FEMTO LDV飞秒激光辅助LASIK术后角膜形态和视觉质量的研究

发布时间：2018-04-09 21:37

  本文选题：飞秒激光　切入点：角膜瓣　出处：《郑州大学》2010年博士论文

【摘要】：第一部分FEMTO LDV飞秒激光制作LASIK角膜瓣相关因素分析 目的观察LASIK术中应用FEMTO LDV飞秒激光制作角膜瓣的特点,评估影响角膜瓣厚度及直径的相关因素。 方法对130人(260只眼)进行研究,其中预设角膜瓣厚度90μm组26人52只眼,预设值为110μm组104人208只眼。预计角膜瓣直径8.5mm到9.5mm。术中应用卡尺测量角膜瓣直径,与预设角膜瓣直径进行差异性分析,并与术前角膜中央最大K值、术前角膜厚度、年龄的相关性进行回归分析。术后1周使用傅立叶域光学相干断层扫描仪(OCT)测量角膜瓣的厚度,与预设角膜瓣厚度进行差异性分析,并与术前角膜中央最大K值、角膜中央厚度、年龄、眼压以及角膜瓣直径进行相关分析。 结果90μm角膜瓣组平均厚度为95.12士7.65(75.50～109.50)μm, 110μm角膜瓣组平均厚度为104.81±3.09(95.75～112.50)μm。左右眼间角膜瓣厚度差异无统计学意义(t110μm.=-1.223,t90μm=-1.343,P0.05).两组角膜瓣厚度与术中制作角膜瓣直径呈负相关(rl10μm=-0.363,r90μm=-0.434,P0.01),与患者术前年龄,角膜厚度,角膜中央最大K值以及眼内压均无明显相关性(rl10μm=-0.160,0.054,-0.011,-0.363；r90μm=-O.024,0.074,-0.212,-O.434,a11 P0.05).术中角膜瓣直径与术前角膜中央最大K值及角膜厚度呈正相关(p0.001,p0.05)。最常见并发症为角膜瓣缘出血,未影响激光消融。 结论FEMTO LDV飞秒激光制作角膜瓣预测性好、并发症少,且角膜瓣厚度不受术前角膜厚度及角膜中央最大K值影响。 第二部分FEMTO LDV飞秒激光和Hansatome机械角膜刀制瓣辅助LASIK术后角膜共焦显微镜下改变对比分析 目的评估并对比分析FEMTO LDV飞秒激光及Hansatome机械角膜刀制瓣辅助LASIK术后角膜细胞形态。 方法行FEMTO LDV飞秒激光制瓣辅助LASIK手术10人(20只眼),同期行Hansatome机械角膜刀制瓣LASIK手术9人(18只眼)。分别于术前及术后1周,1月,3月应用HRTIII共聚焦显微镜检测角膜中央及角膜瓣边缘的形态学变化,并对比两种制瓣方式术后角膜细胞形态学的异同。 结果术后1周,1月,3月时裂隙灯检查所有眼均未见角膜瓣皱褶发生。两组术后浅基质细胞密度较术前均明显减少(all P0.001)。Hansatome组术后角膜上皮厚度早期有增厚表现,3月时接近术前厚度；FEMTO LDV组上皮厚度手术前后无明显变化。所有眼均可在切削面见到高反光颗粒,其密度FEMTO LDV组术后明显少于Hansatome组(FEMTO LDV vs Hansatome,t1w=-13.505, t1m= 11.900, t3m=-14.084, all P0.001)。两组术后1周时均观察到角膜细胞形态改变,在切削界面后见角膜细胞激活,3月时基质细胞激活减少。FEMTO LDV组术后神经纤维的再生早于Hansatome组。FEMTO LDV组术后1周时,角膜瓣的边缘清晰、整齐。术后3月时,飞秒激光组周边角膜基质高反光,并有不规则的纤维化,提示较强的创伤愈合的过程,而机械角膜刀组角膜瓣边缘基质反光较弱,呈现较轻的纤维化。 结论FEMTO LDV飞秒激光制瓣术后神经纤维再生早,角膜瓣边缘瘢痕化改变明显于Hansatome机械角膜刀。 第三部分飞秒激光与机械角膜刀制瓣辅助LASIK术后视觉质量对比研究 目的评价FEMTO LDV飞秒激光及Hansatome机械角膜刀制瓣辅助LASIK术后有效性,预测性,安全性；对比分析对比敏感度并结合眩光测试以及波前像差的变化,评价患者的视觉质量。 方法应用Technolas217z100准分子激光系统治疗近视患者98人(196只眼),接受FEMTO LDV飞秒激光制瓣92只眼(46人,等效球镜(SE)-6.88±1.65D),同期接受Hansatome微型角膜刀制瓣104只眼(52人,等效球镜(SE)-6.78±1.05D),制瓣后均行波前像差引导的准分子激光切削术。