不同准分子激光角膜屈光手术对近视眼角膜滞后量和角膜阻力因子的影响

吴东芳; 邓应平; 王顺清; 邱乐梅

doi:10.3760/cma.j.issn.2095-0160.2015.06.013

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中华实验眼科杂志

• 临床研究 •

ENGLISH ABSTRACT

不同准分子激光角膜屈光手术对近视眼角膜滞后量和角膜阻力因子的影响

作者及单位信息

出版日期： 2015 -06 -10 ·

DOI： 10.3760/cma.j.issn.2095-0160.2015.06.013

Influence of different types of corneal laser refractive surgeries on corneal hysteresis and corneal resistance factor in myopic eyes

Authors Info & Affiliations

Wu Dongfang

Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, China

Deng Yingping

Wang Shunqing

Qiu Lemei

Published： 2015 -06 -10 ·

DOI： 10.3760/cma.j.issn.2095-0160.2015.06.013

APP内阅读

摘要

背景准分子激光角膜屈光手术因术后痛苦小、视力恢复快、有效性佳和预测性好，成为目前治疗屈光不正的主流方法，但术后角膜生物力学性能降低可导致继发圆锥角膜、角膜扩张等并发症，因此准分子激光角膜屈光术后角膜生物力学的研究是临床上受到关注的问题之一。

目的研究不同准分子激光角膜屈光手术对角膜生物力学的影响。

方法采用前瞻性非随机对照的研究方法，纳入拟行角膜屈光手术的中度近视患者82例164眼，按手术方式的不同将患者分为前弹力层下激光角膜磨镶术（SBK）组（30例60眼）、准分子激光角膜原位磨镶术（LASIK）组（27例54眼）和准分子激光上皮下角膜磨镶术（LASEK）组（25例50眼），3个组受检者基线特征均相匹配。利用眼反应分析仪（ORA）分别测定和比较不同手术方式组术眼术前及术后1周和5个月的角膜滞后量（CH）值和角膜阻力因子（CRF）值，并分析角膜切削厚度与CH、CRF手术前后差值的关系。

结果不同时间点SBK、LASIK、LASEK组间CH和CRF的总体比较差异均无统计学意义（ F _分组＝2.17， P＝0.08； F _分组＝2.67， P＝0.07），各组不同时间点间CH值和CRF值的总体比较差异均有统计学意义（ F _时间＝41.90， P＝0.00； F _时间＝49.65， P＝0.00），3个组术后1周、5个月，CH、CRF值均较术前明显下降，差异均有统计学意义（均 P＝0.00）。对角膜切削厚度与CH、CRF的差值分析发现，术后1周至术后5个月，角膜切削厚度与CH差值均不相关（均 R ²＝0.000），但与CRF差值呈弱相关（1周： Y＝3.253+0.010 X， R ²＝0.007；5个月： Y＝1.073+0.021 X， R ²＝0.004）。

结论SBK、LASIK、LASEK术后术眼的角膜CH和CRF值均下降，导致角膜的生物力学变化，3种手术方式对角膜生物力学的影响相似，CRF在评价角膜屈光手术后角膜生物力学变化方面比CH更有价值。

关键词：角膜/生理;近视/手术;弹性组织;生物力学;激光角膜原位磨镶术;激光上皮下角膜磨镶术;前弹力层下激光角膜磨镶术

ABSTRACT

BackgroundRefractive surgery has propelled itself forward to become widely performed surgical procedure nowadays.After the surgery, corneal biomechanics decreases lead to keratoconus and corneal ectasia.Doctors pay more attention to biomechanics changes after refractive surgeries.

ObjectiveThis clinical study was to investigate the influence of different laser refractive surgeries on corneal biomechanics.

