Ziemer飞秒激光与Moria M2 90刀头制作角膜瓣的厚度与特点比较

目的  应用前节OCT测量比较Ziemer飞秒激光和Moria M2微型角膜刀90刀头制作的LASIK角膜瓣的特点。设计 前瞻性比较性病例系列。研究对象 88例近视患者176眼行LASIK,随机分为Ziemer飞秒激光和Moria M2微型角膜刀90刀头制作角膜瓣各44例88眼。方法  术后1周应用RTVue OCT测量两组患者角膜上0°、45°、90°和135° 4条子午线所在截面上特定7个点的角膜瓣厚度,并对角膜瓣上28个测量点的角膜瓣厚度值进行统计分析。主要指标 角膜瓣厚度和角膜瓣形态。结果 术后1周,飞秒激光组中央角膜瓣厚度为（106.03±6.64） ?滋m,平均角膜厚度（107.38±5.46） ?滋m,均明显低于Moria M2 90组的中央角膜瓣厚度（134.41±11.31） ?滋m和平均角膜瓣厚度（139.38±8.91） ?滋m（P均<0.01）, 飞秒激光组与角膜瓣预期厚度值110 ?滋m更接近,差值为（7.15±4.89） ?滋m,而机械板层刀组角膜瓣厚度值与预计厚度110 ?滋m的差值为（29.51±14.31） ?滋m （P<0.01）。结论 飞秒激光制作角膜瓣的厚度更薄,全角膜瓣厚度平均值更接近预期的110 ?滋m,其角膜瓣的均一性和预测性更好,是薄瓣LASIK手术的首选。（眼科,2013,22： 261-265）     

准分子激光手术不同制瓣方式角膜瓣厚度的研究

目的 评价和比较准分子激光手术不同方式制作角膜瓣厚度的预测性和均匀性以及短期变化.方法 选取3组准分子激光手术连续病例:准分子激光角膜上皮瓣下磨镶术(LASEK)组40例(80只眼),板层角膜刀准分子激光原位角膜磨镶术(LASIK)组78例(155只眼),飞秒激光LASIK组42例(82只眼).LASIK手术采用90μm Moria M_2自动旋转式微型角膜刀或Zeiss VisuMax 飞秒激光制作100 μm角膜瓣.采用眼前节光学相干断层(OCT)扫描系统,由同一检查医师于术后1h、1d、1周、1个月和3个月测量角膜上皮瓣或基质瓣厚度,采集水平子午线、垂直子午线、45°和135°子午线上距离角膜顶点1.5、2.5、3.5mm及角膜顶点共25个点的角膜瓣厚度.统计方法为t检验或方差分析,P<0.05为差异有统计学意义.结果 眼前节OCT测得角膜上皮瓣厚度:术后1h、1d、1周、1个月、3个月分别为(57.91±6.76)、(54.94±4.65)、(54.96±2.70)、(55.26±4.27)、(53.86±5.56)μm,差异有统计学意义(F-=20.25,P<0.05).板层角膜刀组角膜顶点处平均厚度为(129.16±12.10)μm,飞秒激光组为(112.69±5.12)μm,飞秒激光制瓣预测性优于板层角膜刀.板层角膜刀组和飞秒激光组实际瓣厚度与平均瓣厚度差值绝对值的均数分别为(13.16±4.78)μm和(5.26±1.21)μm,飞秒激光制瓣重复性优于板层角膜刀.角膜瓣厚度空间特征:板层角膜刀组角膜瓣呈现中央薄而周边厚的形态,飞秒激光组不同离心度位置角膜瓣厚度均匀一致,差异无统计学意义(F=1.08,P>0.05).结论 眼前节OCT是无创、简捷并可靠的角膜瓣形态检测手段.角膜瓣的眼前节OCT检查表明,飞秒激光制瓣比常规板层角膜刀在预测性和均匀性方面更有优势.     

