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ENGLISH ABSTRACT
FS-LASIK与FS-LASIK Xtra矫正近视术后角膜上皮重塑状态及角膜像差变化比较
李辰
周跃华
李福生
陶冶
盖珊珊
于嘉
于黎黎
作者及单位信息
·
DOI： 10.3760/cma.j.cn115989-20220222-00070
Comparison of corneal epithelial remodeling and corneal aberration changes after FS-LASIK and FS-LASIK Xtra
Li Chen
Zhou Yuehua
Li Fusheng
Tao Ye
Ge Shanshan
Yu Jia
Yu Lili
Authors Info & Affiliations
Li Chen
The Academy of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Yinhai Eye Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
Zhou Yuehua
The Academy of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Yinhai Eye Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
Beijing Ming Vision and Ophthalmology, Beijing 100062, China
Li Fusheng
Beijing Ming Vision and Ophthalmology, Beijing 100062, China
Tao Ye
Beijing Ming Vision and Ophthalmology, Beijing 100062, China
Ge Shanshan
The Academy of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Yinhai Eye Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
Yu Jia
The Academy of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Yinhai Eye Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
Yu Lili
Beijing Ming Vision and Ophthalmology, Beijing 100062, China
·
DOI： 10.3760/cma.j.cn115989-20220222-00070
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摘要

目的探讨飞秒激光辅助准分子激光角膜原位磨镶术(FS-LASIK)与FS-LASIK联合角膜胶原交联(FS-LASIK Xtra)术后角膜上皮重塑状态和角膜像差，分析角膜上皮厚度(CET)与角膜像差的关系。

方法采用队列研究方法，纳入2021年6月至2022年2月于成都中医大银海眼科医院接受FS-LASIK的近视患者172例172眼，按手术方式不同分为FS-LASIK组94眼和FS-LASIK Xtra组78眼，共随访6个月。以角膜中央为基点将角膜分为中央2 mm环区和2~5 mm环区，分别于术前及术后1、3和6个月采用眼前节光学相干断层扫描测量角膜中央0~5 mm范围内9个区域的CET，采用iTrace视觉功能分析系统测量角膜高阶像差(HOA)，研究主要结局为术后6个月CET增加量(ΔCET)及角膜HOA，分析角膜中央ΔCET与角膜像差的关系。

结果FS-LASIK Xtra组术眼术后1、3和6个月角膜中央、上方、鼻上、鼻侧、鼻下、下方、颞下、颞侧、颞上ΔCET均明显低于FS-LASIK组，差异均有统计学意义(均P<0.05)。FS-LASIK Xtra组术眼术后6个月角膜中央、上方、鼻上、下方、颞下ΔCET明显高于术后1个月，术后3个月和6个月颞侧ΔCET均明显高于术后1个月，术后6个月颞上ΔCET均明显高于术后1个月和3个月，差异均有统计学意义(均P<0.05)。FS-LASIK组术眼术后3个月和6个月角膜中央、上方、下方、颞下ΔCET均明显高于术后1个月，术后6个月鼻上ΔCET明显高于术后3个月，术后6个月鼻侧、鼻下、颞侧、颞上ΔCET均明显高于术后1个月和3个月，差异均有统计学意义(均P<0.05)。FS-LASIK Xtra组和FS-LASIK组术眼术后不同时间点垂直三叶草、垂直彗差、水平彗差变化量总体比较差异均无统计学意义(垂直三叶草：χ2分组＝4.27，P＝0.118；χ2时间＝0.01，P>0.05.垂直彗差：χ2分组＝5.74，P＝0.057；χ2时间＝0.08，P＝0.957.水平彗差：χ2分组＝3.97，P＝0.137；χ2时间＝0.51，P＝0.773)。FS-LASIK Xtra组术眼术后1、3和6个月倾斜三叶草变化量均明显高于FS-LASIK组，差异均有统计学意义(均P<0.05)。FS-LASIK Xtra组术眼术后6个月球差变化量明显高于术后1个月，FS-LASIK组术眼术后6个月明显高于术后1个月和3个月，差异均有统计学意义(均P<0.05)。FS-LASIK组术眼术后6个月总HOA变化量明显低于术后1个月和3个月，差异均有统计学意义(均P<0.05)。FS-LASIK组术后1个月和6个月，角膜中央ΔCET与球差均呈弱正相关(rs＝0.257，P＝0.008；rs＝0.244，P＝0.012)，与总HOA均呈弱正相关(rs＝0.253，P＝0.009；rs＝0.279，P＝0.004)。

