长期配戴软性角膜接触镜对LASEK手术上皮瓣制作及术后恢复的影响

发布时间：2018-05-28 06:08

本文选题：软性角膜接触镜 + 准分子激光　；参考：《复旦大学》2012年硕士论文

【摘要】：第一部分长期配戴软性角膜接触镜对LASEK手术上皮瓣制作及术后恢复的影响目的：研究软性角膜接触镜的长期配戴对准分子激光角膜上皮瓣下磨镶术(LASEK)术中上皮瓣制作的影响及对术后临床恢复和疗效的影响。方法：行LASEK近视矫正的患者共365人(580只眼),按照角膜接触镜的配戴情况将患者分成4组。G1组：角膜接触镜配戴时间≥1年且3年,共49人(80只眼),平均年龄(24.49±3.15)岁,MRSE(-5.99±1.99)D,平均配戴时间为(1.60±0.52)年；G2组：角膜接触镜配戴时间≥3年且6年,共40人(66只眼),平均年龄(26.92±4.40)岁,MRSE(-5.78±1.28)D,平均配戴时间为(4.05±0.80)年；G3组：角膜接触镜配戴时间≥6年,共41人(67只眼),平均年龄(32.46±4.28)岁,MRSE (6.28±1.65)D,平均配戴时间为(10.25±2.91)年；G4组(对照组)：无角膜接触镜配戴史,共235人(367只眼),平均年龄(25.26±5.93)岁,MRSE(-5.90±2.28)D。所有患者行LASEK手术,由同一医生操作,术中20%乙醇浸泡时间为14秒,术中激光切削后使用0.2g/L丝裂霉素浸泡30秒,术后1周取角膜接触镜,比较各组术中角膜上皮瓣制作情况。238人(376只眼)完成一个月的随访,各组人数及MRSE分别为：G1组：35人(57只眼)、(-6.57±2.01)D；G2组：24人(39只眼)、(-5.85±1.74)D；G3组：31人(50只只眼)、(-6.45±1.69)D；G4组：148人(230只眼)(6±2.05)D。107人(157只眼)完成三个月的随访,各组人数及MRSE分别为：G1组：20人(29只眼)、(-6.27±1.84)D；G2组：15人(19只眼)(-6.85±1.82)D；G3组：15人(23只眼)、(-5.89±1.04)D；G4组：57人(86只眼)、(-5.98±2.35)D。比较术后第1天症状、视力、上皮水肿情况；术后1周上皮水肿情况；术后1个月时视力、屈光度、Haze程度；术后3个月时视力、屈光度、Haze程度。结果：1、将上皮瓣分为三种类型：Ⅰ型(上皮瓣完整且制作容易)、Ⅱ型(上皮瓣完整且制作困难)和Ⅲ型(上皮瓣不完整且制作很困难),各组制作的上皮瓣Ⅰ型、Ⅱ型和Ⅲ比例分别为：G1组：12.5%、50%、37.5%；G2组：9.09%、60.61%、30.3%；G3组：4.48%、7.76%、47.76%；G4组：22.62%、63.49%、13.89%。G1组、G2组、G3组间比较差异无统计学意义,而这三组与G4组间比较差异均有统计学意义。长期配戴软性角膜接触镜各组上皮瓣的制作难度和不完整率均高于未配戴组。 2、将术后症状分为无、轻度、中度和重度,术后第1天各组症状为无、轻度、中度和重度的比例分别为：G1组：33.33%、35.08%、31.59%、0%；G2组：28.21%、46.15%、20.51%、5.13%；G3组：38%、36%、20%、6%；G4组：36.52、47.83%、15.22%、0.43%。G1组、G2组、G3组间比较差异无统计学意义,而这三组与G4组间比较差异均有统计学意义,配戴角膜接触镜组患者症状重于未配戴者。 3、将术后中央角膜上皮水肿/混浊情况分为无、轻度、中度和重度,各组术后1d角膜上皮水肿/混浊不同程度比例分别为：G1组：38.6%、49.12%、10.53%、1.75%；G2组：30.77%、51.28%、17.95%、0%；G3组：38%、34%、20%、8%；G4组：56.52%、29.57%、13.04%、0.87%。术后1w时各组上皮水肿/混浊不同程度比例分别为：G1组：36.84%、45.61%、17.54%、0%；G2组：35.90%%、33.33%、30.77%、0%；G3组：36%、34%、20%、10%；G4组：61.74%、33.04%、4.78%、0.43%。术后1d、1w时四组分别两两比较：G1组、G2组、G3组间比较差异无统计学意义,而这三组与G4组间比较差异均有统计学意义,术后ld和1w时配戴角膜接触镜者角膜上皮水肿程度重于未配戴者。 4、术后裸眼视力情况：术后1d各组视力为≤0.5、0.6-0.8、≥1者所占比例分别为：G1组：8.77%、66.67%、24.56%；G2组：20.51%、23.08%、51.28%；G3组：18%、64%、18%；G4组：10.87%、46.09%、43.04%。术后lm各组视力为≤0.5、0.6-0.8、≥1者所占比例分别为：G1组：1.75%、21.05%、77.19%；G2组：0%、28.21%、71.79%；G3组：2%、22%、76%；G4组：6.09%、8.70%、85.22%。