SMILE近视矫正术后前房结构参数的早期变化

Early morphological changes of the anterior chamber after small incision lenticule extraction for patients with different degree of myopia

目的探讨飞秒激光小切口角膜基质透镜取出术(SMILE)矫正不同程度近视在术后1个月前房结构参数的变化。方法回顾性对照研究。选取我院2019年3~6月接受SMILE手术的近视和近视散光患者,共158例(158只眼),均选取右眼,按照等效球镜度分为低度近视组(≥-3.00 D)、中度近视组(<-3.00 D且≥-6.00 D)和高度近视组(<-6.00 D),分别于SMILE术前和术后1个月应用Pentacam三维眼前节分析系统测量前房形态参数,包括中央前房深度(ACD)、前房容积(ACV)和水平位前房角度(ACA),3组术后ACD、ACV和ACA变化值的比较和两两比较均采用Kruskal-Wallis H检验。结果3组人群术后早期前房深度变化(H=15.380,P<0.001)、术后前房容积变化(H=6.823,P=0.033)具有统计学意义,3组人群术后前房角变化(H=5.243,P=0.073)无统计学差异。事后两两比较结果显示,术后早期前房深度变化在低度近视组和中度近视组(P=0.001)以及低度近视组和高度近视组(P<0.001)的差异具有统计学意义(P=0.017)。术后早期前房容积变化在低度近视组和高度近视组(P=0.012)的差异具有统计学意义(P=0.017)。结论SMILE术后早期低度近视组前房深度变浅值大于中度近视组、高度近视组,低度近视组前房容积变小值大于高度近视组。

Objective To investigate the morphological changes of the anterior chamber after small incision lenticule extraction(SMILE)for patients with different degree of myopia at one month after the surgery.Methods A total of 158 patients(158 right eyes)with myopia and myopic astigmatism who underwent SMILE surgery in our hospital from March to June 2019 were enrolled for this retrospective study.All patients were divided into three groups:low myopia group(≥-3.00 D),moderate myopia group(<-3.00 D and≥-6.00 D)and high myopia group(<-6.00 D),according to their spherical equivalent.The anterior chamber parameters including central anterior chamber depth(ACD),anterior chamber volume(ACV)and anterior chamber angle(ACA),measured using the Pentacam before and at 1 month after the SMILE surgery.The Kruskal-Wallis H test was used to compare the changes in ACD,ACV and ACA among the three groups.Results The changes in ACD(H=15.380,P<0.001)and ACV(H=6.823,P=0.033)after the surgery were statistically different among the three groups,but the changes of ACA(H=5.243,P=0.073)showed no significant difference among the three groups.Pairwise comparisons showed significant differences in early postoperative changes of ACD between the low myopia group and moderate myopia group(adjusted P=0.001),and between the low myopia group and high myopia group(adjusted P=0.003).There was significant difference in early postoperative changes of ACV between the low myopia group and high myopia group(adjusted P=0.035).Conclusions The ACD decrease after SMILE in the low myopia group was larger than that in the moderate myopia group and high myopia group,and the ACV decrease after SMILE in the low myopia group was larger than the high myopia group.