中高度近视眼SMILE术后早期角膜上皮重塑特点分析

Analysis of early stage of corneal epithelial remodeling after SMILE for moderate and high myopia

目的利用前节OCT分析中高度近视行SMILE术后早期角膜上皮厚度变化特点。设计回顾性病例系列。研究对象2020年5-8月北京同仁医院SMILE手术的、平均年龄(27.03±5.55)岁的中高度近视患者70例(140眼)。方法回顾患者病历资料,分析其术前屈光度、术前及术后1个月前节OCT所测角膜上皮厚度并进行相关统计分析。主要指标术前屈光度、角膜前表面Ks、Kf及中央角膜厚度,术前及术后角膜中央0~2 mm、2~5 mm、5~6 mm范围内上方、下方、鼻侧、颞侧、鼻上、鼻下、颞上、颞下方向角膜上皮层厚度。结果术后1个月时中度近视组角膜中央0~2 mm(t=3.956,P=0.000),2~5 mm上方(t=5.898,P=0.000)、下方(t=7.333,P=0.000)、颞侧(t=8.011,P=0.000)、鼻下方(t=3.878,P=0.000)、颞上方(t=5.803,P=0.000)、颞下方(t=9.160,P=0.000),5~6 mm下方(t=4.668,P=0.000)、颞侧(t=7.470,P=0.000)、鼻下方(t=2.285,P=0.024)、颞上方(t=5.389,P=0.000)、颞下方(t=6.805,P=0.000)相比于术前角膜上皮均增厚。术后1个月时高度近视组中央0~2 mm、2~5 mm及5~6 mm各区域角膜上皮增厚[0~2 mm(t=6.144);2~5 mm(t_(上)=7.770,t_(下)=7.399,t鼻=5.294,t颞=8.902,t_(鼻上)=5.599,t_(鼻下)=6.413,t颞上=7.628,t_(颞下)=8.055;P均=0.000);5~6 mm(t_(上)=3.373,P=0.002;t_(下)=2.927,P=0.006;t鼻=5.373,P=0.000;t颞=5.847,P=0.000;t_(鼻上)=3.770,P=0.001;t_(鼻下)=4.166,P=0.000;t颞上=4.826,P=0.000;t_(颞下)=4.219,P=0.000]。术后1个月角膜上皮厚度变化量与术前等效球镜度(r=-0.118,P=0.039)及术后Km(r=-0.210,P=0.013)呈负相关,与中央角膜基质层切削变化厚度呈正相关(r=0.272,P=0.000)。结论SMILE术后1个月中高度近视组角膜上皮厚度不均匀增加,以颞侧及下方明显;高度近视组较中度近视组增厚更多;中央角膜上皮厚度增加值与术前等效球镜、术后角膜Km负相关,与术中角膜基质切削深度正相关。(眼科,2021,30:270-274).

Object_(I)ve To analyze the characterist_(I)cs of early corneal epithelial thickness changes after femtosecond laser small incision corneal stromal lens extract_(I)on(SMILE)with anterior segment OCT.Design Retrospect_(I)ve case series.Part_(I)cipants 70 pat_(I)ents(140 eyes)with mean age(27.03±5.55)years old of moderate or high myopia and myopic ast_(I)gmat_(I)sm were underwent SMILE surgery from May to August 2020 by a single surgeon in Beijing Tongren Hospital.Method The pat_(I)ents’medical records were reviewed,including the preoperat_(I)ve refract_(I)ve diopter,preoperat_(I)ve and postoperat_(I)ve corneal epithelial thickness by anterior segment OCT.Main Outcome Measures Preoperat_(I)ve refract_(I)on diopter,Ks,Kf value of the cornea anterior surface and the central corneal thickness(CCT).The corneal epithelial thicknesses of 0-2 mm in the center of the cornea,the superior(S),inferior(I),nasal(N),temporal(T),superior-nasal(SN),superior-temporal(ST),inferior-nasal(IN)and inferior-temporal(IT)posit_(I)ons within the range of 2-5 mm and 5-6 mm before and 1 month after the operat_(I)on.Results At 1 month after SMILE,the corneal epithelial of moderate myopia group had stat_(I)st_(I)cally significant thickening(all P<0.05)at 0-2 mm(t=3.956);2-5 mm S(t=5.898),I(t=7.333),T(t=8.011),IN(t=3.878),ST(t=5.803),IT(t=9.160);and 5-6 mm I(t=4.668),T(t=7.470),IN(t=2.285),ST(t=5.389)and IT(t=6.805)compared with preoperat_(I)on.And the corneal epithelialum of high myopia group had stat_(I)st_(I)cally significant thickening(all P<0.05)at all locat_(I)ons compared with preoperat_(I)on[0-2 mm(t=6.144);2-5 mm(tS=7.770,t_(I)=7.399,t_(N)=5.294,tT=8.902,t_(SN)=5.599,t_(I)N=6.413,tST=7.628,t_(I)T=8.055);5-6 mm(tS=3.373,t_(I)=2.927,t_(N)=5.373,tT=5.847,t_(SN)=3.770,t_(I)N=4.166,tST=4.826,t_(I)T=4.219)].Conclusion At 1 month after SMILE,the corneal epithelium thickness increased unevenly in the high myopia group,especially in the temporal and inferiorside.The corneal epithelium thickened much more in high myopia group than moderate myopia group.The central corneal epithelial thickness increment was negat_(I)vely correlated with preoperat_(I)ve SE and postoperat_(I)ve corneal Km,and posit_(I)vely correlated with intraoperat_(I)ve corneal ablat_(I)on depth.