术后3m各组视力为40.5、0.6-0.8、≥1者所占比例分别为：Gl组：0%、17.24%、82.76%；G2组：0%、15.79%、84.21%；G3组：8.70%、4.35%、86.96%；G4组：3.49%、9.30%、87.21%。术后1d、1m时四组分别两两比较：G1组、G2组、G3组间比较差异无统计学意义,而这三组与G4组间比较差异均有统计学意义。术后3m时四组间差异无统计学意义,长期配戴角膜接触镜患者LASEK术后视力恢复较未配戴者慢。 5、术后屈光度：术后1m各组等效球镜值在预期矫正值≤±1D、±1D且≤±2D、±2D者分别为：G1组：80.70%、15.79%、3.51%；G2组：741.36%、25.64%、0%；G3组：80%、18%、2%；G4组：78.70%、16.09%、5.22%。术后3m各组等效球镜值分布比例为：G1组：93.10%、6.90%、0%；G2组：73.68%、26.32%、0%；G3：82.61%、17.39%、0%；G4组：88.37%、9.30%、2.33%。术后1m、3m时四组间屈光度差异均无统计学意义,长期配戴角膜接触镜未对术后患者屈光度造成影响。 6、所有患者术后Haze均没有达到2级及以上,术后1m时haze为0级、0.5级和1级者各组比例分别为：G1组：66.67%、31.58%、1.75%；G2组：76.92%、20.51%、2.56%；G3组：70%、22%、8%；G4组：77.83%、19.57%、2.61%。术后3m时haze为0级、0.5级和1级者各组比例分别为：G1组：68.97%、31.03%、0%；G2组：78.95%、21.05%、0%；G3组:73.91%、21.74%、4.35%；G4组：90.70%、9.30%、0%。术后1m、3m时四组间Haze分布情况差异均无统计学意义。结论：长期配戴软性角膜接触镜对LASEK角膜上皮瓣的制作造成影响,使剥瓣的难度增加,上皮瓣不完整比率增加。长期配戴软性角膜接触镜影响LASEK患者术后恢复,术后刺激症状加重,术后一周内上皮水肿加重,术后视力恢复更慢,但未影响Haze程度和屈光度情况。第二部分探讨-长期配戴软性角膜接触镜者LASEK手术上皮瓣制作最佳乙醇浸泡时间目的：初步探讨长期配戴软性角膜接触镜患者LASEK术中上皮瓣制作的最佳乙醇浸泡时间。方法：选择行LASEK手术矫正近视的长期配戴角膜接触镜患者,满足戴镜1年或1年以上、平均日戴时间超过8小时,每周配戴超过4天。分成两组：A组：随机一眼20%乙醇浸泡14S、另一眼168,采用自身对照比较研究,共12人24眼,平均配戴软性角膜接触镜时间为(6.50±4.08)年,两组MRSE分别为6.22±1.77D(14S组)和-6.32±1.70D(16S组),两组比较无统计学差异。B组：随机一眼20%乙醇浸泡16S、另一眼18S,共15人30眼,平均配戴软性角膜接触镜时间为(7.40±4.36)年。两组MRSE分别为-6.28±1.44D(16S组)和-6.01±1.43D(18S组),两组比较无统计学差异。比较不同乙醇浸泡时间时角膜上皮瓣制作情况。结果：根据角膜瓣制作难度和完整性将上皮瓣分为三种类型：Ⅰ型、Ⅱ型和Ⅲ型,各组制作的上皮瓣Ⅰ型、Ⅱ型和Ⅲ型比例分别为：A组：14S：0%、16.67%、83.88%；16S：0%、66.67%、33.33%,两者比较x2=6.1714,P=0.0130.05,差异有统计学意义。B组：16S：0%、46.67%、53.33%；18S：13.33%、73.34、13.33%,两者比较x2=6.4889,P=0.0390.05,差异有统计学意义。20%乙醇浸泡16S时角膜上皮瓣制作难度低于浸泡14S,上皮瓣完整率高于145。乙醇浸泡18S时角膜上皮瓣制作难度低于浸泡16S,上皮瓣完整率高于16S。结论：长期配戴软性角膜接触镜患者LASEK手术中乙醇浸泡18S时上皮瓣制作完整率明显优于16S和14S。对于长期配戴软性角膜接触镜患者应适当增加乙醇浸泡时间以提高制瓣成功率。
[Abstract]:Part one
Effect of long term wearing soft contact lens on skin flap preparation and postoperative recovery of LASEK operation
Objective: To study the effect of the long-term wear of soft contact lens on the making of the upper flap of the molecular laser corneal epithelial flap (LASEK) and the effect on the postoperative clinical recovery and curative effect.
