本文選題：軟性角膜接觸鏡 + 準(zhǔn)分子激光　； 參考：《復(fù)旦大學(xué)》2012年碩士論文

【摘要】：第一部分 長期配戴軟性角膜接觸鏡對LASEK手術(shù)上皮瓣制作及術(shù)后恢復(fù)的影響 目的：研究軟性角膜接觸鏡的長期配戴對準(zhǔn)分子激光角膜上皮瓣下磨鑲術(shù)(LASEK)術(shù)中上皮瓣制作的影響及對術(shù)后臨床恢復(fù)和療效的影響。 方法：行LASEK近視矯正的患者共365人(580只眼),按照角膜接觸鏡的配戴情況將患者分成4組。G1組：角膜接觸鏡配戴時間≥1年且3年,共49人(80只眼),平均年齡(24.49±3.15)歲,MRSE(-5.99±1.99)D,平均配戴時間為(1.60±0.52)年；G2組：角膜接觸鏡配戴時間≥3年且6年,共40人(66只眼),平均年齡(26.92±4.40)歲,MRSE(-5.78±1.28)D,平均配戴時間為(4.05±0.80)年；G3組：角膜接觸鏡配戴時間≥6年,共41人(67只眼),平均年齡(32.46±4.28)歲,MRSE (6.28±1.65)D,平均配戴時間為(10.25±2.91)年；G4組(對照組)：無角膜接觸鏡配戴史,共235人(367只眼),平均年齡(25.26±5.93)歲,MRSE(-5.90±2.28)D。所有患者行LASEK手術(shù),由同一醫(yī)生操作,術(shù)中20%乙醇浸泡時間為14秒,術(shù)中激光切削后使用0.2g/L絲裂霉素浸泡30秒,術(shù)后1周取角膜接觸鏡,比較各組術(shù)中角膜上皮瓣制作情況。238人(376只眼)完成一個月的隨訪,各組人數(shù)及MRSE分別為：G1組：35人(57只眼)、(-6.57±2.01)D；G2組：24人(39只眼)、(-5.85±1.74)D；G3組：31人(50只只眼)、(-6.45±1.69)D；G4組：148人(230只眼)(6±2.05)D。107人(157只眼)完成三個月的隨訪,各組人數(shù)及MRSE分別為：G1組：20人(29只眼)、(-6.27±1.84)D；G2組：15人(19只眼)(-6.85±1.82)D；G3組：15人(23只眼)、(-5.89±1.04)D；G4組：57人(86只眼)、(-5.98±2.35)D。比較術(shù)后第1天癥狀、視力、上皮水腫情況；術(shù)后1周上皮水腫情況；術(shù)后1個月時視力、屈光度、Haze程度；術(shù)后3個月時視力、屈光度、Haze程度。 結(jié)果：1、將上皮瓣分為三種類型：Ⅰ型(上皮瓣完整且制作容易)、Ⅱ型(上皮瓣完整且制作困難)和Ⅲ型(上皮瓣不完整且制作很困難),各組制作的上皮瓣Ⅰ型、Ⅱ型和Ⅲ比例分別為：G1組：12.5%、50%、37.5%；G2組：9.09%、60.61%、30.3%；G3組：4.48%、7.76%、47.76%；G4組：22.62%、63.49%、13.89%。G1組、G2組、G3組間比較差異無統(tǒng)計學(xué)意義,而這三組與G4組間比較差異均有統(tǒng)計學(xué)意義。長期配戴軟性角膜接觸鏡各組上皮瓣的制作難度和不完整率均高于未配戴組。 2、將術(shù)后癥狀分為無、輕度、中度和重度,術(shù)后第1天各組癥狀為無、輕度、中度和重度的比例分別為：G1組：33.33%、35.08%、31.59%、0%；G2組：28.21%、46.15%、20.51%、5.13%；G3組：38%、36%、20%、6%；G4組：36.52、47.83%、15.22%、0.43%。G1組、G2組、G3組間比較差異無統(tǒng)計學(xué)意義,而這三組與G4組間比較差異均有統(tǒng)計學(xué)意義,配戴角膜接觸鏡組患者癥狀重于未配戴者。 3、將術(shù)后中央角膜上皮水腫/混濁情況分為無、輕度、中度和重度,各組術(shù)后1d角膜上皮水腫/混濁不同程度比例分別為：G1組：38.6%、49.12%、10.53%、1.75%；G2組：30.77%、51.28%、17.95%、0%；G3組：38%、34%、20%、8%；G4組：56.52%、29.57%、13.04%、0.87%。術(shù)后1w時各組上皮水腫/混濁不同程度比例分別為：G1組：36.84%、45.61%、17.54%、0%；G2組：35.90%%、33.33%、30.77%、0%；G3組：36%、34%、20%、10%；G4組：61.74%、33.04%、4.78%、0.43%。術(shù)后1d、1w時四組分別兩兩比較：G1組、G2組、G3組間比較差異無統(tǒng)計學(xué)意義,而這三組與G4組間比較差異均有統(tǒng)計學(xué)意義,術(shù)后ld和1w時配戴角膜接觸鏡者角膜上皮水腫程度重于未配戴者。 4、術(shù)后裸眼視力情況：術(shù)后1d各組視力為≤0.5、0.6-0.8、≥1者所占比例分別為：G1組：8.77%、66.67%、24.56%；G2組：20.51%、23.08%、51.28%；G3組：18%、64%、18%；G4組：10.87%、46.09%、43.04%。術(shù)后lm各組視力為≤0.5、0.6-0.8、≥1者所占比例分別為：G1組：1.75%、21.05%、77.19%；G2組：0%、28.21%、71.79%；G3組：2%、22%、76%；G4組：6.09%、8.70%、85.22%。術(shù)后3m各組視力為40.5、0.6-0.8、≥1者所占比例分別為：Gl組：0%、17.24%、82.76%；G2組：0%、15.79%、84.21%；G3組：8.70%、4.35%、86.96%；G4組：3.49%、9.30%、87.21%。術(shù)后1d、1m時四組分別兩兩比較：G1組、G2組、G3組間比較差異無統(tǒng)計學(xué)意義,而這三組與G4組間比較差異均有統(tǒng)計學(xué)意義。術(shù)后3m時四組間差異無統(tǒng)計學(xué)意義,長期配戴角膜接觸鏡患者LASEK術(shù)后視力恢復(fù)較未配戴者慢。 5、術(shù)后屈光度：術(shù)后1m各組等效球鏡值在預(yù)期矯正值≤±1D、±1D且≤±2D、±2D者分別為：G1組：80.70%、15.79%、3.51%；G2組：741.36%、25.64%、0%；G3組：80%、18%、2%；G4組：78.70%、16.09%、5.22%。術(shù)后3m各組等效球鏡值分布比例為：G1組：93.10%、6.90%、0%；G2組：73.68%、26.32%、0%；G3：82.61%、17.39%、0%；G4組：88.37%、9.30%、2.33%。術(shù)后1m、3m時四組間屈光度差異均無統(tǒng)計學(xué)意義,長期配戴角膜接觸鏡未對術(shù)后患者屈光度造成影響。 6、所有患者術(shù)后Haze均沒有達(dá)到2級及以上,術(shù)后1m時haze為0級、0.5級和1級者各組比例分別為：G1組：66.67%、31.58%、1.75%；G2組：76.92%、20.51%、2.56%；G3組：70%、22%、8%；G4組：77.83%、19.57%、2.61%。術(shù)后3m時haze為0級、0.5級和1級者各組比例分別為：G1組：68.97%、31.03%、0%；G2組：78.95%、21.05%、0%；G3組:73.91%、21.74%、4.35%；G4組：90.70%、9.30%、0%。術(shù)后1m、3m時四組間Haze分布情況差異均無統(tǒng)計學(xué)意義。 結(jié)論：長期配戴軟性角膜接觸鏡對LASEK角膜上皮瓣的制作造成影響,使剝瓣的難度增加,上皮瓣不完整比率增加。長期配戴軟性角膜接觸鏡影響LASEK患者術(shù)后恢復(fù),術(shù)后刺激癥狀加重,術(shù)后一周內(nèi)上皮水腫加重,術(shù)后視力恢復(fù)更慢,但未影響Haze程度和屈光度情況。 第二部分 探討-長期配戴軟性角膜接觸鏡者LASEK手術(shù)上皮瓣制作最佳乙醇浸泡時間 目的：初步探討長期配戴軟性角膜接觸鏡患者LASEK術(shù)中上皮瓣制作的最佳乙醇浸泡時間。 