角膜基质透镜植入和透镜取出术后角膜上皮重塑的对比研究

Comparison of corneal epithelial remodeling between corneal lenticule implantation and corneal lenticule extraction

目的比较飞秒激光辅助微小切口角膜基质透镜植入治疗中高度远视与微小切口角膜基质透镜取出术(small incision lenticule extraction,SMILE)治疗中高度近视术后的角膜上皮重塑情况。设计回顾性比较性病例系列。研究对象2021年2月~2022年9月济南明水眼科医院行飞秒激光辅助下微小切口角膜基质透镜植入术患者(透镜植入组)15例(20眼),行SMILE患者(SMILE组)61例(115眼)。方法分别于术前和术后3~12个月使用频域眼前节OCT(RTVue)的Pachymetry模式扫描角膜各象限的上皮厚度值。主要指标各象限角膜上皮厚度值。结果末次随访时透镜植入组在角膜直径5 mm内上皮变薄更明显,SMILE组在7 mm内上皮增厚更显著。在直径5mm内,组内角膜上皮的变化较术前均具有统计学差异(P<0.05),两组间上皮厚度改变值无统计学差异。结论透镜植入组的上皮厚度较术前变薄,总体呈凹透镜样改变;SMILE组的上皮厚度较术前增厚,总体呈凸透镜样改变。两组上皮重塑程度相似。

Objective To investigate corneal epithelial remodeling after small incision lenticule extraction(SMILE)for moderate-high myopia and femtosecond laser-assisted microincision lenticule implantation for moderate-high hyperopia.Design retrospective comparative case series.Participants 15 patients(20 eyes)with moderate-high hyperopia who underwent femtosecond laser-assisted micro-incision lenticule implantation(lenticule implantation group),and 61 patients(115 eyes)with moderate-high myopia who underwent femtosecond laser-assisted micro-incision lenticule extraction(lenticule extraction group)were enrolled in Jinan Mingshui Eye Hospital from February 2021 to September 2022.Methods The Pachymetry mode of OCT(RTVue)was used to scan the corneal epithelial thickness values in each quadrant of the cornea before and 3~12 months after the surgery.Main Outcome Measures Corneal epithelial thickness in each quadrant.Results At the last follow-up,the epithelial thinning is more obvious in the lenticule implantation group within 5mm diameter,and the epithelial thickness is more significant in the lenticule extraction group within 7 mm diameter.Within the diameter of 5mm,the changes of corneal epithelial thickness were statistically significant(all P<0.05),and there was no significant difference between the two groups.Conclusions The epithelium of the lenticule implantation group was thinner than that before surgery,and the overall“concave lens”change was observed.The epithelium of the SMILE group was thicker than that before surgery,showing a“convex lens”change.The degree of epithelial remodeling was similar in the two groups.