国际眼科杂志
國際眼科雜誌
국제안과잡지
International Eye Science
2015年
10期
1709-1712
,共4页
夏丽坤%王丹%马晶%刘鹤南%杨飏
夏麗坤%王丹%馬晶%劉鶴南%楊飏
하려곤%왕단%마정%류학남%양양
飞秒激光%角膜内皮细胞%飞秒激光小切口基质透镜取出术%近视%散光
飛秒激光%角膜內皮細胞%飛秒激光小切口基質透鏡取齣術%近視%散光
비초격광%각막내피세포%비초격광소절구기질투경취출술%근시%산광
femtosecond laser%corneal endothelium cells%femtosecond laser small incision lenticule extraction%myopia%astigmatism
目的：探讨飞秒激光小切口基质透镜取出术( small incision lenticule extraction, SMILE )对角膜内皮细胞的影响。<br> 方法：采用前瞻性病例研究。将2014-04/10在中国医科大学附属盛京医院自愿接受SMILE手术的近视及近视散光患者60例120眼,按照患者术前是否长期配戴角膜接触镜分为两组：角膜接触镜组(60眼)和非角膜接触镜组(60眼)。采用NIDEK confoscan4型角膜共焦显微镜检测两组患者术前及术后1wk,1、6mo时的角膜内皮细胞密度、六角形细胞百分比,并记录数值进行统计学分析。结果：全部患者手术进行顺利,术中和术后均无危害视力的并发症发生。两组患者的年龄、术前的屈光度数、切除基质透镜的厚度、剩余角膜基质床厚度、术后裸眼视力的差异均无统计学意义(P>0.05)。非角膜接触镜组术前及术后1wk,1、6mo的角膜内皮细胞密度的差异及六角形细胞百分比的差异均无统计学意义( F=0.864、2.488,P=0.460、0.061)。角膜接触镜组术前及术后1wk,1、6mo的角膜内皮细胞密度的差异无统计学意义( F=0.135,P=0.939),但六角形细胞百分比的差异有统计学意义( F=4.913,P=0.002)；经LSD-t检验,角膜接触镜组的六角形细胞百分比术后1 wk 时(30.70±4.08)%较术前(32.23±4.15)%明显降低( P=0.045)；术后1mo 时(33.05±4.28)%恢复至术前水平(P=0.364)；术后6mo时(34.06±5.11)%与术前比较差异无统计学意义(P=0.091)。两组之间比较,角膜接触镜组的角膜内皮六角形细胞百分比于术前及术后1 wk；1 mo时明显低于非角膜接触镜组( t=2.051、1.723、2.092, P=0.037、0.042、0.034),但术后6 mo时与非角膜接触镜组无明显差异( t=0.131,P=0.986)。<br> 结论：在保留剩余角膜基质床厚度≥300μm的条件下, SMILE手术矫正近视和近视散光对角膜内皮细胞密度无影响,仅对角膜内皮六角形细胞百分比造成短暂的影响,其影响程度没有长期配戴角膜接触镜对角膜内皮细胞的影响大,SMILE手术是一种非常安全的角膜屈光手术。
目的：探討飛秒激光小切口基質透鏡取齣術( small incision lenticule extraction, SMILE )對角膜內皮細胞的影響。<br> 方法：採用前瞻性病例研究。將2014-04/10在中國醫科大學附屬盛京醫院自願接受SMILE手術的近視及近視散光患者60例120眼,按照患者術前是否長期配戴角膜接觸鏡分為兩組：角膜接觸鏡組(60眼)和非角膜接觸鏡組(60眼)。採用NIDEK confoscan4型角膜共焦顯微鏡檢測兩組患者術前及術後1wk,1、6mo時的角膜內皮細胞密度、六角形細胞百分比,併記錄數值進行統計學分析。結果：全部患者手術進行順利,術中和術後均無危害視力的併髮癥髮生。兩組患者的年齡、術前的屈光度數、切除基質透鏡的厚度、剩餘角膜基質床厚度、術後裸眼視力的差異均無統計學意義(P>0.05)。非角膜接觸鏡組術前及術後1wk,1、6mo的角膜內皮細胞密度的差異及六角形細胞百分比的差異均無統計學意義( F=0.864、2.488,P=0.460、0.061)。角膜接觸鏡組術前及術後1wk,1、6mo的角膜內皮細胞密度的差異無統計學意義( F=0.135,P=0.939),但六角形細胞百分比的差異有統計學意義( F=4.913,P=0.002)；經LSD-t檢驗,角膜接觸鏡組的六角形細胞百分比術後1 wk 時(30.70±4.08)%較術前(32.23±4.15)%明顯降低( P=0.045)；術後1mo 時(33.05±4.28)%恢複至術前水平(P=0.364)；術後6mo時(34.06±5.11)%與術前比較差異無統計學意義(P=0.091)。兩組之間比較,角膜接觸鏡組的角膜內皮六角形細胞百分比于術前及術後1 wk；1 mo時明顯低于非角膜接觸鏡組( t=2.051、1.723、2.092, P=0.037、0.042、0.034),但術後6 mo時與非角膜接觸鏡組無明顯差異( t=0.131,P=0.986)。<br> 結論：在保留剩餘角膜基質床厚度≥300μm的條件下, SMILE手術矯正近視和近視散光對角膜內皮細胞密度無影響,僅對角膜內皮六角形細胞百分比造成短暫的影響,其影響程度沒有長期配戴角膜接觸鏡對角膜內皮細胞的影響大,SMILE手術是一種非常安全的角膜屈光手術。
목적：탐토비초격광소절구기질투경취출술( small incision lenticule extraction, SMILE )대각막내피세포적영향。<br> 방법：채용전첨성병례연구。장2014-04/10재중국의과대학부속성경의원자원접수SMILE수술적근시급근시산광환자60례120안,안조환자술전시부장기배대각막접촉경분위량조：각막접촉경조(60안)화비각막접촉경조(60안)。채용NIDEK confoscan4형각막공초현미경검측량조환자술전급술후1wk,1、6mo시적각막내피세포밀도、륙각형세포백분비,병기록수치진행통계학분석。결과：전부환자수술진행순리,술중화술후균무위해시력적병발증발생。량조환자적년령、술전적굴광도수、절제기질투경적후도、잉여각막기질상후도、술후라안시력적차이균무통계학의의(P>0.05)。비각막접촉경조술전급술후1wk,1、6mo적각막내피세포밀도적차이급륙각형세포백분비적차이균무통계학의의( F=0.864、2.488,P=0.460、0.061)。각막접촉경조술전급술후1wk,1、6mo적각막내피세포밀도적차이무통계학의의( F=0.135,P=0.939),단륙각형세포백분비적차이유통계학의의( F=4.913,P=0.002)；경LSD-t검험,각막접촉경조적륙각형세포백분비술후1 wk 시(30.70±4.08)%교술전(32.23±4.15)%명현강저( P=0.045)；술후1mo 시(33.05±4.28)%회복지술전수평(P=0.364)；술후6mo시(34.06±5.11)%여술전비교차이무통계학의의(P=0.091)。량조지간비교,각막접촉경조적각막내피륙각형세포백분비우술전급술후1 wk；1 mo시명현저우비각막접촉경조( t=2.051、1.723、2.092, P=0.037、0.042、0.034),단술후6 mo시여비각막접촉경조무명현차이( t=0.131,P=0.986)。<br> 결론：재보류잉여각막기질상후도≥300μm적조건하, SMILE수술교정근시화근시산광대각막내피세포밀도무영향,부대각막내피륙각형세포백분비조성단잠적영향,기영향정도몰유장기배대각막접촉경대각막내피세포적영향대,SMILE수술시일충비상안전적각막굴광수술。
