飞秒激光角膜基质透镜取出术与飞秒激光制瓣LASIK手术对角膜内皮细胞的短期影响

Short-term influence on corneal endothelium cells after femtosecond lenticule exraction and femtosecond laser in situ keratomileusis

目的比较飞秒激光角膜基质透镜取出术(femtosecond lenticule exraction,FLEx)与飞秒激光制瓣LASIK手术对角膜内皮细胞数量以及形态的短期影响。设计前瞻性比较性病例系列。研究对象FLEx和飞秒激光制瓣LASIK手术的近视患者各50例(100眼)。方法分别在手术前、术后1、3天、1周、1个月应用Konan FA-3709P型非接触角膜内皮显微镜检测角膜中心区单位面积内的角膜内皮细胞密度(CD)、角膜内皮细胞面积的变异系数(CV)、六边形角膜内皮细胞比率。主要指标单位面积内的CD、CV和六边形角膜内皮细胞比率。结果与术前相比,在术后1、3天、1周和1个月时,FLEx组和飞秒激光制瓣LASIK组(FS-LASIK组)单位面积内的CD均下降(P均<0.05)。两组间各时间点单位面积内的CD差异均无统计学意义(P均>0.05)。与术前相比,在术后1、3天、1周和1个月时,FLEx组CV均升高(P分别为=0.007、0.014、0.003、0.069);FS-LASIK组CV均升高(P分别为0.039、0.021、0.001、0.002)。两组间各时间点CV差异均无统计学意义(P均>0.05)。与术前相比,在术后1、3天、1周和1个月,FLEx组六边形角膜内皮细胞比率均下降(P分别为0.091、0.254、0.007、0.003);FS-LASIK组六边形角膜内皮细胞比率均下降(P分别为=0.619、0.166、0.040、0.135)。两组间各时间点六边形角膜内皮细胞比率差异均无统计学意义(P均>0.05)。结论 FLEx组及FS-LASIK组在术后早期均会出现单位面积内角膜内皮细胞密度轻度降低、角膜内皮细胞面积变异系数轻度升高,但六边形角膜内皮细胞的比率基本无变化,且这两种手术方式对于角膜内皮细胞数量以及形态的影响并无差异。

Objective To compare the short-term influence on the corneal endothelium cells after femtosecond lenticule exraction （FLEx） and femtosecond laser in situ keratomileusis （FS-LASIK）. Design Prospective comparative case series. Participants Two hundreds eyes of one hundred consecutive patients were enrolled in this prospective study and divided into two groups： FLEx group （100 eyes of 50 patients） and FS-LASIK group （100 eyes of 50 patients）. Methods Preoperatively, and at 1 day, 3 days, 1 week and 1 month after the operation, the mean cell density （CD）, coefficient of variation（CV）, and hexagonality of the corneal endothelial cells were examed and determined by Konan FA-3709P noncontact specular microscope, and the results were statistically compared. Main Outcome Measures The mean CD, CV, and hexagonality of the corneal endothelial cells. Results Compared with at pre-operation, the mean CD at 1 day, 3 day, 1 week, 1 month after surgery in the FLEx group and the FS-LASIK group were significantly decreased （all P〈0.05）. But there was no statistical significant between the two groups in CD at any time point （all P〉0.05）. Compared with at pre-operation, the mean CV at 1 day （P=0.007）, 3 day （P=0.014）, 1 week （P=0.003）, 1 month （P=0.069） after surgery in the FLEx group were increased; the mean CV in the FLEx group were significantly increased at 1 day （P=-0.039）, 3 day （P=0.021）, 1 week （P=0.001）, 1 month （P=0.002） after surgery. There was no statistical significant between the two groups in CV at any time point （all P〉0.05）. Compared with at pre-op- eration, the hexagonalities of the corneal endothelial cells in the FLEx group were not significantly decreased at 1 day （P=0.091）, 3 day （P=0.254） after surgery, were significantly decreased at 1 week （P=0.007） and 1 month （P=-0.003） after surgery; the hexagonalities of the corneal endothelial cells in the FS-LASIK group were no statistical significant change at 1 day （P=0.619）, 3 day （P=0.166）, 1month （P=0.135） after surgery, but were significantly decreased at 1 week after surgery （P=0.040）. There was no statistical significant between the two groups in the hexagonalities of the corneal endothelial at any time point. Conclusion Compared with at pre-operation, the CD decreases slightly, and the CV slightly increases in FLEx group and FS-LASIK group at early postoperation. But the hexagonality of the corneal endothelial cells almost has no change in FLEx group and FS-LASIK group after surgery. There is no statistical significant between the two groups in CD, CV and hexagonality of the corneal endothelial cells.