准分子激光角膜原位磨镶术中角膜瓣厚度影响因素的研究

Multi-factoral analysis on the flap thickness influenced by laser operation in situ keratomileusis

目的 探讨研究准分子激光角膜原位磨镶术（LASIK）中角膜瓣厚度的影响因素。方法 对行LASIK的患者192例（369眼；有15位患者为单眼手术），均使用M2微型角膜板层刀（130刀头）制作角膜瓣。按患者年龄、性别、民族、职业、近视时间、家族史以及手术前后全部检查资料分左右两眼组进行单因素x^2检验，以单因素分析结果P〈0．05的影响因素为自变量进行多因素logistic回归分析。结果 多因素logistic回归分析显示右眼组角膜瓣厚度与球镜度数（P=0．017，OR=0．832，95％CI：0．715～0．968）、角膜厚度（P=0．000，OR=1．023，95％CI：1．011～1．036）有关；左眼组角膜瓣厚度与柱镜度数（P=0．044，OR=2．094，95％CI：1．021～4．294）、负压吸引时间（P=0．019，OR=1．418，95％CI：1．059～1．898）、角膜厚度（P=0．000，OR=1．049，95％CI：1．025～1．073）有关。结论 角膜厚度、柱镜度数、负压吸引时间是影响角膜瓣厚度偏厚的因素，球镜度数是影响角膜瓣厚度偏薄的因素；刀片第二次使用所制作的角膜瓣厚度较第一次变薄。

Objective To investigate the various factors that influencing the flap thickness after laser operation in situ keratomileusis （LASIK）. Methods 369 LASIK eyes （192 cases;among them, 15 patients for surgery monocular） with M2 130 microkeratome heads, grouped by left or right eye were analyzed by Chi-square test and logistic regression analysis based on age, sex, occupation, family history of myopia and ophthalmologic examination results before and after LASIK. The result of analysis of one-way variance which P〈 0.05 as the variance to described with logistic regression analysis. Results Results from logistic regression analysis showed that the flap thickness after LASIK of right eye group was related to two factors： the preoperative refractive power （ P = 0. 017, OR = 0. 832,95 % CI ： 0.715-0. 968）, and the corneal thickness （ P = 0. 000, OR = 1. 023,95 % CI ： 1.011-1. 036） while left eye group was related to three factors： the preoperative astigmatism power （P= 0.044, OR = 2.094,95% CI： 1.021-4.294）, negative pressure suction time （ P ： 0.019, OR = 1.418,95 % CI ： 1. 059-1. 898 ） and the corneal thickness （P= 0.000, OR = 1.049, 95% CI： 1.025- 1.073）. Conclusion Corneal thickness, the preoperative astigmatism power and the negative pressure suction time tended to make the flap thicker while the preoperative refractive power tended to make the flap thinner. Results showed that the flap thickness performed at the first time was more obvious than at the second time.