飞秒激光微小切口角膜基质透镜摘除术治疗近视及散光的临床研究

发布时间：2018-03-31 10:16

  本文选题：微小切口角膜基质透镜摘除术　切入点：准分子激光原位角膜磨镶术　出处：《浙江大学》2014年博士论文

【摘要】：[目的]研究飞秒激光微小切口角膜基质透镜摘除术(SMILE)治疗近视及散光的临床疗效。比较SMILE与飞秒激光制瓣准分子激光原位角膜磨镶术(FS-LASIK),前弹力层下激光角膜磨镶术(SBK)和准分子激光原位角膜磨镶术(LASIK)术后的视觉质量、干眼和生物力学稳定性。 [方法]前瞻性临床对照研究。选取于我院行SMILE术的近视患者43例(81只眼),FS-LASIK术49例(97只眼),SBK术44例(82只眼)和LASIK术40例(78只眼)。比较四组术前及术后1月、3月、6月的视力、屈光度、高阶像差、对比敏感度、泪液分泌试验I长度(Schirmer I).泪膜破裂时间(BUT)、McMonnies问卷评分和的变化。分析术前及术后1月、6月非接触式眼压计(NCT)测眼压(IOP)变化率与A超测角膜厚度(CCT)变化率的相关性并予以回归。比较四组对术眼角膜硬度的改变程度。采用配对样本t检验,单向方差分析,非参数检验,相关分析,直线回归,一般线性模型的协方差分析。 [结果]在6个月的随访期内,SMILE组的87.7%眼屈光度在+0.5D范围内,98.8%眼在士1.0D范围内；FS-LASIK, SBK和LASIK组相应的数据与SMILE组之间无显著性差异。四组在手术前后各个时间点的等效球镜均无统计学差异。四组术后UCVA和BCVA达到20/20及以上的或达到20/25及以上在术后各时间点的分布均无显著差异。术后6月时,除每组各2眼丢失了1行BCVA外,其余眼均达到或优于术前的BCVA。SMILE组术后1月、3月和6月的HO As, SA和CA与术前相应值相比均有显著增加(P0.05)；其余三组有相同趋势。在术后1月、3月和6月,SMILE组的HOAs和SA值较小,具有显著差异(P0.05)。而术后CA的增加各组之间没有显著差异。SMILE组术后的无眩光CS和眩光CS较术前有降低。与术前相比,SMILE组术后1月的无眩光CS在6.3、4.0、2.5视角均较术前显著降低(P0.05),术后1月的眩光CS在1.6视角均较术前显著降低(P0.05)；术后3月及6月逐步恢复术前水平。各组之间,术前和术后的无眩光CS和眩光CS在各空间频率下均无显著性差异。SMILE组术前的Schirmer Ⅰ长度为17.49±7.48mm；在术后1月时较术前水平下降,在术后3月及6月有恢复术前水平趋势。LASmK组在术后3月和6月的Schirmer Ⅰ长度较SMILE、FS-LASIK与SBK组短,且差异有显著意义(P0.05)。SMILE组术前BUT为10.35±3.28s,术后1月和3月的BUT在较术前显著下降,至术后6月有恢复术前水平趋势。其余三组术后BUT的下降趋势与SMILE组相同。在术后1月时,SMILE组BUT下降的幅度较LASIK组显著少(P0.05),而在其他组别以及其他术后随访的时间点都无显著差异。术后1月,四组的McMonnies问卷评分均较术前显著增高(P0.05)。术后3月,SMILE组与SBK组恢复术前水平。至术后6月,FS-LASIK组McMonnies问卷评分恢复术前水平,而LASIK组恢复趋势不明显。在术后6月,LASIK组的McMonnies司卷评分较SMILE、FS-LASIK和SBK组明显高(P0.05)。四组在术后IOP值和CCT值均降低,相关性分析均显示密切相关(P0.05),随着CCT改变率的增加IOP改变率也随之增加。术后IOP改变率与CCT改变率做直线回归,得直线回归方程：IOP改变率=c+k*CCT改变率。术后6月时,四条回归直线之间进行比较,检验总体斜率之间没有显著性差异(Pk0.05),总体截距之间有显著性差异(Pc0.05)。SMILE组IOP改变率最小,而LASIK组lOP改变率最大。四组患者在随访期内均没有出现术中及术后的严重并发症。 [结论]SMILE矫正近视和散光与FS-LASIK, SBK, LASIK一样均安全、有效、稳定,可预测佳。SMILE术后高阶像差尤其是球差引入较少,无眩光对比敏感度降低较少,干眼程度较轻,恢复较快,角膜硬度的改变较少,生物力学稳定性较好。
[Abstract]:Objective To study the clinical effects of femtosecond laser micro - incision corneal matrix lens extraction ( SMILE ) in the treatment of myopia and astigmatism . The visual quality , dry eye and biomechanical stability were compared between SMILE and femtosecond laser in situ keratometry ( FS - LASIK ) , laser keratectomy ( SBK ) and LASIK after LASIK .

Methods Forty - four patients ( 81 eyes ) , 49 cases ( 97 eyes ) , 44 cases of SBK ( 82 eyes ) and 40 cases of LASIK ( 78 eyes ) were treated with SMILE in our hospital . The visual acuity , refractive index , higher order aberration , contrast sensitivity and tear secretion test I were compared before and after operation in four groups . The relationship between the rate of change of intraocular pressure ( IOP ) and the rate of change of corneal thickness ( CCT ) was measured before and after operation .

Results During the 6 - month follow - up period , 87.7 % of the cases of SMILE were in the range of + 0.5D , and 98 . 8 % were in the range of + 0.5D ;
There was no significant difference between the data of FS - LASIK , SBK and LASIK group and SMILE group . There was no significant difference between the four groups after operation . UCVA and BCVA were 20 / 20 and above , or 20 / 25 and above , respectively . After 6 months of operation , the remaining eyes reached or superior to BCVA before operation . The HO As , SA and CA in the SMILE group were significantly increased in January , March and June after operation ( P0.05 ) .
There was no significant difference between the patients with SMILE group ( P0.05 ) . Compared with preoperative treatment , no glare CS and glare CS were significantly lower in SMILE group than before operation ( P0.05 ) , and the glare CS of SMILE group was significantly lower than that before operation ( P0.05 ) .
There was no significant difference between preoperative and postoperative non - glare CS and glare CS at all spatial frequencies . Schirmer 鈪，

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