屈光手术后角膜上皮厚度的变化规律及影响因素

Corneal epithelial thickness changes after refractive surgery and related influencing factors

人类角膜上皮具有较强的重塑能力,当角膜表面呈现不规则形态时,角膜上皮会以增厚的形式在一定程度上重塑角膜。角膜屈光手术后角膜形态发生改变,这种变化会刺激角膜上皮细胞重新排列,呈现出角膜上皮厚度的变化。角膜上皮增厚的程度与手术方式、屈光不正的矫正量、切削深度和切削区域相关:经上皮准分子激光屈光性角膜切削术(transepithelial photorefractive keratectomy,Trans-PRK)后1个月表现出明显的角膜上皮增厚且增厚区域主要在周边区;飞秒激光辅助原位角膜磨镶术(femtosecond laser-assisted in situkeratomileusis,FS-LASIK)和飞秒激光小切口微透镜取出术(femtosecond laser small incision lenticule extraction,SMILE)在术后1周就表现出明显的角膜上皮增厚,不同的是FS-LASIK增厚区域主要为旁中央区,而SMILE增厚区域为周边区。角膜上皮厚度的变化对术后视力恢复、术后屈光度的预测以及对角膜屈光稳定性的影响不容忽视。

Human corneal epithelium has strong ability to remodel itself.When the corneal surface is irregular,the corneal epithelium will reshape the cornea in the form of thickening to a certain extent.The corneal surface changes after corneal laser surgery,which will stimulate the rearrangement of corneal epithelial cells,showing the change of corneal epithelial thickness.The epithelial remodeling is related to surgical procedure,refractive error correction,laser ablation depth and area.Transepithelial photorefractive keratectomy(Trans-PRK)showed obvious epithelial thickening one month after operation,and the thickening area was mainly in the peripheral area;femtosecond laser-assisted in situkeratomileusis(FS-LASIK)and femtosecond laser small incision lenticule extraction(SMILE)showed obvious thickening one week after operation.The difference is that FS-LASIK thickening area is mainly the para-central area,while SMILE thickening area is the peripheral area.The influence of corneal epithelial thickness on postoperative visual acuity,postoperative diopter prediction and corneal refractive stability should not be ignored.