应用OCT对LASIK术后两种角膜瓣对比研究

目的 应用眼前节相干光断层扫描仪(OCT)评估飞秒激光和微型板层角膜刀所制的准分子激光原位角膜磨镶术(LASIK)后角膜瓣厚度及边切角(side-cut angle).方法 回顾性临床病例对照研究.选取2010年10月至2010年11月在厦门大学附属厦门眼科中心行LASIK术患者58例(116只眼),其中使用Femto LDV飞秒激光制瓣组32例(64只眼),使用Bausch Lomb Zyoptix XP板层角膜刀组26例(52只眼),手术均由同一名医生完成.应用OCT及相关软件测量患者术后3个月角膜瓣上14个点位厚度,及0°、90°、180°、270°四个角膜瓣边缘的边切角.结果 飞秒激光组制作的角膜瓣中央厚度均值为(104.8±7.2) μm,Zyoptix XP微型角膜刀组均值为(115.4±19.5) μm.两种制瓣方式所制角膜瓣皆为中间薄、周边厚、形状近似一凹透镜.但飞秒激光组所制角膜瓣均匀性明显高于微型角膜刀组,差异有统计学意义(P ＜0.001).飞秒激光组角膜瓣厚度偏差程度(实测值与预计值之差)明显低于微型角膜刀组(P＜0.05).结论 LASIK术中使用飞秒激光所制角膜瓣较Zyoptix XP机械板层角膜刀所制角膜瓣具有更好的预测性,角膜瓣均匀性更好.     

飞秒激光制瓣LASIK及TransPRK手术治疗近视对角膜像差的影响

目的 观察飞秒激光制瓣LASIK手术及TransPRK手术治疗低中度近视患者对角膜像差的影响。设计 前瞻性病例对照研究。研究对象 等效球镜度-1.00 ~ -6.75 D的近视患者73例131眼。方法 37例68眼行飞秒激光制瓣LASIK手术,36例63眼行TransPRK手术。均使用阿玛仕准分子激光消像差切削模式。术前及术后1、3、6个月进行视力、屈光度、波前像差仪检查。主要指标 视力、残余屈光度、彗差、球差、总高阶像差。结果 术后1个月,飞秒激光制瓣LASIK组裸眼视力达到或超过术前最佳矫正视力者为75%,TransPRK组为47.62%（P=0.001）。术后3个月及6个月,飞秒激光制瓣LASIK组裸眼视力达到或超过术前最佳矫正视力者分别为86.76%、91.18%,TransPRK组分别为79.37%、90.48% （P=0.26,0.89）。术后残余屈光度,在术后3个月TransPRK组（0.13±0.35 D）较飞秒激光制瓣LASIK组（-0.02±0.41 D）略高,术后1个月及6个月均无显著差别。两组术后高阶像差均较术前提高（P<0.001）。术后1个月角膜彗差在TransPRK组为（0.25±0.10 μm）,较飞秒激光制瓣LASIK组（0.30±0.17 μm）小（P=0.04）;术后3、6个月角膜彗差在TransPRK组分别为（0.28±0.10 μm）、（0.30±0.12 μm）,与飞秒激光制瓣LASIK组（0.31±0.16 μm）、（0.35±0.11 μm）相似（P=0.12,0.13）。术后各时间点两组的球差、总高阶像差差异均无统计学意义。结论 飞秒激光制瓣LASIK手术及TransPRK手术治疗低中度近视患者术后角膜像差均有所提高,术后1个月TransPRK角膜彗差较飞秒激光制瓣LASIK小,术后3个月及6个月两种手术方式对角膜像差的影响相似。（眼科,2015,24：225-229）     

飞秒激光与机械板层刀制瓣LASIK对角膜瓣厚度稳定性的影响

目的：探究飞秒激光与机械板层刀制瓣准分子激光原位角膜磨镶(LASIK)术对角膜瓣厚度稳定性和干眼症的影响。

方法：回顾性分析于本院眼科行LASIK术的近视患者80例160眼,根据制瓣方式不同分为飞秒激光组和机械板层刀组。测量术后两组患者不同时间点(1h,1d,1wk,1、3mo)的角膜瓣厚度,并比较不同方向上距离角膜顶点1、2、3mm及角膜顶点角膜瓣厚度的差异。比较患者术后1、3mo,1、2a OSDI评分和干眼症的发生率。

结果：飞秒激光组角膜瓣顶点厚度为99.62±4.50μm,机械板层刀组角膜瓣顶点厚度为125.25±12.81μm。飞秒激光制瓣不同离心点位置的角膜瓣厚度较为均匀,而机械板层刀制瓣角膜厚度变化较大。术后1、3mo,1、2a机械板层刀组OSDI评分高于飞秒激光组(P<0.01)。随访2a时间,飞秒激光组干眼发病率低于机械板层刀组(χ²=4.692,P=0.030)。术后1、2a,飞秒激光组轻度干眼所占比例高于机械板层刀组(P=0.044、0.001)。

