角膜屈光手术后不同区域角膜厚度变化及其对矫正效果的观察和研究
发布时间：2018-08-10 22:22
【摘要】：目的:本研究旨在分析飞秒激光小切口角膜基质透镜取出术(small incision lenticule extraction,SMILE)与飞秒激光辅助下的准分子激光角膜原位磨镶术(femtosecond laser assisted in situ keratomileusis,FS-LASIK)后不同区域角膜厚度短期变化及其与屈光度的关系;探讨SMILE术后长期不同区域角膜厚度的变化特点和临床结果及其影响因素,并综合分析屈光手术近期和远期角膜恢复的影响因素。方法:回顾性研究。本研究共纳入2014年6月至2015年1月在天津市眼科医院,行角膜屈光手术患者86例(148眼),其中SMILE组60例(104眼),FS-LASIK组26例(42眼),分别于术前、术后1天、1周、1个月、3个月和6个月测量角膜最薄点、中心区(直径2mm范围)、内环区(直径2-5mm范围)和外环区(直径5-6mm范围)角膜厚度,以研究两种手术术后不同区域角膜厚度的分布特点;另选取自2011年8月至2012年3月于天津市眼科医院屈光手术中心行SMILE手术治疗近视及散光的患者8例(16眼),分别测量术前、术后1天、1周、1个月、3个月、6个月和5年时角膜最薄点(0mm)以及以最薄点为顶点在周围直径2mm、4mm、6mm、8mm处4个同心圆将角膜分成直径2mm、2-4mm、4-6mm、6-8mm、8-10mm区域5个区域角膜厚度。以术前最薄点角膜厚度-术中切除透镜厚度=角膜理论厚度,以最薄点角膜厚度-角膜理论厚度=角膜厚度偏差量(△′CT),以术后不同时间本区域角膜厚度-术后1天时相同区域角膜厚度=该时刻本区域角膜厚度变化量(△CT)。统计学方法SMILE和FS-LASIK两组间角膜厚度、等效球镜度(spherical equivalent,SE)、最佳矫正视力(best corrected visual acuity,BCVA)比较采用重复度量两因素方差分析,组内比较应用重复度量单因素方差分析,不同参数间的相关性用Pearson或Spearman直线相关分析。P0.05认为差异有统计学意义。结果:1、SMILE和FS-LASIK术后角膜厚度均变薄,两组术后1周较1天时3个区域角膜厚度均变薄(SMILE:p≤0.002;FS-LASIK:p0.001),且FS-LASIK组幅度更大(p0.001)。3个月较1个月时均增厚(SMILE:p0.001;FS-LASIK:p0.001)。2、6个月时,SMILE 3个区域均与3月时无差别(p0.05),FS-LASIK内环区与3个月时无差别(p0.05),中心区和外环区,外环区线性增加,变化有统计学意义(p=0.023,0.001)。3、术后1天、1周、1个月、3个月和6个月,角膜厚度偏差量SMILE组分别为20.06±6.75μm、15.42±6.84μm、17.21±8.02μm、24.42±8.68μm、24.81±8.64μm;FS-LASIK组为-1.57±13.61μm、-14.88±7.46μm、-12.90±8.74μm、-5.52±7.91μm、-3.30±6.80μm,差异有统计学意义(F分组=475.150,p0.001;F时间=113.313,p0.001;F交叉=13.873,p0.001)。4、SMILE和FS-LASIK中心区△CT均与术前SE相关(p0.05),SMILE和FS-LASIK术后△CT与年龄、术前角膜厚度、术后等效球镜度(△SE)无相关(p0.05)。5、SMILE术后5年时,角膜最薄点、直径2mm、4mm、6mm、8mm、10mm区域的厚度分别比6个月时增厚了7.56μm、7.69μm、8.50μm、7.88μm、6.25μm、20.53μm,变化均有统计学意义(p≤0.030)。6、SMILE术后5年时,等效球镜度、裸眼视力、最佳矫正视力分别为-0.1016±0.2103D、Log Mar-0.123±0.115、Log Mar0.025±0.066,与6个月时差异均无统计学差异(p0.05)。结论:1.SMILE和FS-LASIK术后1周角膜厚度降低最明显,FS-LASIK组为著,3个月均轻度增厚,6个月时,SMILE中心区、内环区、外环区均基本稳定,FS-LASIK中央区及外环区持续明显增厚,可能与瓣膜有关。2.无论SMILE或FS-LASIK中央区厚度变化量与术前SE均相关。SMILE厚度的总体变化小于FS-LASIK,提示手术设计时nomogram调整。3.SMILE术后6个月至5年间不同区域角膜厚度有增厚,但与术后屈光度无相关。4.SMILE术后5年时等效球镜度、裸眼视力、最佳矫正视力均保持稳定,具有较好的稳定性。
[Abstract]:AIM: To analyze the short-term changes of corneal thickness and refractive index after femtosecond laser assisted in situ keratomileusis (FS-LASIK) and small incision lenticle extraction (SMILE). Methods: A retrospective study was conducted in 86 patients who underwent refractive surgery in Tianjin Ophthalmological Hospital from June 2014 to January 2015. (148 eyes), 60 cases (104 eyes) in SMILE group and 26 cases (42 eyes) in FS-LASIK group. The thinnest corneal spot, central area (2 mm in diameter), inner area (2-5 mm in diameter) and outer area (5-6 mm in diameter) were measured before operation, 1 day, 1 week, 1 month, 3 months and 6 months after operation, respectively. 8 cases (16 eyes) with myopia and astigmatism underwent SMILE from August 2011 to March 2012 in the Refractive Surgery Center of Tianjin Ophthalmological Hospital. The corneal thinnest point (0 mm) and the thinnest point (2 mm, 4 mm, 6 mm, 8 mm) were measured before surgery, 1 day, 1 week, 1 month, 3 months, 6 months and 5 years after surgery. The cornea was divided into five areas with a diameter of 2 mm, 2-4 mm, 4-6 mm, 6-8 mm and 8-10 mm. The corneal thickness was the thinnest point before operation - the intraoperative resection lens thickness = the theoretical corneal thickness, the thinnest point corneal thickness - the theoretical corneal thickness = the deviation of corneal thickness (delta'CT). The corneal thickness of the area was the same at different time after operation - the same at 1 