飞秒激光角膜基质透镜取出术对角膜内皮细胞影响的一年观察

One-year influence of smile incision lenticule extraction on corneal endothelium cells

目的探讨飞秒激光小切口角膜基质透镜取出术(SMILE)对角膜内皮的影响。设计前瞻性病例系列。研究对象SMILE手术矫正近视患者46例(92眼)。方法分别在术前、术后1天、1周、1个月、6个月、1年用非接触角膜内皮显微镜检查角膜中央区单位面积内角膜内皮细胞密度(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(6A)。对手术前后各个时间点各指标进行比较观察其变化,并将术后1年的角膜内皮指标与切削深度进行相关性分析。主要指标CD、CV、6A。结果与术前相比,术后1天、1周CD均下降(P=0.000、0.040),术后1个月、6个月、1年无明显变化(P均>0.05);而CV(P均>0.05)、6A(P均>0.05)均无明显变化。术后1年切削深度与角膜内皮细胞三个参数(CD、CV、6A)的改变之间无相关关系(P均>0.05)。结论 SMILE手术后1年内对角膜内皮细胞无影响。

Objective To study the long-term influence on the corneal endothelial cells after small incision lenticule extraction （SMILE）. Design Prospective case series. Participants 92 eyes of 46 patients underwent SMILE in Tongren Eye Center. Methods Preoperatively, and at 1 day, 1 week, 1 month, 6 month, 1 year after the operation, the mean central cell density （CD）, coefficient of variation （CV）, and hexagonality （6A） of the corneal endothelial cells were measured by Konan FA-3709P noncontact specular microscope, and the results （pre and after operation）were statistically compared. At the same time, the correlation between the cutting depth and the corneal endothelial cell indexes at 1 year after the operation was analyzed. Main Outcome Measures CD, CV, 6A. Results Compared with preoperation, the mean CD at 1 day, 1 week after surgery were significantly decreased （P=0.000, 0.040）. At 1 month, 6 month, 1 year postoperation, the mean CD had no significant difference compared with preoperation （all P〉0.05）; the CV （all P〉0.05） and 6A （all P〉0.05） of the corneal endothelial cells had no significantly decreased at all the postoperative timepoint. There is no correlation between the cutting depth and corneal endothelial cells related indexes （CD, CV and 6A of the corneal endothelial cells） （all P〉0.05）. Conclusion There is no significant influence on the corneal endothelial cells one year after SMILE.