结论：相对于机械板层刀制瓣,飞秒激光制瓣LASIK术患者的角膜瓣厚度稳定性更好,更为均匀,误差更小,且患者术后干眼的发生率更低,以轻度干眼为主。     

飞秒激光与角膜板层刀制作角膜瓣的厚度及形态比较

目的应用前节光学相干断层扫描仪（OCT）,比较WaveLight FS200飞秒激光与Moria M2 90角膜板层切开刀制作角膜瓣的厚度及形态特点。方法前瞻性病例对照研究。对61例行双眼准分子激光原位角膜磨镶术（LASIK）的近视患者分别采用WaveLight FS200飞秒激光制瓣（WaveLight组,36例）和Moria M2 90角膜板层切开刀制瓣（Moria组,25例）。术后1周,采用Visante 前节OCT测量180°、90°、45°、135°轴位上距离角膜顶点0、±2、±3.5 mm处的角膜瓣厚度。运用独立样本t检验对2组数据进行统计学分析。结果WaveLight组中央角膜瓣厚度为（105.53±5.86）µm,而Moria组为（132.96±13.91）µm（t=-13.16,P<0.01）。WaveLight组中央角膜瓣精确度为（6.17±3.98）µm,而Moria组为（23.60±12.64）µm（t＝-15.20,P<0.01）。WaveLight组角膜瓣均匀性指数为（4.07±0.94）µm,Moria组为（8.48±2.35）µm（t＝-12.60,P<0.01）。WaveLight组角膜瓣的对称性指数[（33.81±11.28）µm]明显小于Moria组[（68.46±26.66）µm],差异有统计学意义（t＝-8.67,P<0.01）。结论前节OCT显示WaveLight FS200飞秒激光制作的角膜瓣与Moria M2 90角膜板层切开刀相比,中央厚度更精确、重复性更好,角膜瓣形态更均匀。     

两种不同制瓣方式对LASIK术角膜瓣厚度的影响

目的:比较Ziemer LDV飞秒激光与Moria M2机械板层刀不同制瓣方式对LASIK术角膜瓣厚度的影响。 方法：选取近视患者100例200眼（近视度数-2.00~-12.00D,散光度数0.00 ~ -3.50D）,分别应用Ziemer LDV飞秒激光（设定角膜瓣切削厚度110μm）与Moria M2 （110刀头）微型角膜刀制作角膜瓣,各50例 100眼。术后1wk,应用眼前节RTVue FD-OCT 测量,每个角膜上 0°,45°,90°,135°四条子午线所在截面上中心点、距离中心1,2,3mm特定7个点（共计28个点）的角膜瓣厚度测量,并作分析比较。 结果:角膜瓣中央点厚度:Ziemer LDV飞秒激光组108.69±11.75μm,Moria M2 微型角膜刀组130.75±13.36μm,所有观测点（共28点）两组间有明显统计学差异（P<0.01）。角膜中心点厚度与预计值差值比较:Ziemer LDV飞秒激光组 9.70±6.84μm,Moria M2 微型角膜刀组 21.63±11.79μm。Ziemer LDV飞秒激光组预计值差值明显低于Moria M2 微型角膜刀组（t=17.493,P＜0.01）。Ziemer LDV飞秒激光组与Moria M2微型角膜刀组同一截面中各点角膜瓣厚度值差异有统计学差异（P<0.01）。 结论:角膜瓣制作方式相比,在角膜瓣的精确性、可预测性等方面 Ziemer LDV飞秒激光优于Moria M2 微型角膜刀。Ziemer LDV组与Moria M2 机械板层刀组都未表现角膜瓣厚度的均匀性。     

传统与个体化LASIK术中实际角膜切削深度的对比研究

目的：对比研究传统与个体化准分子激光原位角膜磨镶术（laser in situ keratomileusis,LASIK）中实际角膜切削深度的差异。方法：前瞻性对照研究,随机选取采用Technolas 217z100型准分子激光机进行LASIK手术的中低度近视及近视散光患者87例161眼,分为传统切削组和个体化切削组。术中采用光学相干厚度测量仪（online optical coherence pachymetry,OCP）实时监测所有患者的角膜厚度,并记录掀瓣后激光切削前及切削后的角膜基质厚度,计算出实际角膜切削深度。比较各组实际角膜切削深度与理论切削深度的差异及两组实际角膜切削深度与理论切削深度差值的组间差异。结果：传统切削组实际角膜切削深度为94.37±22.76μm,理论切削深度为85.69±21.19μm,差异有统计学意义（P〈0.05）。个体化切削组实际角膜切削深度为90.08±15.98μm,理论切削深度为76.30±13.65μm,差异有统计学意义（P〈0.05）。传统切削组实际角膜切削深度较理论切削深度增加8.68±6.30μm,个体化切削组实际角膜切削深度较理论切削深度增加13.78±7.63μm,差异有统计学意义（P〈0.05）。个体化切削组实际角膜切削深度与理论切削深度差值较传统切削组切削深度差值增加5.10±1.10μm。结论：传统LASIK及个体化LASIK术中实际角膜切削深度均比理论切削深度增加。个体化LASIK中实际角膜切削深度偏差较传统LASIK切削深度偏差更大。     

