中低度近视FS-LASIK、SMILE及ICL植入术的效果比较

目的比较飞秒激光制瓣准分子激光原位角膜磨镶术(FS-LASIK)、全飞秒激光小切口角膜基质透镜取出术(SMILE)和有晶状体眼后房型人工晶状体(ICL V4c)植入术三者矫正中低度近视的效果。方法采用回顾性研究。以惠州爱尔眼科医院2019年6月至2020年4月矫正中低度近视120例(120眼)作为研究对象,受术者分为FS-LASIK组、SMILE组及ICL组,每组40例(40眼),各组分别接受相应的手术,术后随访3个月比较其矫正效果。结果术后1个月及3个月,3组间视力及有效性指数对比差异无统计学意义(P>0.05);ICL组安全性指数高于SMILE组及FS-LASIK组(P<0.05)。术后3个月FS-LASIK组的三叶草像差、彗差和球差出现明显变化,而SMILE组的变化较小,ICL组变化最小(P<0.05)。结论对中低度近视FS-LASK、SMILE及ICL植入术三者均有确切疗效,而ICL V4c植入术的安全性最高,患者的视觉质量最好。     

SMILE术中角膜帽下地塞米松平衡液冲洗与否的早期临床观察

目的观察飞秒激光小切口角膜基质透镜取出术(SMILE)中角膜帽下地塞米松平衡液冲洗与否对术后视觉质量及角膜组织结构形态的影响。方法选择拟进行双眼SMILE手术的24例(48眼)纳入研究,每例患者随机选取一眼透镜取出后,行地塞米松平衡液冲洗角膜帽下基质腔隙(实验组),对侧眼不冲洗(对照组)。分别于术后第1天、第7天及1个月对比观察两组的裸眼视力、屈光状态、角膜中央厚度(CCT)、眼压(NCT);同时利用共焦显微镜及前段光学相干断层扫描(OCT)检查对比观察两组角膜上皮细胞、神经纤维、基质细胞、内皮细胞形态结构。采用配对t检验比较两组的裸眼视力、屈光状态等各指标有无差异。结果术后第1天、第7天及1个月两组间裸眼视力比较:实验组为4.99±0.07、5.06±0.08、5.05±0.06;对照组为5.01±0.07、5.05±0.08、5.06±0.09;3个时间点两组间裸眼视力均无统计学差异(P均>0.05);术后第1天、第7天及1个月的屈光度(SE,D):实验组为0.03±0.49、0.1±0.37、0.02±0.4;对照组为0.09±0.54、0.19±0.48、0±0.52,3个时间点两组间SE比较均无统计学差异(P均>0.05)。共焦镜检查不同时间点比较:角膜上皮层细胞密度[术前(4578.73±268.40,4539.57±329.25)个/mm^2,术后第1天(4565.21±247.31,4627.23±271.03)个/mm^2,术后第7天(4640.01±246.79,4517.71±281.43)个/mm^2];角膜内皮细胞密度[术前(2541.50±259.59,2443.52±305.58)个/mm^2,术后第1天(2387.01±248.55,2495.27±238.52)个/mm^2,术后第7天(2484.49±223.71,2482.53±323.82)个/mm^2],术前术后两组间均无统计学差异(P>0.05);角膜上皮下神经纤维丛术前术后两组间比较无明显变化;切削界面高反光物两组间比较没有明显差异;角膜前基质细胞密度[术前(789.51±67.17,802.03±67.94)个/mm^2,术后第1天(889.37±60.62,912.27±95.87)个/mm^2,术后第7天(796.67±75.03,818.39±59.65)个/mm^2]在术后第1天、第7天较术前均有增加,但两组之间没有统计学差异(P>0.05),术后1 d两组前基质细胞较术前增加,有统计学差异(P<0.05);角膜后基质细胞术后各时间点两组间比较无统计学差异(P>0.05)。角膜OCT在术后1 d、7 d两组在角膜帽下均未出现明显层间间隙和积液,两组间角膜中央厚度无统计学差异(P>0.05)。结论SMILE术中地塞米松平衡液角膜帽下冲洗对术后裸眼视力、屈光度及角膜组织结构形态无明显影响。     

中低度近视SMILE术后超早期视觉质量变化的研究

目的观察飞秒激光小切口角膜基质透镜取出术(SMILE)术后超早期患者视觉质量变化,探讨其变化发生的可能原因。方法选取中低度近视患者23例46眼行SMILE术,术前及术后24 h超早期行主观视觉质量问卷,测量最佳矫正视力的全程视力(远视力5 m,中视力60 cm,近视力33 cm)、对比敏感度(CS)、眩光敏感度(GS)及集合近点(NPC)和调节幅度(AA)。结果视觉质量主观问卷显示术后超早期主观视觉质量较术前下降(P=0.001)。术后裸眼视力(UCVA)明显提高(P=0.0001)。术前与术后最佳矫正视力(BCVA)中远视力没有变化(P=0.096),而中视力和近视力均较术前下降(P=0.039,0.003)。术后CS、GS降低(PCS=0.0001,PGS=0.04),NPC、AA较术前无明显变化(P=0.68,0.13)。结论SMILE术后超早期患者可获得预期理想远视力,但中、近视力尚未恢复。超早期中出现的异常视觉质量改变可能与对比敏感度和眩光敏感度的改变有关。     