Methods: a total of 365 patients (580 eyes) treated with LASEK myopia were divided into 4 groups of.G1 groups according to the contact lens wear. The wear time of the corneal contact lens was more than 1 years and 3 years, and 49 people (80 eyes), the average age (24.49 + 3.15) years, MRSE (-5.99 + 1.99) D, and the average wear time was (1.60 + 0.52) years; group G2: corneal contact mirror matching. A total of 40 people (66 eyes), 40 (26.92 + 4.40) years old (26.92 + 4.40) years, MRSE (-5.78 + 1.28) D, average age of (4.05 + 0.80) years, and group G3: corneal contact lens wear time, 6 years, 41 people (32.46 + 40) years, MRSE (26.92) D, and G4 group (control group): A total of 235 people (367 eyes), the average age (25.26 + 5.93) years, MRSE (-5.90 2.28) D. all patients underwent LASEK surgery, the same doctor operated, the 20% ethanol immersion time was 14 seconds, the intraoperative laser cutting was soaked with 0.2g/L Mitomycin for 30 seconds after the operation, and the corneal contact lens was taken for 1 weeks after the operation to compare the corneal epithelium in each group. .238 people (376 eyes) were followed up for one month, and the number of groups and MRSE were: group G1: 35 (57 eyes), (-6.57 + 2.01) D; G2 group: 24 (39 eyes), (-5.85 + 1.74) D; G3 group: 31 (50 eyes), (-6.45 + 1.69) D; G4 group: 148 people (230 eyes) (6 + 2.05)) completed the follow-up months, each group completed the follow-up months, groups completed each group, each group completed the month follow-up, group complete, each group completed the months follow-up, group completion, groups completed each group, each group completed the months follow-up, group completion, each group completed each group The number and MRSE were: group G1: 20 people (29 eyes), (-6.27 + 1.84) D; G2 group: 15 people (19 eyes) (-6.85 1.82) D; G3 group: 15 people (23 eyes), (-5.89 + 1.04) D; G4 group: 57 people (86 eyes), (-5.98 + 2.35) compared to postoperative first days symptoms, visual stress, epithelial edema, postoperative edema in epithelium; visual acuity, flexion at month after operation. The degree of Haze, the degree of visual acuity, diopter and Haze at 3 months after operation.
