飞秒激光小切口角膜基质透镜取出术后加强手术的原因及临床效果

Cause and Clinical Effect of Strengthen Surgery After Femtosecond Laser Small Incision Lenticule Extraction

目的 分析飞秒激光小切口角膜基质透镜取出术(SMILE)后行经上皮准分子激光屈光性角膜切削术(T-PRK)加强手术的原因,观察其手术效果。方法 回顾性研究。选取2016年6月至2022年12月在郑州华厦视光眼科医院SMILE术后接受加强手术的19例(29眼)患者,从屈光度、眼轴、曲率、调节张力、术后干眼、出现时间及用药等方面分析其原因,观察加强手术的效果。结果 加强手术发生时间为SMILE术后7~48(26.59±16.02)个月。等效球镜度为-0.75~-3.65(-1.43±0.54)D,均为屈光回退。加强手术大多在SMILE手术开展早期。其中中度近视7眼,高度近视22眼。2眼角膜曲率>45 D,其他均<42 D。调节张力的变化,散瞳后球镜度低于常瞳下球镜度(P=0.005)。18岁患者接受加强手术前眼轴长度均高于SMILE术前,其他均低于SMILE术前。所有患者术后均有不同程度的干眼,以人工泪液滴眼及OPT强脉冲光治疗,治疗后泪河高度大于治疗前,泪膜破裂时间长于治疗前(P<0.05)。视力提高2行者5眼,3行者15眼,4行者9眼。马来酸噻吗洛尔眼液治疗后裸眼视力高于治疗前(P=0.023),可以延缓视力下降。加强手术后3个月患者裸眼视力均高于术前最佳矫正视力。结论 SMILE手术安全、稳定,但中高度近视、角膜扁平、眼轴进行性增长、调节张力大者以及术后有干眼者易进行加强手术。加强手术率低,T-PRK安全有效。

Objective To analyze the causes of transepithelial photo refractive keratectomy(T-PRK)strengthen surgery after femtosecond laser small incision lenticule extraction(SMILE),and observe its surgery efficacy.Methods A retrospective study was conducted.A total of 19 patients(29 eyes)who underwent corneal strengthen surgery after SMILE in Zhengzhou Huaxia Vision Eye Hospital were selected from June 2016 to December 2022.The causes were analyzed in terms of diopter,axial,curvature,adjustment amplitude,postoperative dry eye,occurrence time,and medication,and the clinical effect of corneal strengthen surgery was observed.Results The occurrence time of enhanced surgery was 7-48(26.59±16.02)months after SMILE surgery.Spherical equivalent was-0.75--3.65(-1.43±0.54)D,all patients were refractive regression.Strengthening surgery mostly occured in the early stages of SMILE surgery.Among them,7 eyes were moderate myopia and 22 eyes were high myopia.Two eyes had corneal curvature>45 D,and the rest of the patients had corneal curvature<42 D.The diopter after mydriasis pupil was lower than the diopter under the normal pupil about the changes of adjusting tension(P=0.005).The axial length of 18 year old patients before undergoing enhanced surgery was higher than that before SMILE surgery,while others were lower than before SMILE surgery.All patients had different degrees of dry eye after SMILE,and they were treated with tear drops and OPT intense pulsed light treatment.The height of the lacrimal canal after treatment was larger than before treatment,the tear film rupture time was longer than before treatment(P<0.05).Visual acuity improved by 5 eyes in 2 rows,15 eyes in 3 rows,and 9 eyes in 4 rows.After treatment of timolol eye dropst,the naked eye vision was higher than before treatment(P=0.023),which can delay visual impairment.After 3 months of enhanced surgery,the naked eye visual acuity of patients was higher than the best corrected visual acuity before surgery.Conclusion SMILE surgery is safe and stable,however,patients with moderate to high myopia,corneal flattening,progressive axial growth,high adjusting tension and postoperative dry eyes are more likely to undergo strengthen surgery.The incidence of strengthen surgery is low,and T-PRK is safe and effective.