飞秒激光小切口基质透镜取出术和飞秒激光基质透镜取出术后早期角膜知觉变化的对比研究

Early outcomes of corneal sensitivity changes after small incision lenticule extraction and femtosecond lenticule extraction

目的评估和对比飞秒激光小切口基质透镜取出术（SMILE）和飞秒激光基质透镜取出术（FLEx）后早期角膜中央和周边区知觉的恢复情况。方法病例对照研究。收集接受SMILE和FLEx术的屈光不正患者47例（87只眼），其中SMILE组28例（53只眼），FLEx组19例（34只眼）。分别在术前、术后1周、1个月、3个月使用Cohet—Bonnet角膜知觉计检查角膜中央、上方、下方、鼻侧和颞侧5个部位的角膜知觉。不同部位之间和术前、术后不同时间段之间的差异采用Mann·Whitneyu检验，角膜中央区切除厚度、角膜中央厚度、术前等效球镜度、表面曲率等与角膜中央知觉变化之间采用Spearman相关分析。结果在术后1周、1个月和3个月时，SMILE组在中央、下方、鼻侧、颞侧（除上方外）的角膜知觉均较FLEx组高，且差异具有统计学意义（Z=-5．219，-7．120，-6．735，-7．139，-5．945，-6．644，-7．006，-7．121，-5．262，-3．086，-4．140，-3．523；P〈0．01）。而上方角膜知觉仪检查结果除了在术后1周时，SMILE组为（4．794-0．90）cm，FLEx组为（4．314-1．19）cm，两术式相比无统计学意义（Z=-1．807，P=0．071）外，在术后1个月和3个月时，SMILE组的角膜知觉分别为（5．23±0．62）和（5．57±0．57）cm，FLEx组的角膜知觉分别为（4．43±1．20）和（g．85±1．11）cm，两术式相比差异有统计学意义（Z=-2．935，-2．678；P=0．003，0．007），与其他部位相似。在SMILE组中，术后3个月时，中央、上方、下方、鼻侧、颞侧的角膜知觉分别为（5．744-0．51）、（5．57±0．57）、（5．70±0．55）、（5．83±0．37）、（5．84±0．30）em，与术前相比差异均无统计学意义（Z=一1．255，-0．893，-0．570，-0．630，-0．935；P=0．209，0．440，0．569，0．529，0．350）。在FLEx组术后3个月时，上方角膜知觉为（4．854-1．11）em，与术前相比差异无统计学意义（Z=-1．095，P=0．272）。SMILE和FLEx手术后角膜知觉的变化与角膜中央厚度、中央切除厚度、等效球镜度以及术前角膜表面曲率之间均无明显相关性（SMILE组：r=0．159，-0．202，0．106，0．060；P〉0．05。FLEx组：r=-0．156，-0．059，0．058，-0．005；P〉0．05）。结论SMILE和FLEx术后角膜知觉均下降，随着时间的延长角膜知觉逐渐恢复到术前水平，SMILE术后角膜知觉的下降程度较FLEx少且恢复较快。

Objective To evaluate and compare the recovery of central and peripheral corneal sensitivity in the early period after small incision lenticule extraction （SMILE） and femtosecond lenticule extraction （FLEx）. Methods In this study, 47 cases （87 eyes） which underwent SMILE and FLEx were included. Central, superior, inferior, nasal and temporal corneal sensitivity was measured using a Cochet-Bonnet esthesiometer （Luneau Ophthalmologie） before and 1 week, l month, and 3 months after SMILE and FLEx. The results were analyzed with Mann-Whitney test by SPSS13.0 software. Results There were statistical differences between SMILE and FLEx group in the central, inferior, nasal and temporal corneal sensitivity at 1 week, 1 month and 3 months postoperatively （Z = - 5. 219, - 7. 120, - 6. 735, - 7. 139, -5.945, -6.644, -7.006, -7.121, -5.262, -3.086, -4.140, -3.523. P〈0.01）. However, the superior corneal sensitivity in the SMILE group did not show significant difference （ Z = - 1. 807, P = 0. 071 ） as compared to FLEx group （with exception of 1 week postoperatively）. At 1 month and 3 months postoperatively, corneal sensitivity in the superior quadrant were （5.23±0. 62） and （5.57±0. 57） cm in the SMILE group, and were （4.43±1.20） and （4.85±1. 11） cm in the FLEx group. There were statistical differences between these two groups （ Z = - 2. 935, - 2. 678. P = 0. 003, 0. 007 ）. In the SMILE group, corneal sensitivity in the central, superior, inferior, nasal and temporal quadrants at 3 months postoperatively was （5.74 ±0. 51 ）, （5.57 ±0. 57）, （5.70±0. 55）, （5.83±0. 37）, （5.84±0. 30） cm respectively, there were no significant differences as compared with preoperative data （Z = - 1. 255, - 0. 893, - 0. 570, - 0. 630, - 0. 935. P = 0. 209, 0. 440, 0. 569, 0. 529, 0. 350）. In the FLEx group, corneal sensitivity in the superior at 3 months postoperatively was 4. 85 ±1.11, there was not significant difference compared with preoperative data （ Z = - 1. 095, P=0. 272）. There were no correlations between the changes of central corneal sensitivity and central corneal ablation depth, central corneal thickness and preoperative spherical equivalent （ SMILE group： r = 0. 159, - 0. 202, 0. 106, 0. 060. P 〉 0. 05. FLEx group ： r = - 0. 156, - 0. 059, 0. 058, - 0. 005. P 〉 0. 05 ） after SMILE and FLEx surgery. Conclusions Corneal sensitivity decreases after SMILE and FLEx, and then returns to its original state over time. The decrease of corneal sensitivity after the SMILE was fewer and the recovery was faster as compared with FLEx.