飞秒激光与角膜板层刀制作角膜瓣的准分子激光原位角膜磨镶术后玻璃体后脱离的对比研究

Comparison of posterior vitreous detachment lase in situ keratomileusis WANG Ting-ting, Eye Hospital, Tianjin 300384, China after femtosecond laser and microkeratome-assisted

目的比较飞秒激光与角膜板层刀制作角膜瓣的准分子激光原位角膜磨镶术（LASIK）后早期玻璃体后脱离（PVD）的发生及变化情况。方法前瞻性研究。依据患者自愿选择，40例（80只眼）近视患者行飞秒激光（INTRALASEFS60型，美国AMO公司）制瓣的LASIK作为飞秒激光组，另外40例（80只眼）近视患者作为角膜板层刀组行角膜板层刀（AMADEUSII型，瑞士Ziemer公司）制瓣的LASIK。两组患者均行眼部B超及光学相干断层成像技术（OCT）检查，比较两组术前与术后1周、1个月、3个月、6个月时PVD发生及变化情况。分别随机选取患者1只眼统计分析，采用独立样本资料的x。检验比较两组术后PVD发生率，采用logistic多元回归分析PVD变化与年龄、性别、眼别、眼轴长度、屈光度数、眼压、角膜厚度及负压吸引时间之间的相关性。结果飞秒激光组中术前发现PVD者18只眼（45．O％），11只眼（27．5％）术后新发PVD或原有部分PVD扩大。角膜板层刀组中术前发现PVD者21只眼（52．5％），8只眼（20.0％）术后新发PVD或原有部分PVD扩大。两组术后PVD变化差异无统计学意义（X^2=2．257，P=0．133）。logistic回归分析显示负压吸引时间与飞秒激光组术后PVD发生明显相关（OR=1．089，P=0．027），眼轴长是角膜板层刀组术后发生PVD的危险因素（OR=4．712，P=0．007）。未观察到视网膜裂孔、视网膜脱离等严重眼后节并发症。结论与AMADEUSII板层刀制瓣的LASIK相比，INTRALASEFS60飞秒激光制瓣不增加PVD的风险。眼轴长者更易发生PVD。术后6个月随访中未发现严重的眼后节并发症。

Objective To compare the incidence of posterior vitreous detachment （ PVD ） early after femtosecond laser and microkeratome-assisted LASIK and their changes after follow-up observation. Methods It was a prospective study. According to the choices of the patients, 40 cases （80 eyes ） underwent femtosecond laser （INTRALASE FS 60, Abbott Medical Optics, American） LASIK surgery in the femtosecond group and 40 cases （ 80 eyes） underwent microkeratome-assisted （ AMADEUS ]I , Ziemer, Switzerland） LASIK surgery in the microkeratome group. The occurrence of PVD was observed by B ultrasound and OCT examination pre- and 1 week, 1, 3 and 6 months post-operatively. Data from one eye in each patient were randomly selected for statistical analysis. Independent sample X2 test was used to compare postoperative PVD between these two groups. Multiple logistic regression was used to investigate the association of PVD changes with age, gender, eye, axial length, refraction, IOP, corneal thickness and suction time. Results In femtosecond group, 18 eyes （45.0%） had partial PVD before surgery. In 11 eyes （27.5%）, PVD developed in non-PVD eye or PVD increased in eyes already had PVD preoperatively. In microkeratome group, 21 eyes （ 52. 5% ） had partial PVD preoperatively. In 8 eyes （ 20.0% ）, PVD developed in non-PVD eyes or PVD increased in eyes already had PVD preoperatively. There was no statistically significant difference between these 2 groups （ X^22 = 2. 257, P = 0. 133 ）. Logistic regression analysis indicated that the suction time was associated with the postoperative development of PVO in femtosecond group （ OR = 1. 039, P = 0. 027 ） and long axial length was a significant risk factor for the development of PVD in microkeratome group （ OR = 4. 712, P = 0. 007 ）. No serious posterior segment complications such as retinal breaks or retinal detachment were observed postoperatively. Conclusions INTRALASE FS60 femtosecond laser does not increase the incidence of PVD compared to AMADEUS U microkeratome-assisted LASIK. PVD is more likely to occur in eyes with long axial length. No serious posterior segment complications were observed during the 6 month follow-up period.