高度近视SMILE术后眼压变化及其相关因素分析

Changes of postoperative intraocular pressure and the relative factors after SMILE for high myopia

目的:分析高度近视眼飞秒激光小切口角膜基质透镜取出术(small incision lenticule extraction,SMILE)术后非接触眼压(IOP_(NCT))的变化趋势及其影响因素。方法:回顾性分析2015-03/2016-10在我院行SMILE手术的高度近视108例216眼患者资料,随访记录术前、术后1d,1wk,1、3mo的IOP_(NCT)、3.0mm半径内角膜平均曲率、角膜中央厚度(CCT)等。对手术前后IOP_(NCT)进行重复测量数据方差分析及LSD-t检验比较组间差异,并采用Pearson相关进行分析,对术后IOP_(NCT)与各影响因素进行多元线性回归分析。结果:(1)对高度近视眼患者SMILE手术前后各时段IOP_(NCT)进行检验,结果显示术前IOP_(NCT)与术后1d,1 wk,1、3mo IOP_(NCT)差异均有统计学意义(t=17.785,P=0.019;t=17.981,P=0.016;t=18.841,P=0.012;t=19.364,P=0.001);术后IOP_(NCT)较术前降低,但术后各时间点IOP_(NCT)差异均无统计学意义(t=1.871,P=0.818;t=3.062,P=0.328;t=1.143,P=0.373)。(2)高度近视眼患者SMILE术后CCT及曲率分别与IOP_(NCT)呈正相关(r=0.4356、0.295,P<0.05)。(3)对高度近视眼SMILE术后的IOP_(NCT)、CCT、曲率进行多元线性回归分析,回归方程为Y=-14.601+0.348X_1+0.03X_2(Y表示IOP_(NCT),X_1表示角膜曲率,X_2表示CCT),回归方程有统计学意义(P<0.001);SMILE手术前后IOP_(NCT)变化值(△IOP_(NCT))与术中切削角膜厚度(△CCT)、曲率变化值进行多元线性回归分析,回归方程为:Y=3.679+0.28X_1+0.012X_2(Y表示△IOP_(NCT),X_1表示平均角膜曲率变化值,X_2表示△CCT),回归方程有统计学意义(P<0.001)。结论:高度近视眼患者SMILE术后IOP_(NCT)较术前降低,短期内使用糖皮质激素滴眼液对眼压无明显影响,术后IOP_(NCT)与CCT及曲率呈正相关。

AIM： To explore the changes of intraocular pressure measured by noncontact tonometer （IOPNcT） with high myopia and analyze the relative fators after small incision lenticule extraction（SMILE）. METHODS： A retrospective study. Totally 108 cases （216 eyes） with high myopia received SMILE during March 2015 to October 2016 were involved. The IOPNcT, corneal central thickness （CCT） and corneal curvature for 3too were recorded and analyzed by ANOVA, LSD t test. The Pearson correlation analysis and multiple linear regression model analysis were used to evaluate the relationship between IOPNcT and its influence factors. RESULTS： （1） There was significant statistical difference in IOPNcT after SMILE at ld, lwk, 1 and 3mo compare with preoperative （t= 17. 785, P=0.019; t= 17.981, P=0.016; t=18.841, P=0.012; t=19.364, P= 0.001）; the IOPNcT after SMILE decreased. The IOPNcT values at every time after SMILE was no statistical difference （t=1.871, P=0.818; t=3.062, P=0.328; t= 1.143, P=0.373）. （2） The IOPNcT in high myopia were positive correlated with CCT and corneal curvature after SMILE （r=0.4356, 0.295; P〈0.05）, respectively. （3） The multiple linear regression model analysis revealed that Y= - 14. 601 ＋ 0. 348X1 ＋ 0. 03Xo （ Y was lOP Xt wascorneal curvature, X2 was CCT, P〈0.001） Y=3.679＋ 0.28X1 ＋ 0. 012X2 （ Y was /klOPNcT, Xl was variation of corneal curvature,X2 was/kCCT, P〈0. 001 ）. CONCLUSION- The IOPNcT decreased after SMILE in high myipia, and it showed that there was no significant influence to use glucocorticoid eye drops in short terms. There was positive correlation among IOPNcT, CCT and corneal curvature after SMILE.