Results: 1, the epithelial flap was divided into three types: type I (complete epithelial flap and easy to make), type II (complete epithelial flap and difficulty in making) and type III (incomplete and difficult epithelial flap). The ratio of type I, type II and III of the upper flap of each group were: group G1: 12.5%, 50%, 37.5%; group G2: 9.09%, 60.61%, 30.3%; group G3: 4.48%, 7.76%, 47.76%, group G4: 22.62%, 63.49%, 13.89%.G1, group G2, and group G3, the difference was not statistically significant, but the difference between the three groups and the G4 group was statistically significant. The difficulty and the incomplete rate of the epithelial flap in each group were higher than those in the unmatched group.
2, the postoperative symptoms were divided into no, mild, moderate and severe, and first days after the operation, the symptoms were no, mild, moderate and severe: group G1: 33.33%, 35.08%, 31.59%, 0%; group G2: 28.21%, 46.15%, 20.51%, 5.13%; group G3: 38%, 36%, 20%, 6%; 36.52,47.83%, 0.43%.G1, G2, and G3 groups were not statistically different The differences between the three groups were statistically significant compared with those of the G4 group.
3, the postoperative edema / turbidity of the central corneal epithelium was divided into no, mild, moderate and severe. The proportion of 1D corneal edema / opacities in group G1: 38.6%, 49.12%, 10.53%, 1.75%; group G2: 30.77%, 51.28%, 17.95%, 0%; group G3: 38%, 34%, 20%, 8%; G4 group: 1W in each group after 0.87%. The proportion of different degrees of epithelial edema / turbidity were: group G1: 36.84%, 45.61%, 17.54%, 0%; group G2: 35.90%%, 33.33%, 30.77%, 0%; group G3: 36%, 34%, 20%, 10%; G4 group: 61.74%, 33.04%, 1W, 1W, respectively: G1 group, G2 group, G3 group, and there was no statistical difference, but this group was compared with G4 group. The difference was statistically significant. After LD and 1W, the degree of corneal edema was higher than that of the non wearer.
4, visual acuity after operation: the visual acuity of 1D group after operation was less than 0.5,0.6-0.8, and the proportion of more than 1 were: group G1: 8.77%, 66.67%, 24.56%; group G2: 20.51%, 23.08%, 51.28%; G3 group: 18%, 64%, 18%; group G4, 10.87%, 46.09%, LM, LM, < 0.5,0.6-0.8, > G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1: Group: G1: 77.19%; group G2: 0%, 28.21%, 71.79%; group G3: 2%, 22%, 76%; group G4: 6.09%, 8.70%, and 85.22%. after 3M, the visual acuity of each group was 40.5,0.6-0.8, and the proportion of the group of more than 1 was: Gl group: 0%, 17.24%, 82.76%; G3 group: G4 group: 1D Comparison: there was no statistically significant difference between group G1, group G2 and G3 group, but there was significant difference between the three groups and G4 groups. There was no statistical difference between the four groups at 3M after operation, and the visual acuity recovery after LASEK surgery in the patients with long-term wear corneal contact was slower than that of the non wearer.