【In Press】 Femtosecond laser corneal refractive surgery for the correction of high myopic anisometropic amblyopia in juveniles

AIM: To evaluate the effects of femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small-incision lenticule extraction (SMILE) to correct high myopic anisometropic amblyopia in juvenile patients. METHODS: From November 2013 to January 2015, 33 amblyopic patients with high myopic anisometropic amblyopia were studied. FS-LASIK (30 eyes) or SMILE (3 eyes) was performed in the amblyopic eyes. Visual acuity, refraction, contrast sensitivity, stereoacuity and complications were evaluated. Patients completed follow-up examinations at 3d, 1mo, 3mo and the last follow-up time (mean 8.17±3.23mo) after surgery. RESULTS: The mean age at surgery was 9.04±3.04y (range 6-16). The mean spherical equivalent in the amblyopic eyes was significantly decreased from -10.00±2.39 D preoperatively to -0.06±1.06 D at 1mo, -0.19±1.33 D at 3mo and -0.60±1.43 D at approximately 8mo postoperatively (P<0.05 for all). The mean myopic anisometropia was significantly decreased from -9.45±2.33 D preoperatively to +0.37±1.48 D at 1mo, -0.46±1.47 D at 3mo and -0.09±1.83 D at approximately 8mo (P<0.05 for all). The logarithm of the minimum angle of resolution (logMAR) for uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively) of the amblyopic eye improved from 1.74±0.35 and 0.98±0.63 preoperatively to 0.45±0.31 and 0.41±0.33 at approximately 8mo after surgery, respectively. The LogMAR CDVA at 3d, 1, 3 and 8mo postoperatively improved by means of 1.42, 2.22, 2.96, and 4.39 lines, and a gain of more than two lines accounted for 45%, 50%, 74% and 86% of all patients, respectively. The contrast sensitivity of both amblyopic eyes and dominant eyes at 0.5, 2, 8 cycles per degree (cpd) was significantly improved postoperatively (P<0.05 for all). Of the 33 pediatric patients, no patients had near stereopsis preoperatively and seven patients (21.2%) recovered near stereopsis (400″ to 60″) at approximately 8 months after surgery. No intraoperative or postoperative complications occurred in any patients. CONCLUSION: FS-LASIK or SMILE can be promising alternative methods to correct high myopic anisometropic amblyopia in juvenile patients who have failed with traditional approaches.     

SMILE术后角膜帽的观察研究——基于傅里叶频域光学相干断层扫描（FD-OCT）

目的　通过傅里叶频域光学相干断层扫描（FD-OCT）对VisuMax飞秒激光制作角膜帽的早期临床观察,评价帽厚度的精确性、重复性、均一性及规整性,并研究SMILE术后不同方向不同时间帽厚度变化及其角膜上皮等可能的影响因素。方法　回顾性研究。选取44例（87眼）拟行SMILE术的近视患者,采用FD-OCT测量术后1周、1个月角膜6 mm直径范围内水平和垂直子午线方向的角膜帽厚度。应用RVe软件工具在每个截面图上特定的7个点标定角膜帽的厚度。采用配对样本t检验分析术后帽厚度预期值与实际值差异及术后不同时间帽厚度差异,术后角膜帽厚度与术前参数等相关性采用Pearson线性相关分析。结果　精确性:术后实际角膜帽厚度均较理论值厚,差异均有统计学意义（均为P<0.05）;重复性:术后1周、1个月水平方向帽厚度标准差分别为2.64 μm、3.41 μm,术后1周、1个月垂直方向帽厚度标准差分别为3.36 μm、3.10 μm;均一性:术后1周水平方向各位点的帽厚度差异有统计学意义（t=3.246,P=0.004）、术后1个月水平方向各位点的帽厚度差异也有统计学意义（t=2.295,P=0.034）;术后1周、1个月垂直方向各位点帽厚度差异均无统计学意义（均为P>0.05）。术后不同时间帽厚度相关影响因素:中央角膜厚度（CCT）与术后1周、1个月角膜帽厚度均存在正相关性（r=0.438、0.360,P＜0.001、0.001）,术前角膜中央区上皮厚度与术后1周、1个月角膜帽厚度均存在正相关性（r=0.323、0.296,P=0.002、0.005）,且CCT对术后角膜帽厚度的影响较大。多元线性回归方程结果显示:术后1周角膜帽厚度=96.226+0.032×CCT+0.212×术前角膜中央区上皮厚度,术后1个月角膜帽厚度=97.022+0.029×CCT+0.219×术前角膜中央区上皮厚度。结论　飞秒激光制帽早期可有良好的可重复性,且角膜帽形态均一、规整。随着术前CCT及角膜中央区上皮厚度的增厚,术后帽厚度较预设帽厚度厚,影响制帽的精确性。其中术前角膜CCT是影响角膜帽厚度的主要因素。     