结论与FS-LASIK相比，FS-LASIK Xtra术后ΔCET明显较小，但2个组各区域CET增加的均一性相似。2种手术方法术后角膜HOA变化趋势接近，上皮整体分布与角膜像差有一定联系。

近视;角膜激光手术;角膜波前像差;飞秒激光;角膜胶原交联;光学相干断层扫描;角膜上皮重塑
ABSTRACT

ObjectiveTo investigate the status of corneal epithelial remodeling and changes in corneal aberration after femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) and FS-LASIK combined with corneal collagen cross-linking (FS-LASIK Xtra), and to analyze the relationship between corneal epithelial thickness (CET) and corneal aberration.

MethodsA cohort study was conducted.A total of 172 patients (172 eyes) who underwent FS-LASIK at Yinhai Eye Hospital of Chengdu University of Traditional Chinese Medicine were enrolled from June 2021 to February 2022.The 172 eyes were divided into FS-LASIK group (94 eyes) and FS-LASIK Xtra group (78 eyes) according to the surgical procedure, with a total follow-up of 6 months.The cornea was divided into a central 2-mm ring and a ring of 2-5 mm centered on the central cornea.CET at 9 regions in the central 0-5 mm area was measured by OCT before and at 1, 3 and 6 months after surgery, and the corneal higher-order aberration (HOA) was measured by the iTrace visual function analyzer.The main outcomes were the increase in CET (ΔCET), and corneal HOA at 6 months after surgery.The relationship between central corneal ΔCET and corneal aberration was analyzed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Yinhai Eye Hospital of Chengdu University of Traditional Chinese Medicine (No.2021yh-009). Written informed consent was obtained from each subject.

ResultsAt 1, 3 and 6 months after surgery, the central, superior, superior nasal, nasal, inferior nasal, inferior, inferior temporal, temporal and superior temporal ΔCET were significantly smaller in FS-LASIK Xtra group than in FS-LASIK group (all at P<0.05). In FS-LASIK Xtra group, 6-month postoperative central, superior, superior nasal, inferior and inferior temporal ΔCET were significantly larger than those at 1 month after surgery, and 3- and 6-month postoperative temporal ΔCET were significantly larger than that at 1 month after surgery, and 6-month postoperative superior temporal ΔCET was significantly larger than those at 1 and 3 months after surgery (all at P<0.05). In FS-LASIK group, 3- and 6-month postoperative central, superior, inferior and inferior temporal ΔCET were significantly larger than those at 1 month after surgery, and 6-month postoperative superior nasal ΔCET was significantly larger than that at 3 months after surgery, and 6-month postoperative nasal, inferior nasal, temporal, superior temporal ΔCET were significantly larger than those at 1 and 3 months after surgery (all at P<0.05). There was no significant difference in vertical trefoil, vertical and horizontal coma changes at different time points after surgery between both groups (vertical trefoil: χ2group=4.27, P=0.118; χ2time=0.01, P>0.05.vertical coma: χ2group=5.74, P=0.057; χ2time=0.08, P=0.957.horizontal coma: χ2group=3.97, P=0.137; χ2time=0.51, P=0.773). The tilted trefoil changes at 1, 3 and 6 months after surgery of FS-LASIK Xtra group were significantly larger than those of FS-LASIK group (all at P<0.05). The 6-month spherical aberration change in FS-LASIK Xtra group was significantly higher than that at 1 month after surgery, and the 6-month spherical aberration change in FS-LASIK group was significantly higher than that at 1 and 3 months after surgery (all at P<0.05). The 6-month total HOA change in FS-LASIK group was significantly lower than that at 1 and 3 months after surgery (all at P<0.05). In FS-LASIK group, central corneal ΔCET was weakly positively correlated with spherical aberration at 1 and 6 months after surgery (rs=0.257, P=0.008; rs=0.244, P=0.012), and was weakly positively correlated with total HOA (rs=0.253, P=0.009; rs=0.279, P=0.004).

