应用角膜地形图对准分子激光角膜屈光手术不同术式

发表者：李莹人已读

应用角膜地形图对准分子激光角膜屈光手术不同术式

和切削比对术后角膜变化的分析

金科姜洋李莹罗岩金玉梅艾凤荣

作者单位：100730 北京，中国医学科学院北京协和医院眼科

通讯作者：李莹， Emal：liyingpumch@sohu.com

国家自然基金项目批准号：81170826

【摘要】目的 应用角膜地形图对准分子激光手术中不同术式和切削比对术后角膜变化进行分析。设计回顾性病例系列。研究对象 北京协和医院眼科接受准分子激光屈光手术的患者52例（103眼）。方法按手术方式将患者分为准分子激光原位角膜磨镶术组（L组）27例53眼和新型表层屈光手术组（A组）25例50眼。两组组中，再按切削比（AD/CT）分为1组（AD/CT ≤ 0.15）26例和2组（AD/CT > 0.15）26例。术前及术后第1周、1个月和3个月进行常规检查，包括角膜地形图的检查。分析不同术式组之间、不同切削比组之间术后角膜地形图变化的特点。主要指标 术前及术后测定角膜表面不规则指数（SAI）、角膜表面规则指数（SRI）、垂直子午线的角膜镜度数及其差值（ΔSimK）和最大模拟角膜镜度数（SimK）等效值。结果在L2和A2组术后各时期SAI较术前比较差异均存在统计学意义（p均=0.000），而L1和A1组无显著差异存在（p>0.05）。在L2组，术后1周SRI较术前增加差异存在统计学意义（p =0.010），而术后1月及3月无存在统计学差异（p>0.05）；在A2组，术后1周及1月SRI均较术前增加差异存在统计学意义（p值分别为0.000，0.005），而术后3月无存在统计学差异（p>0.05）；而在L1和A1组术后各时期较术前均无统计学差异存在（p>0.05）。在各组中，术后各时期ΔsimK及SimK等效值较术前比较均有所下降，差异存在统计学意义（p均=0.000）。术后SAI和ΔSimK的变化受手术方式和切削比的共同影响（P值均小于0.05），而SRI和SimK等效值的变化仅受切削比的影响（P值均小于0.05）。结论准分子激光角膜屈光手术后角膜地形图参数均发生一定程度的变化，LASIK术后的变化程度大于ASA，且切削比越大，变化程度越大。

The influence of different surgery type and ablation ratio on the changes of corneal topography after excimer laser refractive surgery JIN Ke, JIANG Yan，LI Ying，LUO Yan，JIN Yu-mei，AI Feng-rong. Department of Ophthalmology, Peking Union Medical College Hospital , Chinese Academy Of Medical Science, Beijing 100730, China

【Abstract】 Objective To analysis the changes of corneal topography after excimer laser photorefractive keratectomy and the influence of surgery type and ablation ratio. Design Retrospective case series. Participants A total of 52 myopic patients (103 eyes) who performed excimer laser refractive surgery in our hospital. Methods All cases had completed all per-operative exams were included. The patients were grouped by the type of surgery: Laser in situ keratomileusis (LASIK) group and Advanced surface ablation(ASA) group; in both of two groups, the patients were grouped by ablation depth/corneal thickness ratio (AD/CT): group 1(AD/CT ≤ 0.15) and group 2 (AD/CT > 0.15). Routine examination and corneal topography were underwent pre-operation and 1 week, 1 month and 3 months post-operation. Main Outcome Measures Surface asymmetry index (SAI), surface regularity index (SRI), Δ simulated keratoscopy reading (ΔSimK) and simulated keratoscopy reading (SimK). Results In group L2 and A2，all the 3 pos-toperation SAI value improved significantly compared with pre-operation value（p=0.000）, not in group L1 nor A1（p>0.05）. In group L2，the 1-week-pos-toperation SRI value improved significantly compared with pre-operation value（p=0.010）, but not the 1-month nor the 3-month-post-operation SRI value（p>0.05）. In group A2，the 1-week and 1-month-postoperation SRI value improved significantly compared with pre-operation value（p=0.000，0.005）, but not the 3-month-postoperation SRI value（p>0.05）.No significant differences of SRI show in group L1 and nor A1 either between pre-operation and post-operation（p>0.05）. In all patients，both ΔsimK and SimK equivalent value decreased significantly compared with pre-operation value（p=0.000）. The changes of SAI and ΔSimK were influenced by both surgery type and also ablation ratio（p<0.05）, while the changes of SRI and SimK equivalent only by ablation ratio（p<0.05）. Conclusion The postoperative corneal topographic parameters underwent a certain degree of changes, and the changes after LASIK were greater than after ASA, and the changes are increasing with the ablation ratio.