AIM: To observe the changes of corneal endothelial cell density and morphology after femtosecond laser small incision lenticule extraction ( SMILE) . <br> METHODS: In this prospective study, 60 patients ( 120 eyes ) with myopia or myopic astigmatism, who volunteered to receive SMILE from April 2014 to October 2014 in Shengjing Hospital of China Medical University, were divided into two groups: contact lens group ( 60 eyes) and non-contact lens group (60 eyes). The values of corneal endothelial cell density and the percentages of hexagonal cells, detected by NIDEK confoscan4 corneal confocal microscopy before and 1wk, 1, 6mo after surgery, were recorded and analyzed. <br> RESULTS: All patients were with successful surgery and there were no complications intraoperative and postoperative. No differences were noted between two groups in terms of average age, refractive error, stromal ablation depth, residual stromal bed depth, and postoperative uncorrected visual acuity (P>0. 05). Using the analysis of variance of repeated measurement data, there were no statistically significant differences regarding mean endothelial cell density and percentage of hexagonal cells in pre- and 1wk, 1, 6mo post-SMILE within non-contact lens group ( F= 0. 864, 2. 488; P=0.460, 0. 061). In the contact lens group, no differences were found regarding mean endothelial cell density in pre- and 1wk, 1, 6mo post-operation ( F=0. 135, P=0.939 ) , but there were significant differences in the percentage of hexagonal cells (F=4. 913, P=0. 002). The percentage of hexagonal cells decreased significantly at 1wk post-operation ( 30. 70±4. 08 )% compared with preoperative (32. 23±4. 15)% (P=0. 045), returned to the preoperative levels at 1mo after surgery (33. 05±4. 28)%(P=0. 364), and showed no difference (P=0. 091) at 6mo after surgery (34. 06±5. 11)% with preoperative data. The percentages of hexagonal cells in the contact lens group were significantly lower in pre- and 1wk, 1mo post-operation than those in the non-contact lens group ( t=2. 051, 1. 723, 2. 092; P=0. 037, 0. 042, 0. 034), however, there was no statistically significant difference between two groups at 6mo after surgery (t=0. 131, P=0. 986). <br> CONCLUSION: If the required residual stromal thickness limit was≥300μm, SMILE to correct myopia or myopic astigmatism has no effect on the corneal endothelial cell density, only has short effect on the percentage of corneal hexagonal cells, which is slighter than wearing contact lens. SMILE to correct myopia is safe for corneal endothelium.