day after operation. Regional corneal thickness = the change of regional corneal thickness (delta CT) at that time. Statistical methods: Corneal thickness, spherical equivalent (SE) and best corrected visual acuity (BCVA) were compared between SMILE and FS-LASIK groups using two-factor analysis of variance of repetitive measures, and single-factor analysis of repetitive measures within the group. Results: 1. Corneal thickness was thinner after SMILE and FS-LASIK, and thinner at 1 week than at 1 day in both groups (SMILE: P < 0.002; FS-LASIK: P < 0.001), and greater in FS-LASIK group (p 0.001). At 2 and 6 months, there was no difference among the three regions of SMILE (p0.05). There was no difference between the three regions of FS-LASIK and that at 3 months (p0.05). Corneal thickness increased linearly in the central and outer regions, and in the outer ring regions (p = 0.023, 0.001). 3 days, 1 week, 1 month, 3 months and 6 months after operation. The degree deviation of SMILE group was 20.06+6.75, 15.42+8.84, 15.42+6.84, 17.21+8.02, 17.21+8.02, 24.42+8.68, 24.42+8.68, 24.81+8.64, SMILE group was 20.06 +6.75, 15.42 +6.75, 15.42 +6.84, 15.42 +8.84, 17.21 +8.02, 24.42 +8.48, 24.42 +8.68, 24.81 +8.68, 24.81 +8.64, SMILE group was - 1.57 +13.61, 14.88.61, 14.88 [-14.88 [-88 [-7.88 F cross = 13.873, P 0.001).4, SMILE After SMILE and FS-LASIK, the thickness of the thinnest cornea was 7.56, 7.69, 8.50, 7.88 and 6.25 microns respectively thicker than that at 6 months. 5 years after SMILE, the equivalent sphericity, naked eye vision, best corrected visual acuity were - 0.1016 + 0.2103D, Log Mar - 0.123 + 0.115, Log Mar 0.025 + 0.066, respectively. There was no significant difference between 6 months after SMILE and FS-LASIK (p 0.05). Conclusion: 1. In the ASIK group, the central, inner and outer zones of SMILE were stable at 6 months. The central and outer zones of FS-LASIK were significantly thickened, which may be related to the valve. 2. The changes of central zone thickness of SMILE or FS-LASIK were correlated with preoperative SE. Nomogram adjustment. 3. Corneal thickness in different areas increased between 6 months and 5 years after SMILE, but not related to postoperative diopter. 4. Equivalent sphericity, naked eye vision and best corrected visual acuity remained stable at 5 years after SMILE.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6
本文编号：2176382
[Abstract]:AIM: To analyze the short-term changes of corneal thickness and refractive index after femtosecond laser assisted in situ keratomileusis (FS-LASIK) and small incision lenticle extraction (SMILE). Methods: A retrospective study was conducted in 86 patients who underwent refractive surgery in Tianjin Ophthalmological Hospital from June 2014 to January 2015. (148 eyes), 60 cases (104 eyes) in SMILE group and 26 cases (42 eyes) in FS-LASIK group. The thinnest corneal spot, central area (2 mm in diameter), inner area (2-5 mm in diameter) and outer area (5-6 mm in diameter) were measured before operation, 1 day, 1 week, 1 month, 3 months and 6 months after operation, respectively. 