方法：選擇行LASEK手術(shù)矯正近視的長期配戴角膜接觸鏡患者,滿足戴鏡1年或1年以上、平均日戴時間超過8小時,每周配戴超過4天。分成兩組：A組：隨機一眼20%乙醇浸泡14S、另一眼168,采用自身對照比較研究,共12人24眼,平均配戴軟性角膜接觸鏡時間為(6.50±4.08)年,兩組MRSE分別為6.22±1.77D(14S組)和-6.32±1.70D(16S組),兩組比較無統(tǒng)計學(xué)差異。B組：隨機一眼20%乙醇浸泡16S、另一眼18S,共15人30眼,平均配戴軟性角膜接觸鏡時間為(7.40±4.36)年。兩組MRSE分別為-6.28±1.44D(16S組)和-6.01±1.43D(18S組),兩組比較無統(tǒng)計學(xué)差異。比較不同乙醇浸泡時間時角膜上皮瓣制作情況。 結(jié)果：根據(jù)角膜瓣制作難度和完整性將上皮瓣分為三種類型：Ⅰ型、Ⅱ型和Ⅲ型,各組制作的上皮瓣Ⅰ型、Ⅱ型和Ⅲ型比例分別為：A組：14S：0%、16.67%、83.88%；16S：0%、66.67%、33.33%,兩者比較x2=6.1714,P=0.0130.05,差異有統(tǒng)計學(xué)意義。B組：16S：0%、46.67%、53.33%；18S：13.33%、73.34、13.33%,兩者比較x2=6.4889,P=0.0390.05,差異有統(tǒng)計學(xué)意義。20%乙醇浸泡16S時角膜上皮瓣制作難度低于浸泡14S,上皮瓣完整率高于145。乙醇浸泡18S時角膜上皮瓣制作難度低于浸泡16S,上皮瓣完整率高于16S。 結(jié)論：長期配戴軟性角膜接觸鏡患者LASEK手術(shù)中乙醇浸泡18S時上皮瓣制作完整率明顯優(yōu)于16S和14S。對于長期配戴軟性角膜接觸鏡患者應(yīng)適當(dāng)增加乙醇浸泡時間以提高制瓣成功率。
[Abstract]:Part one
Effect of long term wearing soft contact lens on skin flap preparation and postoperative recovery of LASEK operation
Objective: To study the effect of the long-term wear of soft contact lens on the making of the upper flap of the molecular laser corneal epithelial flap (LASEK) and the effect on the postoperative clinical recovery and curative effect.
Methods: a total of 365 patients (580 eyes) treated with LASEK myopia were divided into 4 groups of.G1 groups according to the contact lens wear. The wear time of the corneal contact lens was more than 1 years and 3 years, and 49 people (80 eyes), the average age (24.49 + 3.15) years, MRSE (-5.99 + 1.99) D, and the average wear time was (1.60 + 0.52) years; group G2: corneal contact mirror matching. A total of 40 people (66 eyes), 40 (26.92 + 4.40) years old (26.92 + 4.40) years, MRSE (-5.78 + 1.28) D, average age of (4.05 + 0.80) years, and group G3: corneal contact lens wear time, 6 years, 41 people (32.46 + 40) years, MRSE (26.92) D, and G4 group (control group): A total of 235 people (367 eyes), the average age (25.26 + 5.93) years, MRSE (-5.90 2.28) D. all patients underwent LASEK surgery, the same doctor operated, the 20% ethanol immersion time was 14 seconds, the intraoperative laser cutting was soaked with 0.2g/L Mitomycin for 30 seconds after the operation, and the corneal contact lens was taken for 1 weeks after the operation to compare the corneal epithelium in each group. .238 people (376 eyes) were followed up for one month, and the number of groups and MRSE were: group G1: 35 (57 eyes), (-6.57 + 2.01) D; G2 group: 24 (39 eyes), (-5.85 + 1.74) D; G3 group: 31 (50 eyes), (-6.45 + 1.69) D; G4 group: 148 people (230 eyes) (6 + 2.05)) completed the follow-up months, each group completed the follow-up months, groups completed each group, each group completed the month follow-up, group complete, each group completed the months follow-up, group completion, groups completed each group, each group completed the months follow-up, group completion, each group completed each group The number and MRSE were: group G1: 20 people (29 eyes), (-6.27 + 1.84) D; G2 group: 15 people (19 eyes) (-6.85 1.82) D; G3 group: 15 people (23 eyes), (-5.89 + 1.04) D; G4 group: 57 people (86 eyes), (-5.98 + 2.35) compared to postoperative first days symptoms, visual stress, epithelial edema, postoperative edema in epithelium; visual acuity, flexion at month after operation. The degree of Haze, the degree of visual acuity, diopter and Haze at 3 months after operation.