ConclusionsThe postoperative ΔCET after FS-LASIK Xtra is smaller than that after FS-LASIK, but the homogeneity of ΔCET in each region is similar between the two groups.The changes in corneal HOA after surgery are similar in both groups, and there is a certain association between the overall epithelial distribution and corneal aberration.

Myopia;Corneal surgery, laser;Corneal wavefront aberration;Femtosecond laser;Corneal collagen crosslinking;Optical coherence tomography;Corneal epithelial remodeling
Zhou Yuehua, Email: mocdef.3ab6177663260HY
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引用本文

李辰,周跃华,李福生,等. FS-LASIK与FS-LASIK Xtra矫正近视术后角膜上皮重塑状态及角膜像差变化比较[J]. 中华实验眼科杂志,2023,41(08)：782-794.

DOI:10.3760/cma.j.cn115989-20220222-00070

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飞秒激光辅助准分子激光角膜原位磨镶术(femtosecond laser-assisted laser in situ keratomileusis，FS-LASIK)是目前角膜屈光手术领域常用的手术方式之一，其主要优点为术后视力恢复快，视觉质量好，角膜混浊发生率低且术后不适症状轻。然而，FS-LASIK手术中角膜瓣的制作会改变角膜的正常组织结构，降低角膜生物力学的稳定性，并存在术后屈光状态回退或增加角膜扩张的风险[ 1 ]。角膜胶原交联术(corneal collagen crosslinking，CXL)是通过紫外线A激活作为光敏剂的核黄素，使角膜基质胶原纤维之间形成新的共价键(Ⅱ型光化学反应)，进而降低角膜的胶原酶活性以增加角膜硬度，从而提高角膜生物力学强度和稳定性的一种新型技术。FS-LASIK联合角膜胶原交联(FS-LASIK combined with corneal collagen cross-linking，FS-LASIK Xtra )可增强术眼的角膜生物力学强度，降低术后角膜扩张等并发症的发生率，特别是高度近视且残留基质床厚度较薄的近视患者、术前检查显示角膜地形图不规则或尚未表现出扩张性危险因素的年轻患者[ 2 , 3 ]。研究发现，高度近视眼接受FS-LASIK Xtra后角膜上皮重塑明显弱于FS-LASIK，角膜稳定性增强及角膜上皮重塑过程减弱可能与近视回退发生率低和/或角膜扩张风险增加等有关[ 4 , 5 ]，故开展FS-LASIK Xtra近视矫正手术以改善术后角膜特性的研究受到关注。角膜屈光术后术眼角膜上皮厚度(corneal epithelial thickness，CET)变化反映了角膜的重塑过程，是评估角膜愈合程度的重要指标。了解不同角膜屈光手术术后角膜上皮重塑特点有助于临床医生更好地选择有效安全的手术方式，但FS-LASIK Xtra与FS-LASIK矫正近视术后术眼角膜上皮重塑状态是否不同鲜有报道。此外，目前就我们所知，关于FS-LASIK Xtra术后角膜基质胶原纤维的重建是否会引起角膜像差的改变而影响视觉质量尚无研究报道。本研究拟对FS-LASIK Xtra和FS-LASIK矫正近视术后术眼CET变化过程进行分析和比较，并对术后CET变化与角膜像差变化间的关系进行分析，为临床上角膜屈光手术方法的选择提供参考依据。
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备注信息
A
周跃华，Email：mocdef.3ab6177663260HY
B

李辰：参与选题、设计及实施研究、采集数据、撰写文章；周跃华：文章知识性内容审阅和智力性内容的修改及定稿；李福生、陶冶、盖珊珊：文章知识性内容审阅和智力性内容的修改；于嘉、于黎黎：实施研究、采集数据

C
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