飞秒激光小切口基质透镜取出术和飞秒激光基质透镜取出术后早期角膜知觉变化的对比研究
비초격광소절구기질투경취출술화비초격광기질투경취출술후조기각막지각변화적대비연구
Early outcomes of corneal sensitivity changes after small incision lenticule extraction and femtosecond lenticule extraction
  • 万方数据
    中华眼科杂志 중화안과잡지
    Chinese Journal of Ophthalmology
    2013年 4期 299-304 ,共6页

    魏升升%王雁%耿维莉%金颖%左彤%王璐%吴迪

    위승승%왕안%경유리%금영%좌동%왕로%오적

    近视%屈光外科手术%激光,飞秒%角膜基质%视知觉%对比研究 近視%屈光外科手術%激光,飛秒%角膜基質%視知覺%對比研究
    근시%굴광외과수술%격광,비초%각막기질%시지각%대비연구
    Myopia%Refractive surgical procedures%Laser,femtosecond%Corneal stroma%Visual perception%Comparative study
    目的 评估和对比飞秒激光小切口基质透镜取出术(SMILE)和飞秒激光基质透镜取出术(FLEx)后早期角膜中央和周边区知觉的恢复情况.方法 病例对照研究.收集接受SMILE和FLEx术的屈光不正患者47例(87只眼),其中SMILE组28例(53只眼),FLEx组19例(34只眼).分别在术前、术后1周、1个月、3个月使用Cohet-Bonnet角膜知觉计检查角膜中央、上方、下方、鼻侧和颞侧5个部位的角膜知觉.不同部位之间和术前、术后不同时间段之间的差异采用Mann-Whitney U检验,角膜中央区切除厚度、角膜中央厚度、术前等效球镜度、表面曲率等与角膜中央知觉变化之间采用Spearman相关分析.结果 在术后1周、1个月和3个月时,SMILE组在中央、下方、鼻侧、颞侧(除上方外)的角膜知觉均较FLEx组高,且差异具有统计学意义(Z=-5.219,-7.120,-6.735,-7.139,-5.945,-6.644,-7.006,-7.121,-5.262,-3.086,-4.140,-3.523;P＜O.01).而上方角膜知觉仪检查结果除了在术后1周时,SMILE组为(4.79±0.90) cm,FLEx组为(4.31±1.19)cm,两术式相比无统计学意义(Z=-1.807,P=0.071)外,在术后1个月和3个月时,SMILE组的角膜知觉分别为(5.23±0.62)和(5.57±0.57) cm,FLEx组的角膜知觉分别为(4.43±1.20)和(4.85±1.11) cm,两术式相比差异有统计学意义(Z=-2.935,-2.678；P=0.003,0.007),与其他部位相似.在SMILE组中,术后3个月时,中央、上方、下方、鼻侧、颞侧的角膜知觉分别为(5.74±0.51)、(5.57 ±0.57)、(5.70±0.55)、(5.83±0.37)、(5.84 ±0.30) cm,与术前相比差异均无统计学意义(Z=-1.255,-0.893,-0.570,-0.630,-0.935；P=0.209,0.440,0.569,0.529,0.350).在FLEx组术后3个月时,上方角膜知觉为(4.85±1.11) cm,与术前相比差异无统计学意义(Z=-1.095,P=0.272).SMILE和FLEx手术后角膜知觉的变化与角膜中央厚度、中央切除厚度、等效球镜度以及术前角膜表面曲率之间均无明显相关性(SMILE组:r=0.159,-0.202,0.106,0.060;P＞0.05.FLEx组:r=-0.156,-0.059,0.058,-0.005;P＞0.05).结论 SMILE和FLEx术后角膜知觉均下降,随着时间的延长角膜知觉逐渐恢复到术前水平,SMILE术后角膜知觉的下降程度较FLEx少且恢复较快.
    목적 평고화대비비초격광소절구기질투경취출술(SMILE)화비초격광기질투경취출술(FLEx)후조기각막중앙화주변구지각적회복정황.방법 병례대조연구.수집접수SMILE화FLEx술적굴광불정환자47례(87지안),기중SMILE조28례(53지안),FLEx조19례(34지안).분별재술전、술후1주、1개월、3개월사용Cohet-Bonnet각막지각계검사각막중앙、상방、하방、비측화섭측5개부위적각막지각.불동부위지간화술전、술후불동시간단지간적차이채용Mann-Whitney U검험,각막중앙구절제후도、각막중앙후도、술전등효구경도、표면곡솔등여각막중앙지각변화지간채용Spearman상관분석.결과 재술후1주、1개월화3개월시,SMILE조재중앙、하방、비측、섭측(제상방외)적각막지각균교FLEx조고,차차이구유통계학의의(Z=-5.219,-7.120,-6.735,-7.139,-5.945,-6.644,-7.006,-7.121,-5.262,-3.086,-4.140,-3.523;P＜O.01).이상방각막지각의검사결과제료재술후1주시,SMILE조위(4.79±0.90) cm,FLEx조위(4.31±1.19)cm,량술식상비무통계학의의(Z=-1.807,P=0.071)외,재술후1개월화3개월시,SMILE조적각막지각분별위(5.23±0.62)화(5.57±0.57) cm,FLEx조적각막지각분별위(4.43±1.20)화(4.85±1.11) cm,량술식상비차이유통계학의의(Z=-2.935,-2.678；P=0.003,0.007),여기타부위상사.재SMILE조중,술후3개월시,중앙、상방、하방、비측、섭측적각막지각분별위(5.74±0.51)、(5.57 ±0.57)、(5.70±0.55)、(5.83±0.37)、(5.84 ±0.30) cm,여술전상비차이균무통계학의의(Z=-1.255,-0.893,-0.570,-0.630,-0.935；P=0.209,0.440,0.569,0.529,0.350).재FLEx조술후3개월시,상방각막지각위(4.85±1.11) cm,여술전상비차이무통계학의의(Z=-1.095,P=0.272).SMILE화FLEx수술후각막지각적변화여각막중앙후도、중앙절제후도、등효구경도이급술전각막표면곡솔지간균무명현상관성(SMILE조:r=0.159,-0.202,0.106,0.060;P＞0.05.FLEx조:r=-0.156,-0.059,0.058,-0.005;P＞0.05).결론 SMILE화FLEx술후각막지각균하강,수착시간적연장각막지각축점회복도술전수평,SMILE술후각막지각적하강정도교FLEx소차회복교쾌.