5, postoperative refractive index: after the operation, the equivalent spherical mirror values of 1m groups were less than 1D, + 1D and < + 2D, and G1 group: G1 group: group G1, 15.79%, 3.51%; G2 group: 741.36%, 25.64%, 0%; G3 group: 80%, 18%, 2%; G4 group: 78.70%, 16.09%, 3M groups, G1 group: 93.10%, 6.90%, etc. .68%, 26.32%, 0%; G3:82.61%, 17.39%, 0%; group G4: 88.37%, 9.30%, and 2.33%. after 1m, 3M, there was no significant difference in diopter between four groups, and the long-term wear of corneal contact lenses did not affect the diopter of postoperative patients.
6, Haze did not reach level 2 and above, and haze was 0, 0.5 and 1 in group G1 after operation: group G1: 66.67%, 31.58%, 1.75%; G2 group: 76.92%, 20.51%, 2.56%; group G3, 70%, 22%, and haze, G4 group: G1 group, respectively: G1 group: G1 group: G1 group: G1 group, respectively: G1 group: G1 group: G1 97%, 31.03%, 0%; group G2: 78.95%, 21.05%, 0%; group G3: 73.91%, 21.74%, 4.35%; group G4: 90.70%, 9.30%, 1m and 3M after 0%., and there was no statistically significant difference in the distribution of Haze between the 0% groups.
Conclusion: the long-term wear of soft corneal contact lens affects the making of the LASEK skin flap, which makes the difficulty of the flaps increase and the ratio of the epithelial flap incomplete. The long-term wear of the soft corneal contact lens affects the recovery of the LASEK patients after the operation, the aggravation of the postoperative stimulation symptoms, the aggravation of the epithelia within one week after the operation, and the slow recovery of the visual acuity after the operation, but the visual acuity is more slowly after the operation, but the visual acuity is more slowly after the operation, but there is no shadow after the operation. The degree of Haze and the diopter.
The second part
To explore the best alcohol immersion time for LASEK skin flap on long term wearing soft contact lens.
Objective: to preliminarily investigate the best time of ethanol soaking in the upper skin flap of LASEK during long-term soft contact lens surgery.
Methods: select a long term corneal contact lens with LASEK surgery to correct myopia for 1 or 1 years. The average daily wear time is more than 8 hours and more than 4 days each week. Group A is divided into two groups: a random one eye 20% ethanol is soaked in 14S, the other is 168, and a total of 12 people and 24 eyes, with an average of soft cornea. The time of contact lens was (6.50 + 4.08) years, the two groups of MRSE were 6.22 + 1.77D (14S group) and -6.32 + 1.70D (16S group). The two groups had no statistical difference.B group: one eye 20% ethanol soaked 16S, another eye was 18S, 15 people, 30 eyes, and the average time of wearing soft contact lens was (7.40 + 4.36) years. MRSE of group two was -6.28 + 1.44D. 1.43D (group 18S), there was no significant difference between the two groups.
Results: according to the difficulty and integrity of the corneal flap, the epithelial flap was divided into three types: type I, type II and type III. The ratio of type I, type II and type III of the upper skin flap in each group were: group A: 14S:0%, 16.67%, 83.88%, 16S:0%, 66.67%, 33.33%, x2= 6.1714, P=0.0130.05, and the difference was statistically significant in group.B: 16S:0%, 4 6.67%, 53.33%, 18S:13.33%, 73.34,13.33%, the difference was x2=6.4889, P=0.0390.05, the difference was statistically significant, the difficulty of making corneal flap was lower than 14S when.20% was soaked in ethanol. The difficulty of making corneal flap was lower than that of 16S while the integrity of epithelial flap was higher than that of 145. ethanol, and the integrity of epithelial flap was higher than 16S..
Conclusion: the complete rate of the upper skin flap in the LASEK operation for the long term soft contact lens with the soft contact lens is superior to that of the 16S and the 14S.. The time of ethanol immersion should be appropriately increased to improve the success rate of the flap for the patients who have long worn the soft contact lens.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.63

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