本文選題：飛秒激光　切入點(diǎn)：角膜瓣　出處：《鄭州大學(xué)》2010年博士論文

【摘要】：第一部分FEMTO LDV飛秒激光制作LASIK角膜瓣相關(guān)因素分析 目的觀察LASIK術(shù)中應(yīng)用FEMTO LDV飛秒激光制作角膜瓣的特點(diǎn),評(píng)估影響角膜瓣厚度及直徑的相關(guān)因素。 方法對(duì)130人(260只眼)進(jìn)行研究,其中預(yù)設(shè)角膜瓣厚度90μm組26人52只眼,預(yù)設(shè)值為110μm組104人208只眼。預(yù)計(jì)角膜瓣直徑8.5mm到9.5mm。術(shù)中應(yīng)用卡尺測(cè)量角膜瓣直徑,與預(yù)設(shè)角膜瓣直徑進(jìn)行差異性分析,并與術(shù)前角膜中央最大K值、術(shù)前角膜厚度、年齡的相關(guān)性進(jìn)行回歸分析。術(shù)后1周使用傅立葉域光學(xué)相干斷層掃描儀(OCT)測(cè)量角膜瓣的厚度,與預(yù)設(shè)角膜瓣厚度進(jìn)行差異性分析,并與術(shù)前角膜中央最大K值、角膜中央厚度、年齡、眼壓以及角膜瓣直徑進(jìn)行相關(guān)分析。 結(jié)果90μm角膜瓣組平均厚度為95.12士7.65(75.50～109.50)μm, 110μm角膜瓣組平均厚度為104.81±3.09(95.75～112.50)μm。左右眼間角膜瓣厚度差異無(wú)統(tǒng)計(jì)學(xué)意義(t110μm.=-1.223,t90μm=-1.343,P0.05).兩組角膜瓣厚度與術(shù)中制作角膜瓣直徑呈負(fù)相關(guān)(rl10μm=-0.363,r90μm=-0.434,P0.01),與患者術(shù)前年齡,角膜厚度,角膜中央最大K值以及眼內(nèi)壓均無(wú)明顯相關(guān)性(rl10μm=-0.160,0.054,-0.011,-0.363；r90μm=-O.024,0.074,-0.212,-O.434,a11 P0.05).術(shù)中角膜瓣直徑與術(shù)前角膜中央最大K值及角膜厚度呈正相關(guān)(p0.001,p0.05)。最常見并發(fā)癥為角膜瓣緣出血,未影響激光消融。 結(jié)論FEMTO LDV飛秒激光制作角膜瓣預(yù)測(cè)性好、并發(fā)癥少,且角膜瓣厚度不受術(shù)前角膜厚度及角膜中央最大K值影響。 第二部分FEMTO LDV飛秒激光和Hansatome機(jī)械角膜刀制瓣輔助LASIK術(shù)后角膜共焦顯微鏡下改變對(duì)比分析 目的評(píng)估并對(duì)比分析FEMTO LDV飛秒激光及Hansatome機(jī)械角膜刀制瓣輔助LASIK術(shù)后角膜細(xì)胞形態(tài)。 方法行FEMTO LDV飛秒激光制瓣輔助LASIK手術(shù)10人(20只眼),同期行Hansatome機(jī)械角膜刀制瓣LASIK手術(shù)9人(18只眼)。分別于術(shù)前及術(shù)后1周,1月,3月應(yīng)用HRTIII共聚焦顯微鏡檢測(cè)角膜中央及角膜瓣邊緣的形態(tài)學(xué)變化,并對(duì)比兩種制瓣方式術(shù)后角膜細(xì)胞形態(tài)學(xué)的異同。 結(jié)果術(shù)后1周,1月,3月時(shí)裂隙燈檢查所有眼均未見角膜瓣皺褶發(fā)生。兩組術(shù)后淺基質(zhì)細(xì)胞密度較術(shù)前均明顯減少(all P0.001)。Hansatome組術(shù)后角膜上皮厚度早期有增厚表現(xiàn),3月時(shí)接近術(shù)前厚度；FEMTO LDV組上皮厚度手術(shù)前后無(wú)明顯變化。所有眼均可在切削面見到高反光顆粒,其密度FEMTO LDV組術(shù)后明顯少于Hansatome組(FEMTO LDV vs Hansatome,t1w=-13.505, t1m= 11.900, t3m=-14.084, all P0.001)。兩組術(shù)后1周時(shí)均觀察到角膜細(xì)胞形態(tài)改變,在切削界面后見角膜細(xì)胞激活,3月時(shí)基質(zhì)細(xì)胞激活減少。FEMTO LDV組術(shù)后神經(jīng)纖維的再生早于Hansatome組。FEMTO LDV組術(shù)后1周時(shí),角膜瓣的邊緣清晰、整齊。術(shù)后3月時(shí),飛秒激光組周邊角膜基質(zhì)高反光,并有不規(guī)則的纖維化,提示較強(qiáng)的創(chuàng)傷愈合的過(guò)程,而機(jī)械角膜刀組角膜瓣邊緣基質(zhì)反光較弱,呈現(xiàn)較輕的纖維化。 