本文選題：飛秒激光小切口基質(zhì)內(nèi)透鏡取出術(shù) + 近視��； 參考：《天津醫(yī)科大學(xué)》2017年博士論文

【摘要】：目的隨著飛秒激光在眼科的應(yīng)用,角膜屈光手術(shù)進(jìn)行了一系列革新。目前常用的手術(shù)方式有飛秒激光輔助的準(zhǔn)分子激光原位角膜磨鑲術(shù)(FS-LASIK)以及飛秒激光小切口基質(zhì)內(nèi)透鏡取出術(shù)(SMILE)。但是對(duì)于這種全新的手術(shù)方式,尤其是SMILE手術(shù),其術(shù)后的視覺效果、生物力學(xué)和視覺質(zhì)量仍有很多未知。本實(shí)驗(yàn)將在探索SMILE術(shù)后一年的屈光效果的基礎(chǔ)上,探討高度近視眼人群與低度近視眼人群的特點(diǎn),了解手術(shù)后視覺質(zhì)量的可能影響因素,將角膜生物力學(xué)納入并加以探討。進(jìn)一步評(píng)估SMILE術(shù)后的角膜像差與生物力學(xué)參數(shù)之間的內(nèi)在關(guān)系,探究二者的相關(guān)性及可能的作用機(jī)制。并探索是否不同能量的飛秒激光參數(shù)設(shè)置可以影響SMILE手術(shù)后的視覺質(zhì)量。方法1.SMILE術(shù)后1年屈光效果的評(píng)價(jià)回顧性的分析在本院屈光手術(shù)中心行SMILE手術(shù)的病人。納入標(biāo)準(zhǔn)除常規(guī)符合SMILE手術(shù)適應(yīng)癥外,病人已完成術(shù)后1天,1周,1個(gè)月,3個(gè)月,6個(gè)月和術(shù)后12個(gè)月的隨訪。共93例病人(156眼)納入研究。按照術(shù)前度數(shù)分為高度近視組(65眼/35人),MRSE≥-6D和中低度近視組(91眼/54人),MRSE6D。比較高度近視組與低中度近視組術(shù)后裸眼視力,最佳矯正視力,以及SMILE手術(shù)的穩(wěn)定性,安全性,預(yù)測(cè)性的差異。2.SMILE、FS-LASIK和FLEx手術(shù)術(shù)后角膜像差的差異性分析回顧性的選取已行SMILE手術(shù),FS-LASIK,或FLEx手術(shù)的病人。納入標(biāo)準(zhǔn)是術(shù)前及術(shù)后3個(gè)月行Pentacam角膜地形圖檢查的手術(shù)病人,其中行SMILE手術(shù)73眼,FS-LASIK手術(shù)52眼,FLEx手術(shù)35眼。然后比較其前后表面及總的角膜像差。3.SMILE手術(shù)及FS-LASIK手術(shù)病人角膜生物力學(xué)與角膜像差相關(guān)性的研究回顧性的選取SMILE手術(shù)與FS-LASIKS手術(shù)病人各75人,納入右眼進(jìn)行研究。使用ORA進(jìn)行角膜生物力學(xué)的測(cè)量,使用Pentacam進(jìn)行角膜像差的測(cè)量。所有患者均進(jìn)行術(shù)前及術(shù)后3月角膜像差和角膜生物力學(xué)的測(cè)量。4不同能量的飛秒激光參數(shù)對(duì)于SMILE術(shù)后屈光效果和視覺質(zhì)量的研究本研究納入行SMILE手術(shù)的55只眼。其中高能量組22眼,33眼在低能量組。兩組病人的術(shù)前年齡和等效球鏡度數(shù),角膜曲率沒有統(tǒng)計(jì)學(xué)差異。使用C-quart進(jìn)行散射的測(cè)量,使用Pentacam角膜地形圖進(jìn)行角膜像差的測(cè)量。病人的隨訪時(shí)間為術(shù)后1周,術(shù)后1月和術(shù)后3月。結(jié)果1.高度近視組和低中度近視組SMILE術(shù)后1年的視力高于術(shù)后1天的視力。SMILE術(shù)后1年高度近視眼出現(xiàn)回退,等效球鏡度較SMILE術(shù)后早期有所增加。為了矯正,手術(shù)時(shí)可以增加一定的度數(shù),增加度數(shù)=0.13*預(yù)矯正的度數(shù)-0.66D。在低中度近視組,術(shù)后一年的屈光度與短期的屈光度無(wú)明顯差異。2.SMILE,FS-LASIK和FLEx手術(shù)后角膜前表面和全角膜像差增加,特別是球差和彗差,然而大部分的后表面像差無(wú)明顯變化。SMILE手術(shù)引入的角膜前表面球差和全角膜球差以及角膜前表面和全角膜第3到第8階像差,要低于FLEx手術(shù),FLEx手術(shù)引入的后表面彗差要高于SMILE手術(shù)和FS-LASIK手術(shù)。3.在SMILE手術(shù)和FS-LASIK手術(shù),術(shù)前CRF與角膜前表面和總的球差和3-6階高階像差有明顯的相關(guān)性。術(shù)前CRF與SMILE手術(shù)引入的彗差有明顯的相關(guān)性。術(shù)前CRF與FS-LASIK手術(shù)引入的后表面水平像差有明顯的相關(guān)性。4.SMILE術(shù)后兩組能量的病人都具有良好的視力和屈光度。術(shù)后3個(gè)月兩組病人的等效球鏡度沒有統(tǒng)計(jì)學(xué)差異。術(shù)后3個(gè)月高能量組病人的散射結(jié)果要低于低能量組,差異有統(tǒng)計(jì)學(xué)意義。結(jié)論1.SMILE手術(shù)高度近視眼仍有一定的回退,或許可以通過(guò)在術(shù)前適當(dāng)增加矯正度數(shù)來(lái)矯正。2.SMILE手術(shù),FS-LASIK手術(shù),以及FLEx手術(shù)主要引入角膜前表面和全角膜彗差和球差。SMILE手術(shù)引入的角膜球差少于FLEx手術(shù),SMILE比FLEx手術(shù)引入的角膜后表面彗差小。FS-LASIK手術(shù)的后表面球差明顯增加。3.角膜生物力學(xué)對(duì)SMILE手術(shù)和FS-LASIK手術(shù)引入的像差有一定影響。手術(shù)前角膜生物力學(xué)越弱,SMILE和FS-LASIK手術(shù)引入的角膜像差越大。角膜阻力因子CRF較CH對(duì)SMILE和FS-LASIK手術(shù)后的生物力學(xué)變化更加敏感。角膜生物力學(xué)是一個(gè)非常重要的參數(shù),很可能影響術(shù)后的視覺質(zhì)量,這對(duì)于手術(shù)病人的篩查以及術(shù)后視覺質(zhì)量的優(yōu)化有一定的意義。4.不同能量的飛秒激光會(huì)影響SMILE術(shù)后的散射,但是對(duì)角膜高階像差沒有明顯的影響。以后的研究可以進(jìn)一步分析不同能量參數(shù)設(shè)置對(duì)于角膜傷口愈合的影響,從而優(yōu)化SMILE的飛秒激光能量參數(shù)設(shè)置。
