LASIK术后早期角膜上皮厚度变化的相关因素及其相互关系

Related factors of epithelial thickness changes in early stage after LASIK and its relationship

目的评价准分子激光原位角膜磨镶术(laser assisted in-situ keratomileusis,LASIK)后不同时间角膜中央上皮厚度的变化,探讨促使角膜上皮厚度变化的相关因素之间的关系。方法 选择行LASIK的患者48例(48眼),术前平均等效球镜度数为(-5.61±2.75)D。按等效球镜度数不同将所有患者分为低中度近视眼(≤-6.00D)21眼与高度近视眼(>-6.00D)27眼。分别在术前及术后第1天、第3天、第7天、第10天、第30天、第60天、第90天观察角膜上皮厚度的变化,应用活体共聚焦显微镜测量角膜上皮厚度,并对其相关性进行分析。结果 术后第1天、第3天、第7天、第10天、第30天、第60天、第90天所有患者视力分别为1.34±0.66、1.24±0.76、1.27±0.73、1.26±0.76、1.08±0.80、0.96±0.76、0.80±0.72。屈光状态平均偏移(1.07±0.63)D、(0.97±0.63)D、(0.79±0.63)D、(0.74±0.64)D、(0.37±0.34)D、(0.50±0.33)D、(0.47±0.52)D。平均角膜上皮厚度变化与术前等效球镜度数变化呈正相关(r=0.538,P=0.047)。角膜上皮厚度与角膜前表面曲率变化呈正相关(r=0.648,P=0.007)。角膜上皮厚度变化与基质厚度厚度变化无相关性(r=0.238,P=0.647)。角膜上皮厚度变化与角膜瓣厚度、基质激活细胞深度均无相关性(r=0.197,P=0.841;r=0.214,P=0.714)。结论 LASIK术后,角膜上皮发生重塑并参与了LASIK术后早期角膜组织修复。

Objective To discuss the changes of central corneal epithelial thickness after LASIK at different time,and investigate the relationship of some factors leaded to these changes.Methods Forty-eight patients（48 eyes） were performed LASIK,the mean spherical equivalent before surgery was（-5.61±2.75）D.Based on the different spherical equivalent,the cases were divided into low and medium myopia group（21 eyes,≤-6.00 D）,high myopia group（27 eyes,-6.00 D）.The changes of corneal epithelial thickness at pre-operation and postoperative 1 day,3 days,7 days,10 days,30 days,60 days and 90 days by confocal microscopy in vivo,the relationship were analyzed.Results The visual acuity at postoperative 1 day,3 days,7 days,10 days,30 days,60 days and 90 days were 1.34±0.66,1.24±0.76,1.27±0.73,1.26±0.76,1.08±0.80,0.96±0.76,0.80±0.72,the mean deflection of refraction were（1.07±0.63）D,（1.97±0.63）D,（0.79±0.63）D,（0.74±0.64）D,（0.37±0.34）D,（0.50±0.33）D,（0.47±0.52）D,respectively.The changes of mean corneal epithelial thickness showed positive correlation with spherical equivalent（r=0.538,P=0.047）.The corneal epithelial thickness showed positive correlation with the changes of anterior corneal curvature（r=0.648,P=0.007）.The changes of corneal epithelial thickness showed no correlation with the changes of corneal stroma thickness（r=0.238,P=0.6470.05）.The changes of corneal epithelial thickness showed no correlation with the thickness of corneal flap,activated-cells area（r=0.197,P=0.841;r=0.214,P=0.714）.Conclusion After LASIK,the corneal epithelium remodeling occurs,which participates in the early reparation of corneal tissue.