LASIK术中实际角膜切削深度的临床研究

目的:观察NIDEK EC5000准分子激光治疗系统准分子激光原位角膜磨镶术(Laser in situ kemtomileusis,LASIK)角膜切削深度的可预测性.方法:采用NIDEK EC5000准分子激光系统对79例近视和(或)近视散光患者进行标准LASIK手术,术中使用超声角膜测厚仪分别测量制瓣后和激光切削后的剩余角膜床厚度,计算实际角膜切削深度,比较实际角膜切削深度同理论预测角膜切削深度的差异.结果:LASIK术中实际切削深度(92.32±29.86)μm,预测切削深度(74.16±25.95)μm,两者差值(18.16±14.71)±m有统计学意义(P＜0.001).实际切削深度与预测切削深度具有较好的相关性,相关系数为0.87(P＜0.001),其直线回归方程为Y=18.06±1.001X.按术前角膜K值、术前等效球镜绝对值及术前中央角膜厚度值分组的实际切削深度与预测切削深度的差值均有统计学意义.实际切削深度与术前等效球镜有关,与术前中央角膜厚度和K值无关.实际切削深度与预测切削深度差值同K值、等效球镜、术前中央角膜厚度均无关.结论:NIDEK EC5000 准分子激光系统LASIK 术中实际角膜切削深度比预测角膜切削深度高(18.16±14.71)μm,在手术设计时要考虑实际切削与机器标示值存在偏差,应尽可能多的预留剩余角膜基质床厚度,以提高手术安全性.     

两种显微角膜板层刀制作角膜瓣厚度的对比分析

目的:对Hansatome自动旋转式显微角膜刀及AmadeusⅡ自动平推式显微角膜刀制作准分子激光原位角膜磨镶术(LASIK)角膜瓣厚度进行对比分析。方法:对来我院行LASIK的患者50例100眼,随机分成两组,一组用Hansatome显微角膜刀160μm刀头制作角膜瓣,另一组用AmadeusⅡ显微角膜刀140μm刀头制作角膜瓣。对所有患者进行术前中央角膜厚度测量及术中角膜基质床厚度测量,从而计算角膜瓣厚度。所有的患者均先行右眼手术再行左眼。对两组患者实际切削的角膜瓣厚度进行对比,同时对两种显微角膜板层刀制作角膜瓣厚度左右眼之间进行对比分析。结果:Hansatome组实际角膜瓣厚度67～158(平均98.70±18.04)μm;AmadeusⅡ组实际角膜瓣厚度69～171(平均110.60±16.47)μm,两种角膜刀制作角膜瓣厚度差异有统计学意义(P=0.001)。Hansatome组右眼104.40±18.78μm,左眼93.00±15.61μm,两眼角膜瓣厚度差异有统计学意义(P=0.01);AmadeusⅡ组右眼115.12±18.74μm,左眼105.20±12.29μm,P=0.024,患者左眼角膜瓣均比右眼要薄,差异有统计学意义。结论:在LASIK术中角膜板层刀制作的角膜瓣厚度与预计值有一定的偏差,术中测量角膜瓣厚度有重要的参考价值。     