分别于术前、术后1周、1月、3月检测两组患者裸眼视力、最佳矫正视力、显然验光、对比敏感度、眩光对比敏感度以及高阶像差。 结果(1)视力：术后1周,飞秒激光组的裸眼视力(UCVA)达到或高于最佳矫正视力(BSCVA)的有59/92(64.13%),机械角膜刀组有76/104(73.08%)；3月时飞秒激光组UCVABSCVA的有86/92(93.48%),机械角膜刀组为96/104(92.31%)。(2)屈光度：术后1周时屈光度飞秒激光组为+0.49D,角膜刀组为+0.35D；术后3月飞秒激光组屈光度为+0.16D,角膜刀组为-0.15D。(3)对比敏感度：飞秒激光组明视下对比敏感度(CS)手术前后的差异无统计学意义,暗视下对比敏感度术后1周时最低,1月时CS值已达术前。(4)眩光的影响：FEMTO LDV组明视下眩光未对CS造成明显影响。暗视下术后1周时CS受眩光影响最明显,在1.5、3.0、6.0、18.0cpd处引起CS下降(P0.05)。术后1月及3月时眩光均未引起CS的下降。术后明视下眩光对两组患者CS的影响没有显著差异。暗视下3月时,在中低空间频率(1.5、3.0、6.0cpd) FEMTO LDV组CS值高于Hansatome组。(5)高阶像差：FEMTO LDV组总高阶像差(HOA),三阶像差及彗差的均方根值(RMS)术后1周,1月时较术前增加(p0.05),至3月时与术前的差异无统计学意义。四阶像差及球差术后各期RMS值均高于术前,差异有统计学意义(p0.05)。术后3月时FEMTO LDV组HOA及彗差均低于Hansatome组(P=0.045,P=0.047)。球差、三叶草两组间均差异无统计学意义(P0.05)。 结论飞秒激光辅助LASIK手术可减少术后高阶像差的增加,获得较好的视觉质量,术后CS优于机械角膜刀组,与术后两组高阶像差不同有关。
[Abstract]:Analysis of the factors related to the production of LASIK corneal flap in the first part of the FEMTO LDV femtosecond laser
Objective To observe the characteristics of the corneal flap made by FEMTO LDV femtosecond laser in LASIK, and to evaluate the factors affecting the thickness and diameter of the corneal flap.
Methods 130 patients (260 eyes) were studied, which presupposes the corneal flap thickness 90 m group and 26 eyes of 52, default group 104 is 110 m. 208 eyes are expected to use caliper to measure the corneal flap diameter of corneal flap diameter of 8.5mm to 9.5mm. in the operation, analyzes the differences with the preset corneal flap diameter, and with the preoperative central corneal maximum K, preoperative corneal thickness, age correlation regression analysis. After 1 weeks, using the Fu Liye domain optical coherence tomography (OCT) measurement of the thickness of the corneal flap, analyzes the differences with the preset corneal flap thickness and preoperative central corneal maximum K, central corneal thickness age, intraocular pressure and corneal flap diameter were analyzed.
