小切口角膜基质内微透镜摘除术与飞秒激光制瓣准分子激光原位角膜磨镶术后角膜生物力学比较研究

Comparative study on corneal biomechanics after micro-incision microlens removal and femtosecond laser excimer laser in situ keratomileusis

目的探讨小切口角膜基质内微透镜摘除(SMILE)术与飞秒激光制瓣准分子激光原位角膜磨镶(FS-LASIK)术后角膜生物力学比较。方法选取2017年03月到2018年05月我院收治的近视患者,共70例140眼,采用随机数字表法进行分组,各35例70眼,对照组施以FS-LASIK术治疗,试验组施以SMILE术治疗,对患者术前及术后1个月的角膜滞后因子(CH)、角膜阻力因子(CRF)、泪膜破裂时间(BUT)、角膜前表面最薄点高度、角膜后表面最薄点高度的变化情况进行观察。结果FS-LASIK、SMILE两组患者的角膜滞后因子(CH)、角膜阻力因子(CRF)术后均较术前明显降低(P<0.05);但SMILE组降低的程度略低于FS-LASIK组,但差异无显著性(P>0.05);术前两组的BUT、角膜前、后表面最薄点高度无显著差异(P>0.05);术后1个月,试验组的BUT明显长于对照组,差异显著(P<0.05);但两组患者术后1个月的角膜前、后表面最薄点高度无显著差异(P>0.05)。结论SMILE术后干眼症状明显比FS-LASIK少,且两种手术方式均降低了角膜的生物力学性能,但SMILE的角膜生物力学稳定性可能优于FS-LASIK术。

Objective:To explore the corneal biomechanics comparison between small incision corneal stroma microlens removal(SMILE)and femtosecond laser flap excimer laser in situ keratomileusis(FS-LASIK).Methods:From March 2017 to May 2018,a total of 70 cases of 140 eyes of myopia were selected and grouped by random number table method.Each of 35 cases of 70 eyes.The control group was treated with FS-LASIK.The group was treated with SMILE.The corneal hysteresis factor(CH),corneal resistance factor(CRF),tear film rupture time(BUT),height of the thinnest point on the anterior surface of the cornea and posterior surface of the cornea Observe the change in height at the thinnest point.Results:The corneal hysteresis factor(CH)and corneal resistance factor(CRF)of the FS-LASIK and SMILE groups were significantly lower than those before the operation(P<0.05);however,the reduction in the SMILE group was slightly lower than that of FS-LASIK Group,but the difference was not significant(P>0.05);the BUT,the thickness of the thinnest point on the anterior and posterior corneal surfaces of the two groups before surgery were not significantly different(P>0.05);1 month after surgery,the BUT of the experimental group was significantly longer than In the control group,the difference was significant(P<0.05);however,there was no significant difference in the height of the thinnest points on the anterior and posterior surfaces of the cornea 1 month after the operation between the two groups(P>0.05).Conclusion:The symptoms of dry eyes after SMILE are significantly less than those of FS-LASIK,and both surgical methods reduce the biomechanical properties of the cornea,but the biomechanical stability of SMILE may be better than that of FS-LASIK.