前弹力层下角膜磨镶术术后角膜知觉和角膜神经修复的研究

Recovery of corneal sensitivity and corneal nerves after sub-Bowman's keratomileusis

目的对比分析微型角膜刀制瓣与飞秒激光制瓣辅助前弹力层下角膜磨镶术(sub-Bowman's keratomileusis,SBK)术后角膜中央知觉及上皮下神经纤维密度的变化。方法接受SBK治疗的近视患者,根据制瓣方式分为FEMTO-LDV飞秒激光制瓣(FEMTO-LDV)组和OneUse-Plus微型角膜刀制瓣(OUP)组,每组各25例(50眼)。观察术后1个月、3个月、6个月的裸眼视力(uncorrected visual acurity,UCVA)、角膜中央知觉和上皮下神经纤维的变化情况等。结果术后6个月两组患者UCVA均≥1.0。术后1个月FEMTO-LDV组的角膜中央知觉较OUP组好(P=0.003),术后3个月、6个月两组比较,差异均无统计学意义(P=0.813、0.409);术后6个月两组的角膜中央知觉与术前相比均降低(均为P=0·000)。术后1个月、3个月、6个月两组角膜中央上皮下神经纤维密度差异均无统计学意义(P=0.238、0.776、0.824)。结论飞秒激光与微型角膜刀制瓣的SBK均获得了良好的UCVA,角膜中央上皮下神经纤维的恢复相同,飞秒激光制瓣的SBK术后1个月角膜知觉恢复优于微型角膜刀。

Objective To compare changes in central corneal sensitivity and subbasal nerve density after sub-Bowman＇s keratomileusis（SBK）with femtosecond laser flap or microkeratome flap.Methods Patients with myopia undergoing SBK were divided into two groups according to the type of flap creation：FEMTO-LDV femtosecond laser group（FEMTO-LDV group）and One Use-Plus microkeratome group（OUP group）,25 cases（50 eyes）in each group.The uncorrected visual acurity,central corneal sensitivity and subbasal nerve fiber bundles were measured at 1 month,3 months,6 months after operation.Results UCVA for both groups was at least equal to 1.0 at 6 months after operation.At postoperative 1 month,central corneal sensation in FEMTO-LDV group was higher than that in OUP group（P=0.003）;At postoperative 3 months and 6 months there was no significant difference between two groups（P=0.813,0.409）;Compared with preoperative values,corneal sensations in two groups both reduced at postoperative 6 months（both P=0.000）.At 1 week,1 month,3 months after operation.There was no significant difference in the subbasal nerve density between two groups（P=0.238,0.776,0.824）.Conclusion The recovery of subbasal nerve fiber bundles is the same in SBK with femtosecond laser or microkeratome,but uncorrected visual acurity in SBK with femtosecond laser is better than that in SBK with microkeratome.