角膜瓣厚度对高度近视准分子激光手术角膜后表面前移的影响

目的 探讨高度近视眼经过不同厚度角膜瓣的准分子激光原位角膜磨镶术(LASIK)及上皮瓣下角膜磨镶术矫后角膜后表面高度的变化(前移).方法 病例对照研究.选择等效球镜度数-6.00～-10.00 D的准分子激光近视矫正手术患者151例(151只眼),其中行Epi-LASIK和LASEK手术的(上皮瓣组)46只眼,角膜瓣厚度为110(薄瓣组)和130μm(常规瓣组)的LASIK分别为64和41只眼.术前、术后应用Pentacam眼前节分析系统对角膜厚度、后表面的屈光度和前移进行测量.角膜后表面前移量与其他变量之间的相关性应用Spearman相关分析,P<0.05为相关性具有统计学意义;其他参数比较采用方差分析检验.结果 术前中央角膜厚度和角膜切削深度各组间的差异无统计学意义(X2=1.944,0.719;P>0.05),预计角膜基质床厚度上皮瓣组为(362±23)μm,薄瓣组为(320±25)μm,常规瓣组为(300±21)μm,两两间差异均有统计学意义(F=85.685,P<0.05).上皮瓣组角膜后表面屈光度数变化和前移为:(-0.12±0.14)D和(0.9±1.8)μm;薄瓣组为(-0.20±0.22)D和(1.3±1.6)μm;常规瓣组为(-0.21±0.18)D和(1.5±1.5)μm.角膜后表面屈光度数的改变与前移之间有显著相关性,薄瓣组和常规瓣组后表面前移与切削深度有显著相关性(r=0.265,0.311;P<0.05).结论 在留有足够角膜基质床厚度的情况下,上皮下切削与LASIK术后,角膜后表面前移量均微小;随着角膜瓣厚度的增加和切削深度的增加,角膜后表面前移量有逐渐增加的趋势.     

Posterior corneal topographic changes after retreatment LASIK

PURPOSE: To evaluate posterior corneal topographic changes after retreatment after myopic laser in situ keratomileusis (repeat LASIK). DESIGN: Retrospective nonrandomized comparative self-controlled trial. PARTICIPANTS: Thirty-three eyes of 23 patients who underwent repeat LASIK for residual myopia. INTERVENTION: Retreatments were performed. Slit-scanning corneal topography was performed before and at 1, 3, and 6 months after repeat LASIK. MAIN OUTCOME MEASURES: Posterior corneal topographic changes before and after repeat LASIK were correlated with central corneal pachymetry (preoperatively, before repeat LASIK, after repeat LASIK), residual bed thickness (RBT) and ablation depth (after primary laser in situ keratomileusis (LASIK) and repeat LASIK). On the basis of the amount of posterior corneal elevation after repeat LASIK, the eyes were divided into two groups: group 1 (>66 micro m) and group 2 (< or =66 micro m). Student's t test/Mann-Whitney rank-sum test was used to determine the significant difference of mean level of each variable between the two groups. RESULTS: After primary LASIK, an increase in posterior corneal elevation had significant positive correlation with attempted correction (P = 0.02), ablation depth (P = 0.008), and significant negative correlation with preoperative central pachymetry (P = 0.0003), RBT (P = 0.0003), and postoperative central pachymetry (P = 0.00008). After repeat LASIK, the mean increase in posterior corneal elevation had significant negative correlation with preoperative central pachymetry (P = 0.03). However, its correlation with the ablation depth (P = 0.43) during repeat LASIK and RBT after repeat LASIK (P = 0.11) was statistically insignificant. On multiple linear regression analysis, the attempted correction (P < 0.01) and RBT after primary LASIK (P < 0.001) were two independent significant determinants of an increase in posterior corneal elevation after primary LASIK. However, for increase in posterior corneal elevation after repeat LASIK, preoperative central pachymetry (P < 0.01) and posterior corneal elevation increase after primary LASIK (P < 0.05) were the two significant determinants. Compared with group 2, group 1 had significantly high values of posterior corneal elevation both after primary LASIK (P = 0.0037) and after repeat LASIK (P = 0.0000). This group also had significantly low values of central pachymetry preoperatively (P = 0.0003) and after primary LASIK (P = 0.0001) and repeat LASIK (P = 0.0001) surgeries. The mean RBT after primary LASIK (P = 0.0006) and after repeat LASIK (P = 0.001) was also lower in group 1. CONCLUSIONS: Posterior corneal elevation increases after repeat LASIK. Eyes with an increase in posterior corneal elevation after primary LASIK and with thinner cornea are more predisposed.     

