飞秒激光小切口角膜基质透镜取出术联合角膜胶原交联术矫正近视的角膜生物力学

Corneal biomechanics of small incision lenticule extraction combined with corneal collagen cross-linking in the treatment of myopia

目的研究飞秒激光小切口角膜基质透镜取出术(SMILE)联合角膜胶原交联术(CXL)矫正近视的角膜生物力学参数的变化。方法前瞻性研究,选取SMILE手术的患者32例(64眼),按照眼科检查结果,将患者分为SMILE组和SMILE+CXL组,其中SMILE组18例(36眼),SMILE+CXL组14例(28眼)。SMILE组行常规SMILE手术。SMILE+CXL组先行SMILE手术,分离并取出角膜基质透镜后,再用Vibex Xtra核黄素溶液均匀反复注入角膜基质囊袋内,持续45 s,应用Avedro交联系统行跨上皮快速交联,选择波长365 nm,采用连续照射模式,照度30 mW/cm2的紫外线照射45 s,照射总能量为1.35 J/cm2。术后随访1、3个月,比较两组患者术前基本资料及术后眼科检查参数,手术前后角膜生物力学参数,角膜内皮细胞计数。结果所有手术均顺利完成,术后均达到或超过术前最佳矫正视力,SMILE+CXL组患者术后早期有畏光,流泪等症状。SMILE组与SMILE+CXL组术后1天、术后1月和术后3月术前最佳矫正视力(LogMAR)比较,差异有统计学意义,P<0.05;SMILE组与SMILE+CXL组术后1天、术后1月和术后3月等效球镜(SE)比较,差异有统计学意义,P<0.05;SMILE组与SMILE+CXL组术后1月和术后3月眼压(IOP)比较,差异有统计学意义,P<0.05。和术后1天相比,两组术后1月和术后3月LogMAR差异有统计学意义,P<0.05;和术后1天相比,两组术后1月和术后3月SE差异有统计学意义,P<0.05。和术后1月相比,SMILE+CXL组术后3月LogMAR差异有统计学意义,P<0.05;和术后1月相比,两组术后3月IOP增加,P<0.05。所有患者手术前后AT1、AT2、AL1、AL2、V1、V2、HCR、DA比较差异有统计学意义,P<0.05。SMILE组与SMILE+CXL组两组比较,术后3个月AT1、HCT、AL1、AL2、V1、V2、PD比较差异有统计学意义,P<0.05。结论SMILE术后角膜生物力学降低,SMILE联合CXL矫正近视早期安全、有效。CXL术后角膜硬度增加,形变速度减慢,长期效果仍需进一步观察。

Objective To study the changes of corneal biomechanical parameters of small incision lenticule extraction(SMILE)combined with corneal collagen cross-lingking(CXL)to correct myopia.Methods Prospective studies were carried out on thirty-two patients(64 eyes)who underwent SMILE surgery.They were divided into two groups according to eye exam results,including 18 petients(36 eyes)in the SMILE group and 14 patients(28 eyes)in the SMILE combined with corneal collagen crossing-linking group(SMILE+CXL).The SMILE group received routine SMILE surgery.The SMILE+CXL group first received SMILE surgery,after the separation and removal of the corneal stroma lens,they were given Vibex Xtra riboflavin solution uniformly repeated drops in the corneal capsular bag,with 45 s,Avedro accelerate cross-linking system was used for line across epithelial rapid cross-linking,the wavelength of 365 nm was chosen,with 30 mW/cm2 ultraviolet irradiation illumination for 45 s of the cornea with the continuous illumination model,and the total energy was 1.35 J/cm2.The patients were followed up for 1 month and 3 months after the operation,and the basic preoperative data and postoperative ophthalmic examination parameters,corneal biomechanical parameters before and after operation,and corneal endothelial cell count were compared between the two groups.Results All the operations were completed successfully.All patients achieved or exceeded the best corrected visual acuity after the operation.The patients in SMILE+CXL group had more obvious irritation symptoms such as eye pain and tears than SMILE group.LogMAR 1 day,1 month and 3 months after the operation were compared between the SMILE group and the SMILE+CXL group,and the difference was statistically significant(P<0.05).Comparison of spherical equivalent(SE)between the SMILE group and the SMILE+CXL group 1 day,1 month and 3 months after surgery showed statistically significant differences(P<0.05).Intraocular pressure(IOP)was compared between the SMILE group and the SMILE+CXL group 1 month and 3 months after surgery,and the difference was statistically significant(P<0.05).Compared with 1 day after surgery,LogMAR of 1 month and 3 months after surgery was statistically significant between the two groups(P<0.05).Compared with 1 day after surgery,there was a statistically significant difference in SE between the two groups at 1 month and 3 months after surgery(P<0.05).Compared with 1 month after surgery,LogMAR difference was statistically significant in SMILE+CXL group 3 months after surgery,P<0.05.Compared with 1 month after surgery,IOP increased 3 months after surgery in both groups(P<0.05).All patients had statistically significant differences in AT1,AT2,AL1,AL2,V1,V2,HCR and DA before and after the surgery(P<0.05).Compared with the SMILE+CXL group,AT1,HCT,AL1,AL2,V1,V2 and PD showed statistically significant differences 3 months after surgery,P<0.05.Conclusion The corneal biomechanics decreased after SMILE.SMILE combined with corneal collagen cross-linking was safe and effective in early myopia correction.The corneal hardness increased and the corneal deformation rate decreased after corneal collagen cross-linking.