不同手术参数对飞秒激光LASIK术后角膜知觉恢复的影响

The effect of different surgical parameters on the recovery of corneal sensation following FS-LASIK

目的 探讨飞秒激光LASIK术中制瓣参数及切削参数的不同对术后中央角膜知觉恢复的影响.方法 前瞻性实验研究.选取32例（64眼）行飞秒激光LASIK手术的近视患者,每例患者术前双眼屈光状态相近,飞秒激光制瓣参数选择随机设定一眼边切角90＆#176;,另一眼150＆#176;,角膜瓣厚度100 μm或110 μm,切削参数包括预设的光学治疗区直径和基质切削深度,然后行常规飞秒LASIK手术.采用广义线性模型分析边切角和角膜瓣厚度、光学治疗区直径和基质切削深度对术后中央角膜知觉的影响后,按不同基质切削深度分为3组：Ⅰ组,＜80 μm;Ⅱ组,80～100 μm;Ⅲ组,＞100μm.分别在术前,术后1周、1个月、3个月使用Cochet-Bonnet角膜知觉计检查中央角膜知觉.采用重复测量方差分析比较术前、术后各随访时间点及各组间在同一时间点的中央角膜知觉差异.结果 术后1周、1个月中央角膜知觉与基质切削深度有关（B=-0.231、-0.247,P＜0.05）,术后3个月与基质切削深度无关（B=-0.222,P＞0.05）.术后1周、1个月、3个月中央角膜知觉与边切角度（B=-2.569、-3.993、-0.607,P＞0.05）、角膜瓣厚度（B=-4.422、-11.058、-10.368,P＞0.05）、光学治疗区直径（B=-3.515、-11.510、-9.058,P＞0.05）均无关.术后1周、1个月、3个月中央角膜知觉较术前均明显下降（F=250.322,P＜0.05）,但各组间在术后1周、1个月、3个月差异无统计学意义（F=2.092,P＞0.05）.结论 不同边切角、角膜瓣厚度和光学治疗区直径对术后角膜知觉的恢复无明显影响,切削深度对术后角膜知觉恢复有影响.

Objective To investigate the effect of different surgical parameters including flap creation parameters and ablation parameters on the recovery of postoperative central corneal sensation following FS-LASIK.Methods This was a prospective experimental study.Thirty-two patients （64 eyes） with myopia who underwent femtosecond laser assisted LASIK were enrolled in this study.Each patient had the similar bilateral refractive conditions.During flap creation before ablation,the side-cut angle was randomly set at 90＆#176; in one eye and 150＆#176; in the other eye,and the flap thickness was set at 100 μm or 110 μm,and ablation parameters including optical treatment zone and ablation depth was caculated by the system.Analyze the impact factors using generalized linear model and then eyes were divided into 3 groups according to ablation depth：group Ⅰ,less than 80 μm,group H,from 80 to 100 μm,group Ⅲ,more than 100 pm.Central corneal sensation was measured preoperatively and at 1 week,1 month and 3 months postoperatively using Cochet-Bonnet esthesiometer.Repeated measures ANOVA were used to analyze the data.Results Central corneal sensation at 1 week and 1 month postoperatively was related to ablation depth （B=-0.231,-0.247,P〈0.05）,however,no correlation was found with ablation at 3 months after LASIK （B=-0.222,P〉0.05） or at 1 week,1 month and 3 months operatively with side-cut angles （B=-2.569,-3.993,-0.607,P〉0.05） and flap thickness （B=-4.422,-11.058,-10.368,P〉0.05） and optical treatment zone （B=-3.515,-11.510,-9.058,P〉0.05）.Compared with preoperative data,central corneal sensation was reduced at 1 week,1 month and 3 months postoperatively （F=250.322,P〈0.05）,however,there was no significant differences among the three groups at different time points （F=2.092,P〉0.05）.Conclusion Ablation depth but not different side-cut angles and flap thicknesses or optical treatment zone has effect on the recovery of corneal sensation postoperatively.