高度近视SMILE术后眼压变化与手术参数的相关性

Correlation of intraocular pressure changes and the surgical parameters after SMILE for high myopia

目的:探讨高度近视飞秒激光小切口角膜基质透镜取出术(SMILE)术后非接触眼压(IOP_(NCT))变化与术中相关参数的相关性。方法:回顾性分析2018-01/2019-07在甘肃省人民医院眼视光学中心行SMILE手术的高度近视患者98例196眼的临床资料。观察手术前后IOP_(NCT)变化情况,记录术中手术光区大小、角膜透镜厚度、角膜帽厚度及残余基质床厚度,分析其与手术前后IOP_(NCT)变化值(△IOP_(NCT),△IOP_(NCT)=IOP_(术前)-IOP_(术后6mo))的相关性。结果:术后1d,1wk,1、3、6mo本组患者IOP_(NCT)(10.84±2.14、11.00±2.19、10.65±2.43、10.45±2.04、10.61±1.39mmHg)与术前(16.79±1.65mmHg)比较均有差异(P<0.001)。相关性分析结果显示,本组患者手术光区大小、角膜透镜厚度均与△IOP_(NCT)呈正相关(r=0.1537、0.8161,均P<0.05);角膜帽厚度、残余基质床厚度均与△IOP_(NCT)呈负相关(r=-0.8326、-0.3351,均P<0.0001)。将上述相关因素引入多因素线性回归模型,回归模型决定系数R^(2)=0.901,回归模型有统计学意义(F=195.704,P<0.001),回归方程Y=16.189+0.227 X_(1)+0.032 X_(2)-0.083 X_(3)-0.007 X_(4)(Y表示△IOP_(NCT),X_(1)表示手术光区大小,X_(2)表示角膜透镜厚度,X_(3)表示角膜帽厚度,X_(4)表示残余基质床厚度)。结论:高度近视SMILE术后眼压变化与手术光区大小、角膜透镜厚度、角膜帽厚度及残余基质床厚度均具有相关性,其回归方程可给临床上SMILE术后真实眼压评估提供一定参考。

AIM:To analyze the correlation of changes in non-contact intraocular pressure(IOP_(NCT))and the surgical parameters after femtosecond laser small incision lenticule extraction(SMILE)for high myopia.MOTHODS:A retrospective analysis,the clinical data of 98 patients(196 eyes)with high myopia were operated SMILE in the optometric center of Gansu Provincial Hospital from January 2018 to July 2019 were analyzed.The change of IOP_(NCT) before and after operation was observed,and recorded the optical zone(OZ),lenticule thickness(LT),cap thickness(CT)and residual stromal thickness(RST)and the correlation with the change value of IOP_(NCT)(△IOP_(NCT),△IOP_(NCT)=IOP_(preoperative)-IOP_(postoperative at 6mo)).RESULTS:After operation at 1d,1wk,1,3 and 6mo,the group of patients with IOP_(NCT)(10.84±2.14,11.00±2.19,10.65±2.43,10.45±2.04,10.61±1.39mmHg)and the preoperative(16.79±1.65mmHg)comparison have a difference(P<0.001).The optical zone and lenticule thickness were positively correlated with△IOP_(NCT) respectively(r=0.1537,0.8161,all P<0.05).The cap thickness and residual stromal thickness were negatively correlated with△IOP_(NCT) respectively(r=-0.8362,-0.3351,all P<0.0001).Introduce the above related factors into a multiple linear regression analysis model.The regression coefficients of variables are statistical significane.The regression equation was Y=16.189+0.227 X_(1)+0.032 X_(2)-0.083 X_(3)-0.007 X_(4)(Y=△IOP_(NCT),X_(1)=OZ,X_(2)=LT,X_(3)=CT,X_(4)=RST).The equation was statistically significant(F=195.704,P<0.001),and the regression model coefficient of determination R^(2)=0.901.CONCLUSION:The intraocular pressure changes after SMILE with high myopic were correlated with optical zone,lenticule thickness,cap thickness and residual stromal thickness.The regression equation would provide reference to evaluation the real intraocular pressure after SMILE in clinic.