飞秒激光小切口基质内透镜取出术（SMILE）术后视觉质量和生物力学及相关临床和基础研究

发布时间：2018-06-05 21:32

本文选题：飞秒激光小切口基质内透镜取出术 + 近视　；参考：《天津医科大学》2017年博士论文

【摘要】：目的随着飞秒激光在眼科的应用,角膜屈光手术进行了一系列革新。目前常用的手术方式有飞秒激光辅助的准分子激光原位角膜磨镶术(FS-LASIK)以及飞秒激光小切口基质内透镜取出术(SMILE)。但是对于这种全新的手术方式,尤其是SMILE手术,其术后的视觉效果、生物力学和视觉质量仍有很多未知。本实验将在探索SMILE术后一年的屈光效果的基础上,探讨高度近视眼人群与低度近视眼人群的特点,了解手术后视觉质量的可能影响因素,将角膜生物力学纳入并加以探讨。进一步评估SMILE术后的角膜像差与生物力学参数之间的内在关系,探究二者的相关性及可能的作用机制。并探索是否不同能量的飞秒激光参数设置可以影响SMILE手术后的视觉质量。方法1.SMILE术后1年屈光效果的评价回顾性的分析在本院屈光手术中心行SMILE手术的病人。纳入标准除常规符合SMILE手术适应症外,病人已完成术后1天,1周,1个月,3个月,6个月和术后12个月的随访。共93例病人(156眼)纳入研究。按照术前度数分为高度近视组(65眼/35人),MRSE≥-6D和中低度近视组(91眼/54人),MRSE6D。比较高度近视组与低中度近视组术后裸眼视力,最佳矫正视力,以及SMILE手术的稳定性,安全性,预测性的差异。2.SMILE、FS-LASIK和FLEx手术术后角膜像差的差异性分析回顾性的选取已行SMILE手术,FS-LASIK,或FLEx手术的病人。纳入标准是术前及术后3个月行Pentacam角膜地形图检查的手术病人,其中行SMILE手术73眼,FS-LASIK手术52眼,FLEx手术35眼。然后比较其前后表面及总的角膜像差。3.SMILE手术及FS-LASIK手术病人角膜生物力学与角膜像差相关性的研究回顾性的选取SMILE手术与FS-LASIKS手术病人各75人,纳入右眼进行研究。使用ORA进行角膜生物力学的测量,使用Pentacam进行角膜像差的测量。所有患者均进行术前及术后3月角膜像差和角膜生物力学的测量。4不同能量的飞秒激光参数对于SMILE术后屈光效果和视觉质量的研究本研究纳入行SMILE手术的55只眼。其中高能量组22眼,33眼在低能量组。两组病人的术前年龄和等效球镜度数,角膜曲率没有统计学差异。使用C-quart进行散射的测量,使用Pentacam角膜地形图进行角膜像差的测量。病人的随访时间为术后1周,术后1月和术后3月。结果1.高度近视组和低中度近视组SMILE术后1年的视力高于术后1天的视力。SMILE术后1年高度近视眼出现回退,等效球镜度较SMILE术后早期有所增加。为了矫正,手术时可以增加一定的度数,增加度数=0.13*预矫正的度数-0.66D。在低中度近视组,术后一年的屈光度与短期的屈光度无明显差异。2.SMILE,FS-LASIK和FLEx手术后角膜前表面和全角膜像差增加,特别是球差和彗差,然而大部分的后表面像差无明显变化。SMILE手术引入的角膜前表面球差和全角膜球差以及角膜前表面和全角膜第3到第8阶像差,要低于FLEx手术,FLEx手术引入的后表面彗差要高于SMILE手术和FS-LASIK手术。3.在SMILE手术和FS-LASIK手术,术前CRF与角膜前表面和总的球差和3-6阶高阶像差有明显的相关性。术前CRF与SMILE手术引入的彗差有明显的相关性。术前CRF与FS-LASIK手术引入的后表面水平像差有明显的相关性。4.SMILE术后两组能量的病人都具有良好的视力和屈光度。术后3个月两组病人的等效球镜度没有统计学差异。术后3个月高能量组病人的散射结果要低于低能量组,差异有统计学意义。结论1.SMILE手术高度近视眼仍有一定的回退,或许可以通过在术前适当增加矫正度数来矫正。2.SMILE手术,FS-LASIK手术,以及FLEx手术主要引入角膜前表面和全角膜彗差和球差。SMILE手术引入的角膜球差少于FLEx手术,SMILE比FLEx手术引入的角膜后表面彗差小。FS-LASIK手术的后表面球差明显增加。3.角膜生物力学对SMILE手术和FS-LASIK手术引入的像差有一定影响。手术前角膜生物力学越弱,SMILE和FS-LASIK手术引入的角膜像差越大。角膜阻力因子CRF较CH对SMILE和FS-LASIK手术后的生物力学变化更加敏感。角膜生物力学是一个非常重要的参数,很可能影响术后的视觉质量,这对于手术病人的筛查以及术后视觉质量的优化有一定的意义。4.不同能量的飞秒激光会影响SMILE术后的散射,但是对角膜高阶像差没有明显的影响。以后的研究可以进一步分析不同能量参数设置对于角膜伤口愈合的影响,从而优化SMILE的飞秒激光能量参数设置。
[Abstract]:Objective with the application of femtosecond laser in the ophthalmology, corneal refractive surgery has been made a series of innovations. The commonly used surgical methods are femtosecond laser assisted excimer laser in situ keratomileusis (FS-LASIK) and femtosecond laser small incision matrix lens removal (SMILE). But it is a new surgical method, especially the SMILE hand. The visual effect, biomechanics and visual quality of the surgery are still unknown. This experiment will explore the characteristics of the high myopia and low myopia people on the basis of the study of the diopter effect of one year after SMILE, to understand the possible influence of the visual quality after the operation and to explore the corneal biomechanics. One step to evaluate the intrinsic relationship between corneal aberration and biomechanical parameters after SMILE, to explore the correlation and possible mechanism of the two, and to explore whether the parameters of the femtosecond laser can affect the visual quality of SMILE after operation. Methods the evaluation of the effect of 1 years after 1.SMILE was reviewed in our hospital. Patients with SMILE surgery in the refractive surgery center were included in the standard, except routine SMILE indications. Patients had completed 1 days, 1 weeks, 1 months, 3 months, 6 months and 12 months after operation. A total of 93 patients (156 eyes) were included in the study. The preoperative degree was divided into high myopia group (65 eyes /35), MRSE > -6D and middle and low myopia group (91 eyes). /54 people), MRSE6D. compared the naked eye vision, best corrected visual acuity, and the stability, safety, predictive difference of SMILE operation in the high myopia group and the low and moderate myopia group,.2.SMILE, the difference analysis of corneal aberration after FS-LASIK and FLEx surgery, a retrospective selection of patients with SMILE surgery, FS-LASIK, or FLEx surgery. Pentacam corneal topography was performed before and 3 months after operation, including 73 eyes of 73, 52 eyes in FS-LASIK operation, 35 eyes in FLEx operation, and then compared the posterior surface and total corneal aberration.3.SMILE operation and the correlation of corneal biomechanics and corneal aberration in the patients with FS-LASIK operation, and a retrospective selection of SMILE hands was made. 75 patients, each with the FS-LASIKS operation, were included in the right eye. ORA was used to measure