Results: 1, the epithelial flap was divided into three types: type I (complete epithelial flap and easy to make), type II (complete epithelial flap and difficulty in making) and type III (incomplete and difficult epithelial flap). The ratio of type I, type II and III of the upper flap of each group were: group G1: 12.5%, 50%, 37.5%; group G2: 9.09%, 60.61%, 30.3%; group G3: 4.48%, 7.76%, 47.76%, group G4: 22.62%, 63.49%, 13.89%.G1, group G2, and group G3, the difference was not statistically significant, but the difference between the three groups and the G4 group was statistically significant. The difficulty and the incomplete rate of the epithelial flap in each group were higher than those in the unmatched group.
2, the postoperative symptoms were divided into no, mild, moderate and severe, and first days after the operation, the symptoms were no, mild, moderate and severe: group G1: 33.33%, 35.08%, 31.59%, 0%; group G2: 28.21%, 46.15%, 20.51%, 5.13%; group G3: 38%, 36%, 20%, 6%; 36.52,47.83%, 0.43%.G1, G2, and G3 groups were not statistically different The differences between the three groups were statistically significant compared with those of the G4 group.
3, the postoperative edema / turbidity of the central corneal epithelium was divided into no, mild, moderate and severe. The proportion of 1D corneal edema / opacities in group G1: 38.6%, 49.12%, 10.53%, 1.75%; group G2: 30.77%, 51.28%, 17.95%, 0%; group G3: 38%, 34%, 20%, 8%; G4 group: 1W in each group after 0.87%. The proportion of different degrees of epithelial edema / turbidity were: group G1: 36.84%, 45.61%, 17.54%, 0%; group G2: 35.90%%, 33.33%, 30.77%, 0%; group G3: 36%, 34%, 20%, 10%; G4 group: 61.74%, 33.04%, 1W, 1W, respectively: G1 group, G2 group, G3 group, and there was no statistical difference, but this group was compared with G4 group. The difference was statistically significant. After LD and 1W, the degree of corneal edema was higher than that of the non wearer.
4, visual acuity after operation: the visual acuity of 1D group after operation was less than 0.5,0.6-0.8, and the proportion of more than 1 were: group G1: 8.77%, 66.67%, 24.56%; group G2: 20.51%, 23.08%, 51.28%; G3 group: 18%, 64%, 18%; group G4, 10.87%, 46.09%, LM, LM, < 0.5,0.6-0.8, > G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1 group: G1: Group: G1: 77.19%; group G2: 0%, 28.21%, 71.79%; group G3: 2%, 22%, 76%; group G4: 6.09%, 8.70%, and 85.22%. after 3M, the visual acuity of each group was 40.5,0.6-0.8, and the proportion of the group of more than 1 was: Gl group: 0%, 17.24%, 82.76%; G3 group: G4 group: 1D Comparison: there was no statistically significant difference between group G1, group G2 and G3 group, but there was significant difference between the three groups and G4 groups. There was no statistical difference between the four groups at 3M after operation, and the visual acuity recovery after LASEK surgery in the patients with long-term wear corneal contact was slower than that of the non wearer.
5, postoperative refractive index: after the operation, the equivalent spherical mirror values of 1m groups were less than 1D, + 1D and < + 2D, and G1 group: G1 group: group G1, 15.79%, 3.51%; G2 group: 741.36%, 25.64%, 0%; G3 group: 80%, 18%, 2%; G4 group: 78.70%, 16.09%, 3M groups, G1 group: 93.10%, 6.90%, etc. .68%, 26.32%, 0%; G3:82.61%, 17.39%, 0%; group G4: 88.37%, 9.30%, and 2.33%. after 1m, 3M, there was no significant difference in diopter between four groups, and the long-term wear of corneal contact lenses did not affect the diopter of postoperative patients.