MethodsA prospective nonrandomized and controlled clinical study was designed.One hundred and sixty-four eyes of 82 patients with moderate myopia were enrolled.The patients were divided into sub-Bowman keratomileusis（SBK) group (60 eyes of 30 patients), laser in situ keratomileusis（LASIK) group (54 eyes of 27 patients) and laser subepithelial keratomileusis (LASEK) group（50 eyes of 25 patients), with the matched demography among the three groups.Corneal hysteresis (CH) and corneal resistance factor (CRF) were detected by ocular response analyzer (ORA) before and 1 week, 5 months after refractive surgery.The correlations between stromal ablation depth and postoperative changing values of CH or CRF were analyzed.

ResultsSignificant differences were found in CH and CRF at different time points in the three groups ( F _time=41.90, P=0.00; F _time=49.65, P=0.00), and the CH and CRF values were significantly lower 1 week and 5 months after surgery than those before surgery (all at P=0.00). However, no significant difference of CH or CRF was seen at all time points among the three groups ( F _group=2.17, P=0.08; F _group=2.67, P=0.07). No correlation was found between corneal ablation depth and CH in 1 week and 5 months after surgery (both at R ²=0.000), however, weaker correlations were seen between corneal ablation depth and CRF 1 week and 5 months after surgery ( Y=3.253+ 0.010 X, R ²=0.007; Y=1.073+ 0.021 X, R ²= 0.004).

ConclusionsSBK, LASIK and LASEK lead to the change of corneal biomechanics by altering CH and CRF, they play the same influence on cornea.CRF appears to be an useful indicator in evaluating corneal biomechanical changes after laser refractive surgery.

KEYWORDS： Cornea/physiology;Myopia/surgery;Elastic tissue;Biomechanics;Keratomileusis, laser in situ;Keratomileusis, laser subepithelial;Keratomileusis, sub-Bowman

Corresponding author: Deng Yingping, Email: mocdef.3ab61855pyd

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No content published by the journals of Chinese Medical Association may be reproduced or abridged without authorization. Please do not use or copy the layout and design of the journals without permission.

All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.

引用本文

吴东芳,邓应平,王顺清,等. 不同准分子激光角膜屈光手术对近视眼角膜滞后量和角膜阻力因子的影响[J]. 中华实验眼科杂志,2015,33(6)：541-545.

DOI:10.3760/cma.j.issn.2095-0160.2015.06.013

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准分子激光角膜屈光手术因术后痛苦小、视力恢复快、有效性佳和预测性好，成为目前治疗屈光不正的主流方法，随着相关技术和手术器械的发展，准分子激光角膜屈光术后患者的满意度和安全性逐渐提高，但术中对角膜组织的切削不可避免地会改变角膜结构，影响角膜生物力学的稳定性，可导致继发圆锥角膜、角膜扩张等并发症发生 ^{[
1
,

2
]}。研究表明，准分子激光角膜屈光手术对角膜组织的切削量与角膜生物力学的稳定性下降明显相关，切削组织越多，角膜滞后量（corneal hysteresis，CH）和角膜阻力因子（corneal resistance factor，CRF）的变化量越大，且不同的术式对角膜生物力学变化的影响不同 ^{[
2
]}。用于测定角膜生物力学的方法包括离体角膜轴向拉伸试验、角膜膨胀法和离体全眼球角膜测定法，目前用于活体角膜生物力学性能的研究方法为眼反应分析仪（ocular response analyzer，ORA）测定法。本研究中采用ORA测定不同准分子激光角膜屈光手术前后CH和CRF的变化，比较准分子激光角膜原位磨镶术（laser in situ keratomileusis，LASIK）、准分子激光上皮下角膜磨镶术（laser subepithelial keratomileusis，LASEK）、前弹力层下激光角膜磨镶术（sub-Bowman keratomileusis，SBK）3种手术方式对角膜生物力学的影响，并分析角膜切削厚度与CH、CRF改变值之间的关系。

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参考文献

参考文献

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Fontes BM , Ambrósio R Jr, Velarde GC ,et al. Ocular response analyzer measurements in keratoconus with normal central corneal thickness compared with matched normal control eyes[J]. J Refract Surg, 2011,27(3):209-215. doi: 10.3928/1081597X-20100415-02 .