[Abstract]:Objective with the application of femtosecond laser in the ophthalmology, corneal refractive surgery has been made a series of innovations. The commonly used surgical methods are femtosecond laser assisted excimer laser in situ keratomileusis (FS-LASIK) and femtosecond laser small incision matrix lens removal (SMILE). But it is a new surgical method, especially the SMILE hand. The visual effect, biomechanics and visual quality of the surgery are still unknown. This experiment will explore the characteristics of the high myopia and low myopia people on the basis of the study of the diopter effect of one year after SMILE, to understand the possible influence of the visual quality after the operation and to explore the corneal biomechanics. One step to evaluate the intrinsic relationship between corneal aberration and biomechanical parameters after SMILE, to explore the correlation and possible mechanism of the two, and to explore whether the parameters of the femtosecond laser can affect the visual quality of SMILE after operation. Methods the evaluation of the effect of 1 years after 1.SMILE was reviewed in our hospital. Patients with SMILE surgery in the refractive surgery center were included in the standard, except routine SMILE indications. Patients had completed 1 days, 1 weeks, 1 months, 3 months, 6 months and 12 months after operation. A total of 93 patients (156 eyes) were included in the study. The preoperative degree was divided into high myopia group (65 eyes /35), MRSE > -6D and middle and low myopia group (91 eyes). /54 people), MRSE6D. compared the naked eye vision, best corrected visual acuity, and the stability, safety, predictive difference of SMILE operation in the high myopia group and the low and moderate myopia group,.2.SMILE, the difference analysis of corneal aberration after FS-LASIK and FLEx surgery, a retrospective selection of patients with SMILE surgery, FS-LASIK, or FLEx surgery. Pentacam corneal topography was performed before and 3 months after operation, including 73 eyes of 73, 52 eyes in FS-LASIK operation, 35 eyes in FLEx operation, and then compared the posterior surface and total corneal aberration.3.SMILE operation and the correlation of corneal biomechanics and corneal aberration in the patients with FS-LASIK operation, and a retrospective selection of SMILE hands was made. 75 patients, each with the FS-LASIKS operation, were included in the right eye. ORA was used to measure the biomechanics of the cornea, and the corneal aberration was measured by Pentacam. All patients were measured by the parameters of the femtosecond laser in the corneal aberration and the biomechanics of the cornea before and after the March, and the refractive effects and visual effects of the postoperative SMILE. The study of sense of mass was included in 55 eyes of the SMILE operation. In the high energy group, 22 eyes and 33 eyes were in the low energy group. There was no statistical difference between the preoperative age and the equivalent lens degree of the two groups and the corneal curvature. The measurement of the scattering by using the C-quart was used to measure the corneal aberration using the Pentacam corneal topography. The patients were followed up. Results 1 weeks after operation, January and March after operation. Results the visual acuity of 1. high myopia group and low and moderate myopia group after 1 years of visual acuity was higher than that of 1 year after the 1 days after the operation, 1 year high myopia appeared to regress, the equivalent spherical mirror degree increased early after the SMILE operation. In order to correct, the operation could increase