6, Haze did not reach level 2 and above, and haze was 0, 0.5 and 1 in group G1 after operation: group G1: 66.67%, 31.58%, 1.75%; G2 group: 76.92%, 20.51%, 2.56%; group G3, 70%, 22%, and haze, G4 group: G1 group, respectively: G1 group: G1 group: G1 group: G1 group, respectively: G1 group: G1 group: G1 97%, 31.03%, 0%; group G2: 78.95%, 21.05%, 0%; group G3: 73.91%, 21.74%, 4.35%; group G4: 90.70%, 9.30%, 1m and 3M after 0%., and there was no statistically significant difference in the distribution of Haze between the 0% groups.
Conclusion: the long-term wear of soft corneal contact lens affects the making of the LASEK skin flap, which makes the difficulty of the flaps increase and the ratio of the epithelial flap incomplete. The long-term wear of the soft corneal contact lens affects the recovery of the LASEK patients after the operation, the aggravation of the postoperative stimulation symptoms, the aggravation of the epithelia within one week after the operation, and the slow recovery of the visual acuity after the operation, but the visual acuity is more slowly after the operation, but the visual acuity is more slowly after the operation, but there is no shadow after the operation. The degree of Haze and the diopter.
The second part
To explore the best alcohol immersion time for LASEK skin flap on long term wearing soft contact lens.
Objective: to preliminarily investigate the best time of ethanol soaking in the upper skin flap of LASEK during long-term soft contact lens surgery.
Methods: select a long term corneal contact lens with LASEK surgery to correct myopia for 1 or 1 years. The average daily wear time is more than 8 hours and more than 4 days each week. Group A is divided into two groups: a random one eye 20% ethanol is soaked in 14S, the other is 168, and a total of 12 people and 24 eyes, with an average of soft cornea. The time of contact lens was (6.50 + 4.08) years, the two groups of MRSE were 6.22 + 1.77D (14S group) and -6.32 + 1.70D (16S group). The two groups had no statistical difference.B group: one eye 20% ethanol soaked 16S, another eye was 18S, 15 people, 30 eyes, and the average time of wearing soft contact lens was (7.40 + 4.36) years. MRSE of group two was -6.28 + 1.44D. 1.43D (group 18S), there was no significant difference between the two groups.
Results: according to the difficulty and integrity of the corneal flap, the epithelial flap was divided into three types: type I, type II and type III. The ratio of type I, type II and type III of the upper skin flap in each group were: group A: 14S:0%, 16.67%, 83.88%, 16S:0%, 66.67%, 33.33%, x2= 6.1714, P=0.0130.05, and the difference was statistically significant in group.B: 16S:0%, 4 6.67%, 53.33%, 18S:13.33%, 73.34,13.33%, the difference was x2=6.4889, P=0.0390.05, the difference was statistically significant, the difficulty of making corneal flap was lower than 14S when.20% was soaked in ethanol. The difficulty of making corneal flap was lower than that of 16S while the integrity of epithelial flap was higher than that of 145. ethanol, and the integrity of epithelial flap was higher than 16S..
Conclusion: the complete rate of the upper skin flap in the LASEK operation for the long term soft contact lens with the soft contact lens is superior to that of the 16S and the 14S.. The time of ethanol immersion should be appropriately increased to improve the success rate of the flap for the patients who have long worn the soft contact lens.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R779.63