8 cases (16 eyes) with myopia and astigmatism underwent SMILE from August 2011 to March 2012 in the Refractive Surgery Center of Tianjin Ophthalmological Hospital. The corneal thinnest point (0 mm) and the thinnest point (2 mm, 4 mm, 6 mm, 8 mm) were measured before surgery, 1 day, 1 week, 1 month, 3 months, 6 months and 5 years after surgery. The cornea was divided into five areas with a diameter of 2 mm, 2-4 mm, 4-6 mm, 6-8 mm and 8-10 mm. The corneal thickness was the thinnest point before operation - the intraoperative resection lens thickness = the theoretical corneal thickness, the thinnest point corneal thickness - the theoretical corneal thickness = the deviation of corneal thickness (delta'CT). The corneal thickness of the area was the same at different time after operation - the same at 1 day after operation. Regional corneal thickness = the change of regional corneal thickness (delta CT) at that time. Statistical methods: Corneal thickness, spherical equivalent (SE) and best corrected visual acuity (BCVA) were compared between SMILE and FS-LASIK groups using two-factor analysis of variance of repetitive measures, and single-factor analysis of repetitive measures within the group. Results: 1. Corneal thickness was thinner after SMILE and FS-LASIK, and thinner at 1 week than at 1 day in both groups (SMILE: P < 0.002; FS-LASIK: P < 0.001), and greater in FS-LASIK group (p 0.001). At 2 and 6 months, there was no difference among the three regions of SMILE (p0.05). There was no difference between the three regions of FS-LASIK and that at 3 months (p0.05). Corneal thickness increased linearly in the central and outer regions, and in the outer ring regions (p = 0.023, 0.001). 3 days, 1 week, 1 month, 3 months and 6 months after operation. The degree deviation of SMILE group was 20.06+6.75, 15.42+8.84, 15.42+6.84, 17.21+8.02, 17.21+8.02, 24.42+8.68, 24.42+8.68, 24.81+8.64, SMILE group was 20.06 +6.75, 15.42 +6.75, 15.42 +6.84, 15.42 +8.84, 17.21 +8.02, 24.42 +8.48, 24.42 +8.68, 24.81 +8.68, 24.81 +8.64, SMILE group was - 1.57 +13.61, 14.88.61, 14.88 [-14.88 [-88 [-7.88 F cross = 13.873, P 0.001).4, SMILE After SMILE and FS-LASIK, the thickness of the thinnest cornea was 7.56, 7.69, 8.50, 7.88 and 6.25 microns respectively thicker than that at 6 months. 5 years after SMILE, the equivalent sphericity, naked eye vision, best corrected visual acuity were - 0.1016 + 0.2103D, Log Mar - 0.123 + 0.115, Log Mar 0.025 + 0.066, respectively. There was no significant difference between 6 months after SMILE and FS-LASIK (p 0.05). Conclusion: 1. In the ASIK group, the central, inner and outer zones of SMILE were stable at 6 months. The central and outer zones of FS-LASIK were significantly thickened, which may be related to the valve. 2. The changes of central zone thickness of SMILE or FS-LASIK were correlated with preoperative SE. Nomogram adjustment. 3. Corneal thickness in different areas increased between 6 months and 5 years after SMILE, but not related to postoperative diopter. 4. Equivalent sphericity, naked eye vision and best corrected visual acuity remained stable at 5 years after SMILE.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6
【参考文献】
相关期刊论文 前10条
1 杨俊;李瑞庄;;角膜厚度常用测量方法及其新进展[J];现代医药卫生;2016年06期
2 李华;王雁;窦瑞;王璐;危平辉;赵伟;李浏洋;;飞秒激光小切口角膜基质透镜取出术后眼压测量及其影响因素分析[J];中华眼科杂志;2016年01期
3 徐漫;孙荔;刘永珍;卢迪;徐艳春;陈蕾;;Pentacam眼前节分析在圆锥角膜诊断中的应用[J];国际眼科纵览;2015年06期
4 魏升升;王雁;左彤;林锦镛;王玉川;;飞秒激光对活体人眼角膜组织瞬间作用后超微结构变化的研究[J];中华眼科杂志;2015年07期
5 李华;王雁;;角膜屈光手术后眼压测量的研究进展[J];中华实验眼科杂志;2015年06期
6 董子献;周行涛;赵婧;朱文清;沈阳;乐琦骅;;飞秒激光透镜切除术后角膜反应的激光扫描共焦显微镜观察[J];中华实验眼科杂志;2013年11期
7 祖培培;王雁;吴迪;魏升升;;角膜屈光手术后早期角膜生物力学特性变化研究[J];中国实用眼科杂志;2013年07期
8 王雁;鲍锡柳;汤欣;左彤;耿维莉;金颖;;飞秒激光角膜微小切口基质透镜取出术矫正近视及近视散光的早期临床研究[J];中华眼科杂志;2013年04期
9 祖培培;王雁;;飞秒激光制瓣LASIK手术后的角膜伤口愈合反应[J];国际眼科纵览;2012年05期
10 吴迪;王雁;;角膜屈光手术后角膜生物力学变化特点的研究进展[J];国际眼科纵览;2012年04期
相关博士学位论文 前1条
1 董子献;飞秒激光角膜基质透镜切除（ReLEx）创伤愈合及机制研究[D];复旦大学;2012年
，本文编号：2176382
本文链接：https://www.wllwen.com/yixuelunwen/wuguanyixuelunwen/2176382.html
最近更新
教材专著