Sirius角膜地形图仪测量LASIK和LASEK术后角膜后表面的研究

目的通过Sirius角膜地形图仪测量LASIK和LASEK术后角膜后表面,分析其变化特点．评价各因素对角膜后表面变化的影响。方法前瞻性临床研究。人选2012年5月至2013年7月在宁波第一医院行准分子激光屈光手术患者,其中LASIK手术37例（74眼）,LASEK手术26例（52眼）,术前应用Sirius角膜地形图仪测量每眼．并完善术前常规检查,记录相关数值。记录患者术中的切削深度、切削比例、残留基质厚度,术后1周、1个月、3个月复查。各时间点之间数据比较应用重复测量资料方差分析．各变量与角膜后表面高度变化量之间的影响程度应用多元线性回归。结果LASIK与LASEK术后1周、1个月和3个月角膜后表面高度与术前比较稍增高,差异有统计学意义（F=43.58、7.51,P〈0.01）;残留基质对LASIK术后1周、1个月和3个月后表面高度变化量有影响（f=-3.421、-3.376、-3.116,P〈0.01）,对LASEK术后1个月和3个月后表面高度变化量有影响（t=-3.077、-2.872,P〈0.01）。结论Sirius角膜地形图仪测定显示LASIK、LASEK术后均表现为角膜后表面微量前移。残留基质厚度对角膜后表面变化影响较大。     

SMILE与FS-LASIK对近视眼角膜基质切削深度可预测性的比较

背景 全飞秒激光小切口角膜基质透镜取出术(SMILE)已越来越多地用于近视的矫治,其手术的安全性、可预测性也受到关注. 目的 分析和比较SMILE与飞秒激光角膜原位磨镶术(FS-LASIK)对中央角膜组织切削深度的可预测性. 方法 采用非随机对照研究方法,选取于2015年10月至2016年5月在北京同仁医院拟行角膜屈光手术的近视患者135例270眼,根据患者的选择分为SMILE组69例138眼和FS-LASIK组66例132眼,组间患者人口基线特征匹配,分别接受SMILE和FS-LASIK,分别于术前及术后1周采用RTVue FD-OCT测量术眼中央角膜厚度值,观察指标包括术中角膜实际切削深度、切削误差和术眼术后屈光度变化,术前与术后1周中央角膜厚度的差值为实际切削深度,预测切削深度与实际切削深度间的偏差值为切削误差,比较2个组间各项测量指标的差异,探讨预测切削深度与实际切削深度值之间的关系. 结果 SMILE组和FS-LASIK组术眼术后球镜度、柱镜度及等效球镜度的差异均无统计学意义(t=-1.826、-1.405、-1.420,均P＞0.05).SMILE组患者术后角膜实际切削深度为(76.96±15.27) μm,低于预测切削深度的(96.76±16.52) μm,差异有统计学意义(t=-23.016,P＜0.01);FS-LASIK组术眼实际切削深度与预测切削深度分别为(77.92±18.69) μm和(77.42±15.60) μm,差异无统计学意义(t=-0.604,P=0.547).SMILE组术后切削误差量平均为(20.55-±8.51) μm,大于FS-LASIK的(7.17±5.97) μm,组间差异有统计学意义(t=14.950,P＜0.01).2个组术眼角膜预测切削深度与实际切削深度值间均呈线性正相关(r=0.799、0.867,均P＜0.01),SMILE组与FS-LASIK组术眼实际切削深度均随着预测切削深度的增加而增加,直线回归方程分别为Y=3.892+0.749X和Y=3.443+0.957X. 结论 SMILE术中实际切削深度低于预测切削深度,而FS-LASIK术中2者无明显差异,FS-LASIK可预测性好于SMILE.     