the biomechanics of the cornea, and the corneal aberration was measured by Pentacam. All patients were measured by the parameters of the femtosecond laser in the corneal aberration and the biomechanics of the cornea before and after the March, and the refractive effects and visual effects of the postoperative SMILE. The study of sense of mass was included in 55 eyes of the SMILE operation. In the high energy group, 22 eyes and 33 eyes were in the low energy group. There was no statistical difference between the preoperative age and the equivalent lens degree of the two groups and the corneal curvature. The measurement of the scattering by using the C-quart was used to measure the corneal aberration using the Pentacam corneal topography. The patients were followed up. Results 1 weeks after operation, January and March after operation. Results the visual acuity of 1. high myopia group and low and moderate myopia group after 1 years of visual acuity was higher than that of 1 year after the 1 days after the operation, 1 year high myopia appeared to regress, the equivalent spherical mirror degree increased early after the SMILE operation. In order to correct, the operation could increase a certain degree and increase the degree of =0.13* preview. There was no significant difference between the diopter of the corrected degree -0.66D. in the low and moderate myopia group and the short-term diopter after one year. The anterior surface and the total corneal aberration of the cornea were increased after FS-LASIK and FLEx operation, especially the spherical aberration and the comet difference. However, most of the posterior surface aberrations did not significantly change the spherical aberration and whole corneal surface introduced by.SMILE operation. The corneal spherical aberration and the third to eighth order aberrations of the anterior corneal surface and all cornea were lower than the FLEx operation. The posterior surface comet difference introduced by the FLEx operation was higher than that of the SMILE operation and FS-LASIK operation.3. in SMILE operation and FS-LASIK operation. The preoperative CRF and the anterior corneal surface and the total spherical aberration and the 3-6 order higher order aberrations were significantly correlated. There is a significant correlation between the comet difference introduced by the operation. There is a significant correlation between the pre operation CRF and the posterior surface level aberration introduced by the FS-LASIK operation. The two groups of energy patients with two groups have good visual acuity and refractive index after the operation. There is no statistical difference between the two groups of patients in the 3 months after the operation. The scattering knot of the high energy group after the operation is 3 months after the operation. Conclusion the difference is statistically significant below the low energy group. Conclusion there is still a certain regression in the high myopia of 1.SMILE operation. It may be possible to correct the.2.SMILE operation, FS-LASIK operation, and FLEx operation mainly by introducing the anterior surface of the cornea and the corneal spherical aberration and the spherical aberration introduced by the spherical aberration.SMILE operation. Less than FLEx operation, SMILE compared with FLEx operation, the posterior surface of the cornea was reduced to small.FS-LASIK surgery, the posterior surface spherical aberration significantly increased.3. corneal biomechanics on SMILE operation and the aberration introduced by FS-LASIK operation. The worse the corneal biomechanics before operation, the greater the corneal aberration introduced by SMILE and FS-LASIK hand operation. The corneal resistance factor C RF is more sensitive than CH to the changes of biomechanics after SMILE and FS-LASIK operation. The corneal biomechanics is a very important parameter, which may affect the visual quality after operation. It has a certain significance for the screening of patients and the optimization of postoperative visual quality. The femtosecond laser with different energy of.4. will affect the scattering after SMILE. There is no obvious effect on the higher order aberration of the cornea. The future study can further analyze the effect of different energy parameters on the healing of corneal wound, thus optimizing the setting of SMILE's femtosecond laser energy parameters.
【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R779.63

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