Results 90 m corneal flap group with an average thickness of 95.12 + 7.65 (75.50 ~ 109.50) m, 110 m corneal flap group with an average thickness of 104.81 + 3.09 (95.75 ~ 112.50) was not statistically significant M. difference between left and right eyes of corneal flap thickness (T110 m.=-1.223, T90 m=-1.343, P0.05) two groups. The corneal flap thickness and intraoperative corneal flap diameter was negatively correlated (rl10 m=-0.363, r90 m=-0.434, P0.01), and the patients age, corneal thickness, corneal maximum K and intraocular pressure were not significantly correlated (rl10 m=-0.160,0.054, -0.011, -0.363; r90 m= -O.024,0.074, -0.212, -O.434. A11 P0.05). The corneal flap diameter and preoperative central corneal maximum K and corneal thickness were positively correlated (p0.001, P0.05). The most common complication was bleeding, without the effect of laser ablation.
Conclusion the FEMTO LDV femtosecond laser made the corneal flap with good predictability and less complications, and the thickness of the corneal flap is not affected by the thickness of the cornea and the maximum central K of the cornea.
Comparison and analysis of second parts of FEMTO LDV femtosecond laser and Hansatome mechanical corneal knife valve assisted corneal confocal microscope after LASIK
Objective to evaluate and compare the corneal cell morphology of FEMTO LDV femtosecond laser and Hansatome mechanical corneal knife to assist LASIK.
Methods FEMTO LDV femtosecond laser flap assisted LASIK operation of 10 people (20 eyes), underwent Hansatome mechanical microkeratome LASIK surgery LASIK 9 people (18 eyes). Before and after surgery to 1 weeks in January, March, morphological changes using HRTIII confocal microscopy detection of central cornea and corneal flap edge. The similarities and differences of corneal cell morphology and the comparison of two kinds of flap preparation styles.
Results after 1 weeks, January, slit lamp examination in all eyes were no cornea flap folds occurred on March. Two groups of postoperative shallow stromal cell density were significantly reduced compared with the preoperative group (all P0.001).Hansatome early postoperative corneal epithelial thickness thickening performance, March close to the preoperative thickness; significant changes before and after FEMTO LDV group operation without epithelial thickness. All eyes can see the high reflective particles in the cutting surface, the density of FEMTO in group LDV was obviously less than group Hansatome (FEMTO LDV vs Hansatome, t1w=-13.505, t1m= 11.900, t3m=-14.084, all P0.001). The two groups at 1 weeks after operation were observed in corneal cell morphological changes, at the cutting interface corneal stromal cells activate cell activation, regeneration of nerve fibers decreased.FEMTO after operation in LDV group in March earlier than 1 weeks after Hansatome group.FEMTO group LDV, corneal flap edge is clear, neat. After March, the femtosecond laser group around the corner Membrane matrix was highly reflective and irregularly fibrosis, suggesting a strong wound healing process. However, the corneal stroma of the corneal stroma group was lighter than the corneal stroma, showing a slight fibrosis.
Conclusion the nerve fibers regenerate early after the FEMTO LDV femtosecond laser flap, and the scarring changes of the corneal flap edge are obvious in the Hansatome mechanical cornea knife.
Comparative study of visual quality after third partial femtosecond laser and mechanical corneal knife valve assisted LASIK
Objective to evaluate the effectiveness, predictability and safety of FEMTO LDV femtosecond laser and Hansatome mechanical corneal flap assisted LASIK, and compare the contrast sensitivity with the glare test and wavefront aberration, and evaluate the visual quality of patients.
Methods using Technolas217z100 excimer laser system in the treatment of 98 patients with myopia (196 eyes), FEMTO LDV femtosecond laser flap in 92 eyes (46, spherical equivalent (SE) -6.88 + 1.65D), underwent Hansatome microkeratome (104 eyes of 52 people, spherical equivalent (SE) -6.78 + 1.05D) after all, the flap making wavefront guided excimer laser photorefractive keratectomy. Respectively before operation, 1 weeks after the operation, in January March, detection of two groups of patients with uncorrected visual acuity, best corrected visual acuity, manifest refraction, contrast sensitivity, glare contrast sensitivity and high order aberrations.
缁撴灉(1)瑙嗗姏锛氭湳鍚，

本文编号：1728266