小牛血去蛋白提取物对LASEK与LASIK术后角膜神经修复作用的研究

目的 探讨准分子激光角膜上皮瓣下磨镶术(LASEK)与准分子激光原位角膜磨镶术(LASIK)术后早期应用小牛血去蛋白提取物对角膜神经修复的作用.方法 采用前瞻性随机对照双盲的方法.2009年1至2月在复旦大学附属眼耳鼻喉科医院视光学中心行LASEK患者25例(49只眼)和LASIK患者23例(44只眼),采用随机数字表法分别随机分为2组:LASEK术后小牛血去蛋白提取物眼用凝胶治疗组16例(32只眼)和未用药对照组9例(17只眼);LASIK术后小牛血去蛋白提取物眼用凝胶治疗组13例(24只眼)和未用药对照组10例(20只眼).所有患者均接受常规准分子激光术前检查和常规操作.术后给予治疗组小牛血去蛋白提取物眼用凝胶每日3次涂眼治疗,连续使用3个月.分别在术前、术后1、3、6个月及1年时采用共焦显微镜检查角膜上皮下神经,并测量角膜中央知觉,泪膜破裂时间(BUT).采用独立样本t检验、配对t检验和非参数检验对数据进行统计学分析.结果 LASEK和LASIK术后1年,共聚焦显微镜观察小牛血去蛋白提取物眼用凝胶治疗组和对照组间角膜神经修复的差异均无统计学意义(均为Z=0.0000,P=1.00),但LASEK治疗组在术后3个月即观察到神经交通支形成.LASEK和LASIK术后1年,角膜上皮下神经的形态仍未恢复到术前水平.LASEK术后1个月,LASIK术后1和3个月小牛血去蛋白提取物眼用凝胶治疗组和对照组角膜中央知觉分别为(4.95±0.84)μm、(3.29±1.40) μm、(4.31±1.61) μm和(3.62±1.38) μm、(2.35±1.51)μm、(3.18±1.62) μm,差异有统计学意义(t=4.23,P<0.01;t=2.10,P<0.05;t=2.31,P<0.05).术后6个月,LASEK治疗组、对照组和LASIK治疗组角膜中央知觉分别为(5.81±0.35) μm、(5.79±0.36)μm及(5.25±0.91)μm,与术前相比差异均无统计学意义(t=-1.26,P>0.05;t=-0.70,P>0.05;t=-1.87,P>0.05).LASEK和LASIK术后1年时,治疗组BUT分别为(8.13±2.18) μm和(7.71±2.14) μm,对照组BUT分别为(8.76±1.64)μm和(7.45±2.37)μm,差异均无统计学意义(t=-0.90,P>0.05;t=0.30,P>0.05).结论 LASEK和LASIK术后早期应用小牛血去蛋白提取物能在一定程度上促进术后角膜神经的修复.(中华眼科杂志,2011,47:539-545)

Abstract：

Objective To evaluate the effects of protein-free calf blood extract for recovery of corneal nerve after LASEK and LSEIK. Methods A prospective, randomized, control and double-blind study was carried out from January through February 2009 at Department of Ophthalmology, Eye Ear Nose and Throat Hospital of Fudan University. Forty-nine eyes of 25 patients who underwent LASEK were randomly divided into two groups. One group with 16 patients (32 eyes) was treated by protein-free calf blood extract eye gel which was defined as drug treated group and the other group with 9 patients (17 eyes) was not treated by protein-free calf blood extract eye gel which was defined as no drug treated group. Forty-four eyes of 23 patients who underwent LASIK were also randomly divided into two groups. One group with 13 patients (24 eyes) was treated by protein-free calf blood extract eye gel which was defined as drug treated group and the other group with 10 patients (20 eyes) was not treated by protein-free calf blood extract eye gel which was defined as no drug treated group. Protein-free calf blood extract eye gel was delivered in both drug treated groups 3 times per day for three months after surgery. Laser scanning confocal microscopic examinations were performed on 48 eyes in vivo. Central corneal sensitivity and tear break-up time (BUT) were tested on 93 eyes preoperatively and 1,3,6 months, and 1 year after surgery. The obtained dates in the study were analyzed using independent samples t-test, paired t-test and Mann-Whitney Test. Results The morphology oserved by confocal microscope of sub-basal nerve fibers was not different between drug treated group and no drug treated group until the last follow up after LASIK or LASEK(Z=0.0000,P=1.00)and(Z=0.0000,P=1.00). Nerve fibers with interconnections were observed in drug treated group at 3 months after LASEK. The morphology of sub-basal nerve fibers had not recovered completely until 1 year after surgery. The central corneal sensitivity was better in drug treated group than in no drug treated group at 1 month after LASEK [(4.95±0.84)μm,(3.62±1.38) μm;t=4.23,P<0.01] and at 1 and 3 months after LASIK [(3.29±1.40)μm,(2.35±1.51)μm;t=2.10,P<0.05],[(4.31±1.61) μm,(3.18±1.62) μm; t=2.31,P<0.05]. At 6 months postoperatively, the central corneal sensitivity of both drug treated group and no drug treated group which underwent LASEK was not significantly different from pre-operation[(5.81±0.35) μm;t=-1.26,P>0.05],[(5.79±0.36)μm;t=-0.70,P>0.05]. At 6 months postoperatively, the central corneal sensitivity of drug treated group which underwent LASIK was not significantly different from pre-operation[(5.25±0.91)μm;t=-1.87, P>0.05]. No significant difference was seen in BUT between drug treated group and no drug treated group after LASEK or LASIK until 1 year after surgery[(8.13±2.18) μm,(8.76±1.64)μm;t=-0.90,P>0.05],[(7.71±2.14) μm,(7.45±2.37)μm;t=0.30,P>0.05]. Conclusion Protein-free calf blood extract could significantly promote the recovery of corneal nerve in the early period after LASEK and LASIK.     

