飞秒激光及微型角膜刀制瓣负压吸引对视网膜神经纤维层厚度的影响

The influence of suction on retinal nerve fiber layer thickness between femtosecond laser flaping and microkeratome flaping

目的探讨比较准分子激光原位角膜磨镶术(LASIK)中Femto LDV飞秒激光及微型角膜刀负压吸引对近视眼黄斑区视网膜厚度和视网膜神经纤维层(RNFL)的影响。设计前瞻性比较性病例系列。研究对象行Femto LDV飞秒激光和微型角膜刀LASIK手术的近视患者各51例102眼。方法分别在LASIK术前、术后30分钟、术后1天、3天及1周应用傅立叶域相干光断层扫描术(FD-OCT)检测黄斑区总视网膜厚度、黄斑内层视网膜厚度及视乳头旁视网膜神经纤维层厚度,扫描模式分别为黄斑总厚度MM6、黄斑神经节细胞丛GCC及视盘ONH程序。主要指标黄斑区视网膜平均厚度及象限厚度,黄斑内层视网膜厚度,RNFL平均厚度及象限厚度。结果飞秒激光组术后30分钟黄斑中心凹及黄斑中心凹旁平均视网膜厚度(243.19±25.51μm,316.21±14.77μm)较术前(238.62±26.58μm,311.67±15.23μm)明显增厚(t=3.272,3.052,P=0.0020,.003);微型角膜刀组术后30分钟黄斑中心凹及黄斑中心凹旁平均视网膜厚度(249.85±22.41μm,320.21±15.97μm)较术前(241.96±17.09μm,314.71±15.86μm)明显增厚(t=3.72,2.179,P=0.000,0.032);术后30分钟飞秒激光组黄斑中心凹、黄斑中心凹旁平均厚度及各象限厚度均低于微型角膜刀组(P均<0.05),但黄斑周边部两组间比较差异无统计学意义(P=0.624)。飞秒激光组与微型角膜刀组术后30分钟、术后1天、3天和1周,黄斑内层视网膜厚度与术前比较差异均无统计学意义(P均>0.05),两组间比较差异无统计学意义(P均>0.05)。飞秒激光组和微型角膜刀组术后30分钟视乳头旁3.45 mm直径范围内RNFL平均厚度(104.17±9.31μm,105.07±9.78μm)均明显低于术前(106.06±9.70μm1,07.10±10.68μm)(t=2.936,4.559,P=0.004,0.000);组间比较,术后30分钟飞秒激光组颞侧象限RNFL厚度(88.81±14.04μm)明显高于微型角膜刀组(84.45±13.24μm)(t=2.094,P=0.038),其余象限及全周平均RNFL厚度两组间比较差异均无统计学意义(P均>0.05)。结论飞秒激光及微型角膜刀在LASIK术后早期均会引起黄斑区视网膜局限性水肿和RNFL厚度变薄,但飞秒激光对黄斑区及RNFL的影响均小于微型角膜刀组。

Objective Tocomparetheinfluenceof suction on macular retinal thickness and retinal nerve fiber layer（RNFL） thick-ness after Femto LDV femtosecond laser flaping and Moria M2 microkeratome flaping in laser in situ keratomileusis（LASIK）.Design A prospective comparative case series.Participants Two hundreds and four eyes of one hundred and two consecutive patients were en-rolled in this prospective study and divided into two groups： the Femto LDV Femtosecond Laser group（102 eyes of 51 patients） and Moria M2 microkeratome group（102 eyes of 51 patients）.Methods Preoperatively,30 minutes,1 day,3 days and 1 week after LASIK,myopia patients were examined by Fourier Domain Optical Coherence Tomography（FD-OCT） in full macular retinal thickness,macular inner retinal thickness and RNFL thickness.The scan modes were the MM6,GCC and optic ONH scans.Main Outcome Measures The average and quadrant of macular retinal thicknesses and RNFL,and macular inner retinal thickness.Results The average retinal thicknesses of fovea and parafovea 30 minutes after LASIK in the Femto LDV group（243.19±25.51 μm,316.21±14.77 μm） were signif-icantly thicker than preoperatively（238.62±26.58 μm,311.67±15.23 μm）（t=3.272,3.052,P=0.002,0.003）.The average retinal thick-nesses of fovea and parafovea 30 minutes after LASIK in the mechanical microkeratome group（249.85±22.41 μm,320.21±15.97 μm） were also significantly thicker than preoperatively（241.96±17.09 μm,314.71±15.86 μm）（t=3.72,2.179,P=0.000,0.032）.The average retinal thicknesses of fovea and parafovea in the Femto LDV group were thinner than the mechanical microkeratome group 30 minutes after LASIK（all P0.05）.The inner macular retinal thicknesses both in the Femto LDV group and mechanical microkeratome group didn’t significantly change 30 minutes,1 day,3 days and 1 week after LASIK.The average RNFL thicknesses 30 minutes after LASIK in the Femto LDV group and mechanical microkeratome group（104.17±9.31 μm,105.07±9.78 μm） were significantly thinner than preoperatively（106.06±9.70 μm,107.10±10.68 μm）（t=2.936,4.559,P=0.004,0.000）.And RNFL thickness of the temporal quadrant in the Femto LDV group（88.81±14.04 μm） was significantly thicker than the mechanical microkeratome group（84.45±13.24 μm） 30 minutes after LASIK（t=2.094,P=0.038）.Conclusion Femto LDV femtosecond laser and mechanical microkeratome will lead to the increase in macular central fovea thickness and the decrease in RNFL thickness values at the early stage after LASIK.But the effect on macular and the RNFL in Femto LDV group is smaller than mechanical microkeratome group.