本文選題：微小切口角膜基質(zhì)透鏡摘除術(shù)　切入點：準分子激光原位角膜磨鑲術(shù)　出處：《浙江大學》2014年博士論文

【摘要】：[目的]研究飛秒激光微小切口角膜基質(zhì)透鏡摘除術(shù)(SMILE)治療近視及散光的臨床療效。比較SMILE與飛秒激光制瓣準分子激光原位角膜磨鑲術(shù)(FS-LASIK),前彈力層下激光角膜磨鑲術(shù)(SBK)和準分子激光原位角膜磨鑲術(shù)(LASIK)術(shù)后的視覺質(zhì)量、干眼和生物力學穩(wěn)定性。 [方法]前瞻性臨床對照研究。選取于我院行SMILE術(shù)的近視患者43例(81只眼),FS-LASIK術(shù)49例(97只眼),SBK術(shù)44例(82只眼)和LASIK術(shù)40例(78只眼)。比較四組術(shù)前及術(shù)后1月、3月、6月的視力、屈光度、高階像差、對比敏感度、淚液分泌試驗I長度(Schirmer I).淚膜破裂時間(BUT)、McMonnies問卷評分和的變化。分析術(shù)前及術(shù)后1月、6月非接觸式眼壓計(NCT)測眼壓(IOP)變化率與A超測角膜厚度(CCT)變化率的相關性并予以回歸。比較四組對術(shù)眼角膜硬度的改變程度。采用配對樣本t檢驗,單向方差分析,非參數(shù)檢驗,相關分析,直線回歸,一般線性模型的協(xié)方差分析。 [結(jié)果]在6個月的隨訪期內(nèi),SMILE組的87.7%眼屈光度在+0.5D范圍內(nèi),98.8%眼在士1.0D范圍內(nèi)；FS-LASIK, SBK和LASIK組相應的數(shù)據(jù)與SMILE組之間無顯著性差異。四組在手術(shù)前后各個時間點的等效球鏡均無統(tǒng)計學差異。四組術(shù)后UCVA和BCVA達到20/20及以上的或達到20/25及以上在術(shù)后各時間點的分布均無顯著差異。術(shù)后6月時,除每組各2眼丟失了1行BCVA外,其余眼均達到或優(yōu)于術(shù)前的BCVA。SMILE組術(shù)后1月、3月和6月的HO As, SA和CA與術(shù)前相應值相比均有顯著增加(P0.05)；其余三組有相同趨勢。在術(shù)后1月、3月和6月,SMILE組的HOAs和SA值較小,具有顯著差異(P0.05)。而術(shù)后CA的增加各組之間沒有顯著差異。SMILE組術(shù)后的無眩光CS和眩光CS較術(shù)前有降低。與術(shù)前相比,SMILE組術(shù)后1月的無眩光CS在6.3、4.0、2.5視角均較術(shù)前顯著降低(P0.05),術(shù)后1月的眩光CS在1.6視角均較術(shù)前顯著降低(P0.05)；術(shù)后3月及6月逐步恢復術(shù)前水平。各組之間,術(shù)前和術(shù)后的無眩光CS和眩光CS在各空間頻率下均無顯著性差異。SMILE組術(shù)前的Schirmer Ⅰ長度為17.49±7.48mm；在術(shù)后1月時較術(shù)前水平下降,在術(shù)后3月及6月有恢復術(shù)前水平趨勢。LASmK組在術(shù)后3月和6月的Schirmer Ⅰ長度較SMILE、FS-LASIK與SBK組短,且差異有顯著意義(P0.05)。SMILE組術(shù)前BUT為10.35±3.28s,術(shù)后1月和3月的BUT在較術(shù)前顯著下降,至術(shù)后6月有恢復術(shù)前水平趨勢。其余三組術(shù)后BUT的下降趨勢與SMILE組相同。在術(shù)后1月時,SMILE組BUT下降的幅度較LASIK組顯著少(P0.05),而在其他組別以及其他術(shù)后隨訪的時間點都無顯著差異。術(shù)后1月,四組的McMonnies問卷評分均較術(shù)前顯著增高(P0.05)。術(shù)后3月,SMILE組與SBK組恢復術(shù)前水平。至術(shù)后6月,FS-LASIK組McMonnies問卷評分恢復術(shù)前水平,而LASIK組恢復趨勢不明顯。在術(shù)后6月,LASIK組的McMonnies司卷評分較SMILE、FS-LASIK和SBK組明顯高(P0.05)。四組在術(shù)后IOP值和CCT值均降低,相關性分析均顯示密切相關(P0.05),隨著CCT改變率的增加IOP改變率也隨之增加。術(shù)后IOP改變率與CCT改變率做直線回歸,得直線回歸方程：IOP改變率=c+k*CCT改變率。術(shù)后6月時,四條回歸直線之間進行比較,檢驗總體斜率之間沒有顯著性差異(Pk0.05),總體截距之間有顯著性差異(Pc0.05)。SMILE組IOP改變率最小,而LASIK組lOP改變率最大。四組患者在隨訪期內(nèi)均沒有出現(xiàn)術(shù)中及術(shù)后的嚴重并發(fā)癥。 [結(jié)論]SMILE矯正近視和散光與FS-LASIK, SBK, LASIK一樣均安全、有效、穩(wěn)定,可預測佳。SMILE術(shù)后高階像差尤其是球差引入較少,無眩光對比敏感度降低較少,干眼程度較輕,恢復較快,角膜硬度的改變較少,生物力學穩(wěn)定性較好。
[Abstract]:Objective To study the clinical effects of femtosecond laser micro - incision corneal matrix lens extraction ( SMILE ) in the treatment of myopia and astigmatism . The visual quality , dry eye and biomechanical stability were compared between SMILE and femtosecond laser in situ keratometry ( FS - LASIK ) , laser keratectomy ( SBK ) and LASIK after LASIK .

Methods Forty - four patients ( 81 eyes ) , 49 cases ( 97 eyes ) , 44 cases of SBK ( 82 eyes ) and 40 cases of LASIK ( 78 eyes ) were treated with SMILE in our hospital . The visual acuity , refractive index , higher order aberration , contrast sensitivity and tear secretion test I were compared before and after operation in four groups . The relationship between the rate of change of intraocular pressure ( IOP ) and the rate of change of corneal thickness ( CCT ) was measured before and after operation .

Results During the 6 - month follow - up period , 87.7 % of the cases of SMILE were in the range of + 0.5D , and 98 . 8 % were in the range of + 0.5D ;
There was no significant difference between the data of FS - LASIK , SBK and LASIK group and SMILE group . There was no significant difference between the four groups after operation . UCVA and BCVA were 20 / 20 and above , or 20 / 25 and above , respectively . After 6 months of operation , the remaining eyes reached or superior to BCVA before operation . The HO As , SA and CA in the SMILE group were significantly increased in January , March and June after operation ( P0.05 ) .
There was no significant difference between the patients with SMILE group ( P0.05 ) . Compared with preoperative treatment , no glare CS and glare CS were significantly lower in SMILE group than before operation ( P0.05 ) , and the glare CS of SMILE group was significantly lower than that before operation ( P0.05 ) .
There was no significant difference between preoperative and postoperative non - glare CS and glare CS at all spatial frequencies . Schirmer 鈪，

本文編號：1690296