Continuous monitoring of corneal thickness changes during LASIK with online optical coherence pachymetry

PURPOSE: To assess the continuous intraoperative monitoring of central corneal thickness (CCT) changes during laser in situ keratomileusis (LASIK) using online optical coherence pachymetry (OCP). SETTING: Department of Ophthalmology, Vivantes Klinikum Neukolln, Berlin, Germany. METHODS: In this prospective nonrandomized comparative clinical case series of consecutive patients, 32 eyes having LASIK for myopia, myopic astigmatism, or hyperopia were continuously monitored intraoperatively in real time with online OCP integrated into a clinical excimer laser. The intraoperative values were compared to the postoperative flap and residual stromal thicknesses measured with corneal optical coherence tomography (OCT) as well as the calculated myopic ablation depth. RESULTS: Continuous monitoring with online OCP enabled intraoperative visualization of the CCT changes during LASIK. The CCT, flap thickness after the microkeratome pass, time-resolved ablation, and residual stromal thickness were assessed. Intraoperatively, the mean flap thickness was 135 microm +/- 38 (SD) and the mean residual stromal thickness, 286 +/- 59 microm. The mean intraoperative flap and residual stromal thickness values were 43.7 microm and 15.4 microm lower, respectively, than the postoperative values assessed with corneal OCT (P<.001 and P=.005, respectively). The optically determined myopic ablation depth was 118 +/- 37 microm, which was 28 microm higher than the nominal ablation depth. There was a significant correlation (P<.001) between the postoperative flap (r=0.79) and residual (r=0.88) thickness measured with corneal OCT as well as the calculated myopic ablation depth (r=0.95). CONCLUSIONS: Intraoperative online OCP could be an important safety feature to monitor the flap and residual stromal thicknesses during LASIK. The individual ablation depth and possible dehydration effects were also monitored continuously.     

LASIK和LASEK术后角膜神经损伤恢复情况比较

目的 通过测定LASIK和LASEK术后角膜上皮下神经丛密度、角膜知觉变化,评估2种手术方式对角膜神经损伤的情况.方法 前瞻性临床病例研究.选取河北省沧州市中心医院LASIK手术患者102例（204眼）,LASEK手术患者34例（68眼）.测定2组术前,术后1周、1个月、3个月、6个月、1年、2年时角膜上皮下神经丛密度和角膜知觉,对上述2个指标采用重复测量方差分析进行比较.结果 术前LASIK组角膜上皮下神经丛密度和角膜知觉分别为（1 582±175）μm、（58.82±0.53）mm.术后1周[（208±32）μm]、1个月[（254 ±32） μm]、3个月[（588±65）μm]、6个月[（648 ±65） μm]、1年[（938±119）μm]时角膜上皮下神经丛密度均较术前降低（F=7.13,P＜0.05）;术后2年时恢复到术前水平（t=0.147,P＞0.05）.术后1周[（0.59±0.40）mm]、1个月[（15.59±2.67）mm]、3个月[（41.18±3.44）mm]、6个月[（52.88±2.58）mm]时角膜知觉均较术前降低（F=78.13,P＜0.05）;术后1年时恢复到术前水平（t=1.144,P＞0.05）.术前LASEK组角膜上皮下神经丛密度和角膜知觉分别为（1 406±195）μm、（58.82±0.53）mm.术后1周[（182±33）μm]、1个月[（538±83）μm]、3个月[（784±74）μm]、6个月[（1024±74）μm]时角膜上皮下神经丛密度均较术前降低（F=34.51,P＜0.05）;术后1年时恢复到术前水平（t=1.906,P＞0.05）;术后1周[（1.18±0.53）mm]、1个月[（38.82±3.11）mm]、3个月[（55.29±1.00）mm]时角膜知觉均较术前降低（F=361.98,P＜0.05）;术后6个月时恢复到术前水平（t=0.899,P＞0.05）.LASEK组在术后1个月、3个月、6个月时角膜知觉恢复优于LASIK组,其余时间点差异无统计学意义.LASEK组在术后6个月和1年时角膜上皮下神经丛密度恢复优于LASIK组,其余时间点差异无统计学意义.结论 LASIK和LASEK术后角膜上皮下神经丛密度、角膜知觉均较术前降低;LASEK术后角膜上皮下神经丛密度、角膜知觉恢