    Objective To evaluate and compare the recovery of central and peripheral corneal sensitivity in the early period after small incision lenticule extraction (SMILE) and femtosecond lenticule extraction (FLEx).Methods In this study,47 cases (87 eyes) which underwent SMILE and FLEx were included.Central,superior,inferior,nasal and temporal corneal sensitivity was measured using a CochetBonnet esthesiometer (Luneau Ophthalmologie) before and 1 week,1 month,and 3 months after SMILE and FLEx.The results were analyzed with Mann-Whitney test by SPSS13.0 software.Results There were statistical differences between SMILE and FLEx group in the central,inferior,nasal and temporal corneal sensitivity at 1 week,1 month and 3 months postoperatively (Z =-5.219,-7.120,-6.735,-7.139,-5.945,-6.644,-7.006,-7.121,-5.262,-3.086,-4.140,-3.523.P ＜0.01).However,the superior corneal sensitivity in the SMILE group did not show significant difference (Z =-1.807,P =0.071) as compared to FLEx group (with exception of 1 week postoperatively).At 1 month and 3 months postoperatively,corneal sensitivity in the superior quadrant were (5.23 ± 0.62) and (5.57 ± 0.57) cm in the SMILE group,and were (4.43 ± 1.20) and (4.85 ± 1.11) cm in the FLEx group.There were statistical differences between these two groups (Z =-2.935,-2.678.P =0.003,0.007).In the SMILE group,corneal sensitivity in the central,superior,inferior,nasal and temporal quadrants at 3 months postoperatively was (5.74 ± 0.51),(5.57 ± 0.57),(5.70-± 0.55),(5.83 ± 0.37),(5.84 ± 0.30) cm respectively,there were no significant differences as compared with preoperative data (Z =-1.255,-0.893,-0.570,-0.630,-0.935.P =0.209,0.440,0.569,0.529,0.350).In the FLEx group,corneal sensitivity in the superior at 3 months postoperatively was 4.85 ± 1.11,there was not significant difference compared with preoperative data (Z =-1.095,P =0.272).There were no correlations between the changes of central corneal sensitivity and central corneal ablation depth,central corneal thickness and preoperative spherical equivalent(SMILE group:r =0.159,-0.202,0.106,0.060.P ＞ 0.05.FLEx group:r =-0.156,-0.059,0.058,-0.005.P ＞ 0.05) after SMILE and FLEx surgery.Conclusions Corneal sensitivity decreases after SMILE and FLEx,and then returns to its original state over time.The decrease of corneal sensitivity after the SMILE was fewer and the recovery was faster as compared with FLEx.
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