結(jié)論FEMTO LDV飛秒激光制瓣術(shù)后神經(jīng)纖維再生早,角膜瓣邊緣瘢痕化改變明顯于Hansatome機(jī)械角膜刀。 第三部分飛秒激光與機(jī)械角膜刀制瓣輔助LASIK術(shù)后視覺質(zhì)量對(duì)比研究 目的評(píng)價(jià)FEMTO LDV飛秒激光及Hansatome機(jī)械角膜刀制瓣輔助LASIK術(shù)后有效性,預(yù)測(cè)性,安全性；對(duì)比分析對(duì)比敏感度并結(jié)合眩光測(cè)試以及波前像差的變化,評(píng)價(jià)患者的視覺質(zhì)量。 方法應(yīng)用Technolas217z100準(zhǔn)分子激光系統(tǒng)治療近視患者98人(196只眼),接受FEMTO LDV飛秒激光制瓣92只眼(46人,等效球鏡(SE)-6.88±1.65D),同期接受Hansatome微型角膜刀制瓣104只眼(52人,等效球鏡(SE)-6.78±1.05D),制瓣后均行波前像差引導(dǎo)的準(zhǔn)分子激光切削術(shù)。分別于術(shù)前、術(shù)后1周、1月、3月檢測(cè)兩組患者裸眼視力、最佳矯正視力、顯然驗(yàn)光、對(duì)比敏感度、眩光對(duì)比敏感度以及高階像差。 結(jié)果(1)視力：術(shù)后1周,飛秒激光組的裸眼視力(UCVA)達(dá)到或高于最佳矯正視力(BSCVA)的有59/92(64.13%),機(jī)械角膜刀組有76/104(73.08%)；3月時(shí)飛秒激光組UCVABSCVA的有86/92(93.48%),機(jī)械角膜刀組為96/104(92.31%)。(2)屈光度：術(shù)后1周時(shí)屈光度飛秒激光組為+0.49D,角膜刀組為+0.35D；術(shù)后3月飛秒激光組屈光度為+0.16D,角膜刀組為-0.15D。(3)對(duì)比敏感度：飛秒激光組明視下對(duì)比敏感度(CS)手術(shù)前后的差異無(wú)統(tǒng)計(jì)學(xué)意義,暗視下對(duì)比敏感度術(shù)后1周時(shí)最低,1月時(shí)CS值已達(dá)術(shù)前。(4)眩光的影響：FEMTO LDV組明視下眩光未對(duì)CS造成明顯影響。暗視下術(shù)后1周時(shí)CS受眩光影響最明顯,在1.5、3.0、6.0、18.0cpd處引起CS下降(P0.05)。術(shù)后1月及3月時(shí)眩光均未引起CS的下降。術(shù)后明視下眩光對(duì)兩組患者CS的影響沒有顯著差異。暗視下3月時(shí),在中低空間頻率(1.5、3.0、6.0cpd) FEMTO LDV組CS值高于Hansatome組。(5)高階像差：FEMTO LDV組總高階像差(HOA),三階像差及彗差的均方根值(RMS)術(shù)后1周,1月時(shí)較術(shù)前增加(p0.05),至3月時(shí)與術(shù)前的差異無(wú)統(tǒng)計(jì)學(xué)意義。四階像差及球差術(shù)后各期RMS值均高于術(shù)前,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。術(shù)后3月時(shí)FEMTO LDV組HOA及彗差均低于Hansatome組(P=0.045,P=0.047)。球差、三葉草兩組間均差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論飛秒激光輔助LASIK手術(shù)可減少術(shù)后高階像差的增加,獲得較好的視覺質(zhì)量,術(shù)后CS優(yōu)于機(jī)械角膜刀組,與術(shù)后兩組高階像差不同有關(guān)。
[Abstract]:Analysis of the factors related to the production of LASIK corneal flap in the first part of the FEMTO LDV femtosecond laser
Objective To observe the characteristics of the corneal flap made by FEMTO LDV femtosecond laser in LASIK, and to evaluate the factors affecting the thickness and diameter of the corneal flap.