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 楊麗萍;陳佳佳;黃振平;;近視患者準(zhǔn)分子激光上皮瓣下角膜磨鑲術(shù)后視野的改變[J];國際眼科雜志;2008年05期

2 王景新;張立莉;谷保民;肖平;李潔;劉建茹;;LASEK術(shù)中制作角膜瓣的時間及其影響因子[J];國際眼科雜志;2009年01期

3 黃歡;王立;彭超;吳秀勻;;絲裂霉素C在LASEK術(shù)中應(yīng)用于高度近視患者預(yù)防haze的臨床研究[J];國際眼科雜志;2010年01期

4 劉云川,李鏡海,周芳,李榮;LASIK手術(shù)的并發(fā)癥[J];山東醫(yī)大基礎(chǔ)醫(yī)學(xué)院學(xué)報;2002年02期

5 齊艷華,廉井財,鄧偉,周德佑,王康孫;正常戴角膜接觸鏡患者的角膜地形圖變化[J];眼科;1997年04期

6 智慧敏;李軍;李曉林;李永芳;;準(zhǔn)分子激光上皮下角膜磨鑲術(shù)后角膜上皮活性與haze的關(guān)系[J];眼外傷職業(yè)眼病雜志(附眼科手術(shù));2007年03期

7 喬寶笛;帖彪;陳鵬;;LASEK術(shù)中術(shù)后角膜上皮瓣異常及其預(yù)防方法[J];眼外傷職業(yè)眼病雜志(附眼科手術(shù));2009年01期

8 張爽;劉淑華;戚偉;郭偉娜;王秋艷;;LASIK與LASEK術(shù)后對比敏感度變化的研究[J];中國現(xiàn)代醫(yī)生;2008年22期

9 許平;譚少健;蔣林志;;LASEK和LASIK術(shù)后對比敏感度的臨床研究[J];中國臨床研究;2011年10期

10 曹利群,王傳富,劉援,姜濤;準(zhǔn)分子激光屈光性角膜切削術(shù)后兔角膜的組織病理學(xué)研究[J];中國激光醫(yī)學(xué)雜志;2003年03期

相關(guān)碩士學(xué)位論文 前1條

1 鄭玉勝;長期配戴角膜接觸鏡者角膜上皮的病理改變[D];泰山醫(yī)學(xué)院;2010年

，

本文編號：1945611