a certain degree and increase the degree of =0.13* preview. There was no significant difference between the diopter of the corrected degree -0.66D. in the low and moderate myopia group and the short-term diopter after one year. The anterior surface and the total corneal aberration of the cornea were increased after FS-LASIK and FLEx operation, especially the spherical aberration and the comet difference. However, most of the posterior surface aberrations did not significantly change the spherical aberration and whole corneal surface introduced by.SMILE operation. The corneal spherical aberration and the third to eighth order aberrations of the anterior corneal surface and all cornea were lower than the FLEx operation. The posterior surface comet difference introduced by the FLEx operation was higher than that of the SMILE operation and FS-LASIK operation.3. in SMILE operation and FS-LASIK operation. The preoperative CRF and the anterior corneal surface and the total spherical aberration and the 3-6 order higher order aberrations were significantly correlated. There is a significant correlation between the comet difference introduced by the operation. There is a significant correlation between the pre operation CRF and the posterior surface level aberration introduced by the FS-LASIK operation. The two groups of energy patients with two groups have good visual acuity and refractive index after the operation. There is no statistical difference between the two groups of patients in the 3 months after the operation. The scattering knot of the high energy group after the operation is 3 months after the operation. Conclusion the difference is statistically significant below the low energy group. Conclusion there is still a certain regression in the high myopia of 1.SMILE operation. It may be possible to correct the.2.SMILE operation, FS-LASIK operation, and FLEx operation mainly by introducing the anterior surface of the cornea and the corneal spherical aberration and the spherical aberration introduced by the spherical aberration.SMILE operation. Less than FLEx operation, SMILE compared with FLEx operation, the posterior surface of the cornea was reduced to small.FS-LASIK surgery, the posterior surface spherical aberration significantly increased.3. corneal biomechanics on SMILE operation and the aberration introduced by FS-LASIK operation. The worse the corneal biomechanics before operation, the greater the corneal aberration introduced by SMILE and FS-LASIK hand operation. The corneal resistance factor C RF is more sensitive than CH to the changes of biomechanics after SMILE and FS-LASIK operation. The corneal biomechanics is a very important parameter, which may affect the visual quality after operation. It has a certain significance for the screening of patients and the optimization of postoperative visual quality. The femtosecond laser with different energy of.4. will affect the scattering after SMILE. There is no obvious effect on the higher order aberration of the cornea. The future study can further analyze the effect of different energy parameters on the healing of corneal wound, thus optimizing the setting of SMILE's femtosecond laser energy parameters.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R779.63

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