Methods 130 patients (260 eyes) were studied, which presupposes the corneal flap thickness 90 m group and 26 eyes of 52, default group 104 is 110 m. 208 eyes are expected to use caliper to measure the corneal flap diameter of corneal flap diameter of 8.5mm to 9.5mm. in the operation, analyzes the differences with the preset corneal flap diameter, and with the preoperative central corneal maximum K, preoperative corneal thickness, age correlation regression analysis. After 1 weeks, using the Fu Liye domain optical coherence tomography (OCT) measurement of the thickness of the corneal flap, analyzes the differences with the preset corneal flap thickness and preoperative central corneal maximum K, central corneal thickness age, intraocular pressure and corneal flap diameter were analyzed.
Results 90 m corneal flap group with an average thickness of 95.12 + 7.65 (75.50 ~ 109.50) m, 110 m corneal flap group with an average thickness of 104.81 + 3.09 (95.75 ~ 112.50) was not statistically significant M. difference between left and right eyes of corneal flap thickness (T110 m.=-1.223, T90 m=-1.343, P0.05) two groups. The corneal flap thickness and intraoperative corneal flap diameter was negatively correlated (rl10 m=-0.363, r90 m=-0.434, P0.01), and the patients age, corneal thickness, corneal maximum K and intraocular pressure were not significantly correlated (rl10 m=-0.160,0.054, -0.011, -0.363; r90 m= -O.024,0.074, -0.212, -O.434. A11 P0.05). The corneal flap diameter and preoperative central corneal maximum K and corneal thickness were positively correlated (p0.001, P0.05). The most common complication was bleeding, without the effect of laser ablation.
Conclusion the FEMTO LDV femtosecond laser made the corneal flap with good predictability and less complications, and the thickness of the corneal flap is not affected by the thickness of the cornea and the maximum central K of the cornea.
Comparison and analysis of second parts of FEMTO LDV femtosecond laser and Hansatome mechanical corneal knife valve assisted corneal confocal microscope after LASIK
Objective to evaluate and compare the corneal cell morphology of FEMTO LDV femtosecond laser and Hansatome mechanical corneal knife to assist LASIK.
Methods FEMTO LDV femtosecond laser flap assisted LASIK operation of 10 people (20 eyes), underwent Hansatome mechanical microkeratome LASIK surgery LASIK 9 people (18 eyes). Before and after surgery to 1 weeks in January, March, morphological changes using HRTIII confocal microscopy detection of central cornea and corneal flap edge. The similarities and differences of corneal cell morphology and the comparison of two kinds of flap preparation styles.
Results after 1 weeks, January, slit lamp examination in all eyes were no cornea flap folds occurred on March. Two groups of postoperative shallow stromal cell density were significantly reduced compared with the preoperative group (all P0.001).Hansatome early postoperative corneal epithelial thickness thickening performance, March close to the preoperative thickness; significant changes before and after FEMTO LDV group operation without epithelial thickness. All eyes can see the high reflective particles in the cutting surface, the density of FEMTO in group LDV was obviously less than group Hansatome (FEMTO LDV vs Hansatome, t1w=-13.505, t1m= 11.900, t3m=-14.084, all P0.001). The two groups at 1 weeks after operation were observed in corneal cell morphological changes, at the cutting interface corneal stromal cells activate cell activation, regeneration of nerve fibers decreased.FEMTO after operation in LDV group in March earlier than 1 weeks after Hansatome group.FEMTO group LDV, corneal flap edge is clear, neat. After March, the femtosecond laser group around the corner Membrane matrix was highly reflective and irregularly fibrosis, suggesting a strong wound healing process. However, the corneal stroma of the corneal stroma group was lighter than the corneal stroma, showing a slight fibrosis.
Conclusion the nerve fibers regenerate early after the FEMTO LDV femtosecond laser flap, and the scarring changes of the corneal flap edge are obvious in the Hansatome mechanical cornea knife.
Comparative study of visual quality after third partial femtosecond laser and mechanical corneal knife valve assisted LASIK
Objective to evaluate the effectiveness, predictability and safety of FEMTO LDV femtosecond laser and Hansatome mechanical corneal flap assisted LASIK, and compare the contrast sensitivity with the glare test and wavefront aberration, and evaluate the visual quality of patients.
Methods using Technolas217z100 excimer laser system in the treatment of 98 patients with myopia (196 eyes), FEMTO LDV femtosecond laser flap in 92 eyes (46, spherical equivalent (SE) -6.88 + 1.65D), underwent Hansatome microkeratome (104 eyes of 52 people, spherical equivalent (SE) -6.78 + 1.05D) after all, the flap making wavefront guided excimer laser photorefractive keratectomy. Respectively before operation, 1 weeks after the operation, in January March, detection of two groups of patients with uncorrected visual acuity, best corrected visual acuity, manifest refraction, contrast sensitivity, glare contrast sensitivity and high order aberrations.
緇撴灉(1)瑙嗗姏錛氭湳鍚，

本文編號(hào)：1728266