中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2013年
4期
292-298
,共7页
王雁%鲍锡柳%汤欣%左彤%耿维莉%金颖
王雁%鮑錫柳%湯訢%左彤%耿維莉%金穎
왕안%포석류%탕흔%좌동%경유리%금영
近视%散光%屈光外科手术%激光,飞秒%角膜基质
近視%散光%屈光外科手術%激光,飛秒%角膜基質
근시%산광%굴광외과수술%격광,비초%각막기질
Myopia%Astigmatism%Refractive surgical procedures%Laser,femtosecond%Corneal stroma
目的 探讨飞秒激光角膜微小切口基质透镜取出术(SMILE)矫正近视及近视散光的安全性、有效性、可预测性、稳定性及手术相关并发症等.方法 前瞻性研究.对入选的50例(88只眼)近视及近视散光患者,常规术前检查及围手术期处理,均施行飞秒激光SMILE手术.术后1d、1周、1个月、3个月随诊,复查裸眼视力(UCVA)、最佳矫正视力(BCVA)、电脑验光、显然验光和检影、眼压及角膜地形图等.失吸眼、有不透明气泡层的眼与其余眼各参数间比较应用独立样本t检验,手术前后眼压比较应用配对t检验,术后不同随访时间预矫等效球镜度数(SE)与实际矫正度数之间应用线性回归分析.结果 SMILE手术末次随访所有患者均获得1.0以上UCVA,均达到术前BCVA,残余等效球镜度数为(-0.11 ±0.29)D,散光度数仅为(0.01 ±0.33)D.术后患者的实际SE与预矫SE呈线性关系(R2=0.943,P＜0.05).手术过程中3例(3只眼,3.4％)患者发生失吸,14例(26只眼,29.5％)患者发生不透明气泡层(OBL).术后无BCVA下降.术后弥漫性板层角膜炎及角膜上皮下雾状混浊的发生率低,未出现其他严重并发症,角膜愈合良好.患者术前、术后1个月、术后3个月的平均眼压分别为(15.03 ±2.92)、(12.97 ±3.12)、(13.33 ±2.34)mm Hg(1 mm Hg=0.133 kPa),较术前相比,1个月时眼压略有降低(t=6.238,P＜0.05),3个月时无明显变化(t=0.053,P＞0.05).结论 SMILE手术用于矫正近视及近视散光具有较好的安全性、有效性、可预测性及稳定性,但需扩大样本量及延长随访时间远期观察.
目的 探討飛秒激光角膜微小切口基質透鏡取齣術(SMILE)矯正近視及近視散光的安全性、有效性、可預測性、穩定性及手術相關併髮癥等.方法 前瞻性研究.對入選的50例(88隻眼)近視及近視散光患者,常規術前檢查及圍手術期處理,均施行飛秒激光SMILE手術.術後1d、1週、1箇月、3箇月隨診,複查裸眼視力(UCVA)、最佳矯正視力(BCVA)、電腦驗光、顯然驗光和檢影、眼壓及角膜地形圖等.失吸眼、有不透明氣泡層的眼與其餘眼各參數間比較應用獨立樣本t檢驗,手術前後眼壓比較應用配對t檢驗,術後不同隨訪時間預矯等效毬鏡度數(SE)與實際矯正度數之間應用線性迴歸分析.結果 SMILE手術末次隨訪所有患者均穫得1.0以上UCVA,均達到術前BCVA,殘餘等效毬鏡度數為(-0.11 ±0.29)D,散光度數僅為(0.01 ±0.33)D.術後患者的實際SE與預矯SE呈線性關繫(R2=0.943,P＜0.05).手術過程中3例(3隻眼,3.4％)患者髮生失吸,14例(26隻眼,29.5％)患者髮生不透明氣泡層(OBL).術後無BCVA下降.術後瀰漫性闆層角膜炎及角膜上皮下霧狀混濁的髮生率低,未齣現其他嚴重併髮癥,角膜愈閤良好.患者術前、術後1箇月、術後3箇月的平均眼壓分彆為(15.03 ±2.92)、(12.97 ±3.12)、(13.33 ±2.34)mm Hg(1 mm Hg=0.133 kPa),較術前相比,1箇月時眼壓略有降低(t=6.238,P＜0.05),3箇月時無明顯變化(t=0.053,P＞0.05).結論 SMILE手術用于矯正近視及近視散光具有較好的安全性、有效性、可預測性及穩定性,但需擴大樣本量及延長隨訪時間遠期觀察.
목적 탐토비초격광각막미소절구기질투경취출술(SMILE)교정근시급근시산광적안전성、유효성、가예측성、은정성급수술상관병발증등.방법 전첨성연구.대입선적50례(88지안)근시급근시산광환자,상규술전검사급위수술기처리,균시행비초격광SMILE수술.술후1d、1주、1개월、3개월수진,복사라안시력(UCVA)、최가교정시력(BCVA)、전뇌험광、현연험광화검영、안압급각막지형도등.실흡안、유불투명기포층적안여기여안각삼수간비교응용독립양본t검험,수술전후안압비교응용배대t검험,술후불동수방시간예교등효구경도수(SE)여실제교정도수지간응용선성회귀분석.결과 SMILE수술말차수방소유환자균획득1.0이상UCVA,균체도술전BCVA,잔여등효구경도수위(-0.11 ±0.29)D,산광도수부위(0.01 ±0.33)D.술후환자적실제SE여예교SE정선성관계(R2=0.943,P＜0.05).수술과정중3례(3지안,3.4％)환자발생실흡,14례(26지안,29.5％)환자발생불투명기포층(OBL).술후무BCVA하강.술후미만성판층각막염급각막상피하무상혼탁적발생솔저,미출현기타엄중병발증,각막유합량호.환자술전、술후1개월、술후3개월적평균안압분별위(15.03 ±2.92)、(12.97 ±3.12)、(13.33 ±2.34)mm Hg(1 mm Hg=0.133 kPa),교술전상비,1개월시안압략유강저(t=6.238,P＜0.05),3개월시무명현변화(t=0.053,P＞0.05).결론 SMILE수술용우교정근시급근시산광구유교호적안전성、유효성、가예측성급은정성,단수확대양본량급연장수방시간원기관찰.
Objective To evaluate the safety,efficacy,predictability,stability and complications of femtosecond laser corneal small incision lenticule extraction (SMILE) procedure for the correction of myopia and myopic astigmatism.Methods In this prospective study,50 patients (88 eyes) with myopia and myopic astigmatism were chosen to be performed SMILE procedure randomly.These patients were followed up at 1 day,1 week,1 month and 3 months postoperatively and were examined for uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA),manifest refraction,intraocular pressure (IOP) and corneal topography.The results were analyzed with paired-t test,independent-samples t test and regression analysis.Results SMILE procedure was performed well in all patients,only 3 cases (3 eyes,3.4％) suffered from the suction loss,14 cases (26 eyes,29.5％) developed opaque bubble layer.All patients gained perfect UCVA (20/20),no eye had decrease of BCVA.The residual spherical equivalent was (-0.11 ±0.29) D,the astigmatism was (0.01 ±0.33) D 3 months postoperatively.The incidence of diffuse lamellar keratitis and haze was low,and no other complications were observed.The IOP was decreased slightly after 1 month (t =6.238,P ＜ 0.05),but no changes after 3 months (t =0.053,P ＜0.05).Conclusion The SMILE procedure is good at the safety,efficacy,predictability and stability for the correction of myopia and myopic astigmatism.
