001784.
[3] Garcia-Gonzalez M, Bouza-Miguens C, Parafita-Fernandez A, et al. Comparison of visual outcomes and flap morphology using 2 femtosecond-laser platforms[J]. J Cataract Refract Surg, 2018, 44(1): 78-84. doi:10.1016/j.jcrs.2017.10.041.
[4] Zheng Y, Zhou YH, Zhang J, et al. Comparison of laser in situ keratomileusis flaps created by 2 femtosecond lasers[J]. Cornea, 2015, 34(3): 328-333. doi:10.1097/ICO.0000000000000361.
[5] Zhang J, Zhou YH, Zhai CB, et al. Comparison of 2 femtosecond lasers for laser in situ keratomileusis flap creation[J]. J Cataract Refract Surg, 2013, 39(6): 922-927. doi:10.1016/j.jcrs.2013.01.042.
[6] Zhou YH, Zhang J, Tian L, et al. Comparison of the Ziemer FEMTO LDV femtosecond laser and Moria M2 mechanical microkeratome[J]. J Refract Surg, 2012, 28(3): 189-194. doi:10.3928/1081597X-20120208-01.
[7] Zhang J, Zhou YH, Zheng Y, et al. Comparison of visual performance recovery after thin-flap LASIK with 4 femtosecond lasers[J]. Int J Ophthalmol, 2017, 10(10): 1566-1572. doi:10.18240/ijo.2017.10.14.
[8] Tomita M, Watabe M, Mita M, et al. Long-term observation and evaluation of femtosecond laser-assisted thin-flap laser in situ keratomileusis in eyes with thin corneas but normal topography[J]. J Cataract Refract Surg, 2014, 40(2): 239-250. doi:10.1016/j.jcrs.2013.07.054.
[9] Izatt JA, Hee MR, Swanson EA, et al. Micrometer-scale resolution imaging of the anterior eye in vivo with optical coherence tomography[J]. Arch Ophthalmol, 1994, 112(12): 1584-1589. doi:10.1001/archopht.1994.01090240090031.
[10] Yu CQ, Manche EE. A comparison of LASIK flap thickness and morphology between the Intralase 60- and 150-kHz femtosecond lasers[J]. J Refract Surg, 2014, 30(12): 827-830. doi:10.3928/1081597X-20141113-04.
[11] Rocha KM, Krueger RR. Spectral-domain optical coherence tomography epithelial and flap thickness mapping in femtosecond laser-assisted in situ keratomileusis[J]. Am J Ophthalmol, 2014, 158(2): 293-301.e1. doi:10.1016/j.ajo.2014.04.012.
[12] Chan C, Saad A, Randleman JB, et al. Analysis of cases and accuracy of 3 risk scoring systems in predicting ectasia after laser in situ keratomileusis[J]. J Cataract Refract Surg, 2018, 44(8): 979-992. doi:10.1016/j.jcrs.2018.05.013.
[13] Flanagan GW, Binder PS. Role of flap thickness in laser in situ keratomileusis enhancement for refractive undercorrection[J]. J Cataract Refract Surg, 2006, 32(7): 1129-1141. doi:10.1016/j.jcrs.2006.01.095.
[14] Zhang Y, Chen YG, Xia YJ. Comparison of corneal flap morphology using AS-OCT in LASIK with the WaveLight FS200 femtosecond laser versus a mechanical microkeratome[J]. J Refract Surg, 2013, 29(5): 320-324. doi:10.3928/1081597X-20130415-03.

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