Management of cap striae following challenging small incision lenticule extraction surgery – A case report

A 24-year-old female underwent small incision lenticule extraction (SMILE) for myopic astigmatism OU. In the left eye, cap-lenticular adhesion along with tearing of the cap occurred, resulting in a gaped incision and transverse striae involving the visual axis on the first post op day. Uncorrected distance visual acuity (UDVA) was 20/32. The case was managed with interface wash and stretching of the cap, in order to iron out the striae. Post intervention, the UDVA improved to 20/20, striae resolved, and interface remained clear through a follow-up of nine months, suggesting that cap striae in SMILE may be similarly managed as the flap striae in laser-assisted in situ keratomileusis (LASIK), resulting in satisfactory visual outcomes.     

飞秒激光小切口基质透镜取出术术后角膜后表面的高度变化

目的观察飞秒激光小切口基质透镜取出术(SMILE)术后角膜后表面的高度变化,并与常规的准分子激光手术前弹力层下屈光性角膜成形磨镶术(SBK)比较。方法前瞻性非随机对照研究。选取同期行近视及近视散光矫正手术的患者100例(200只眼),其中SMILE患者50例(100只眼),SBK50例(100只眼)。每组再按术前的等值球镜(SE)分为低度近视组、中度近视组、高度近视组。采用Pentacam眼前节测量和分析系统分别于术前、术后1个月、3个月及6个月对患者进行测量,统计分析角膜后表面顶点高度变化及角膜后表面中央4 mm范围内的平均高度变化情况。采用独立样本t检验比较两组间术后角膜后表面高度的差异,采用方差分析对同一组内手术前后不同时间角膜后表面高度的变化进行分析。结果不同屈光度行SMILE和SBK术后角膜后表面的顶点高度变化及角膜中央4 mm范围内的平均高度变化无统计学差异;术后不同时间SMILE组低度、中度、高度近视3组之间的角膜后表面的顶点高度变化及角膜中央4 mm范围内的平均高度变化无明显统计学差异;术后不同时间SBK组低度、中度、高度近视三组之间的角膜后表面的顶点高度变化及角膜中央4 mm范围内的平均高度变化无明显统计学差异。术后不同时间SMILE和SBK两组角膜后表面的顶点高度变化及角膜中央4 mm范围内的平均高度变化的比较差异无统计学意义。结论尽管矫正相同屈光度SMILE去除的角膜组织要多,但与SBK比具有同样的角膜后表面稳定性,因而是安全的。     

SMILE术中应用十字定位法矫正低中度散光的临床效果

目的：采用Alpins矢量分析法评估飞秒激光小切口角膜基质透镜取出术(SMILE)术中应用十字定位法矫正低中度散光的临床效果。

方法：前瞻性随机对照研究。纳入2022-05/11在西安市第一医院激光近视治疗中心进行SMILE手术且散光度数≤1.50 D的低中度顺规散光患者50例81眼，依据随机表分为十字组患者25例41眼术中在进行标准SMILE程序之前术者根据十字交叉线调整患者头位，使患者双眼外眦与水平线对齐，眉心及鼻梁与垂直线对齐； 未用十字定位法的对照组25例40眼。观察两组患者术后3 mo视力及屈光情况，采用Alpins矢量分析法对散光变化进行分析评估。

结果：随访期间十字组失访6例11眼，对照组失访8例14眼。最终十字组纳入19例30眼，对照组纳入17例26眼。术后3 mo，两组患者术眼裸眼视力(UCVA)均≥1.0，均未出现严重并发症，两组间UCVA、最佳矫正视力(BCVA)、球镜度及等效球镜度比较均无差异(均P>0.05)。十字组柱镜度数0.00(0.00，0.00)D小于对照组-0.13(-0.50，0.00)D(P=0.01)。矢量分析结果显示，十字组的矢量误差(DV)低于对照组\〖0.00(0.00，0.00)vs 0.13(0.00，0.50)， P=0.01\〗，成功指数(IOS)优于对照组\〖0.00(0.00，0.00)vs 0.18(0.00，0.77)， P<0.01\〗。术后3 mo，十字组和对照组角度误差(AE)在±5°内的眼数分别为26眼(87%)、15眼(58%)。

结论：SMILE术中应用十字定位法校准患者头位，减小了SMILE矫正低中度散光的轴位误差，提高SMILE矫正低中度散光的精确性。     

Management of Advanced and Relapsed/Refractory Extranodal Natural Killer T-Cell Lymphoma: An Analysis of Stem Cell Transplantation and Chemotherapy Outcomes

Background

Extra-Nodal natural killer/T-cell lymphoma (ENKL) is a rare lymphoma representing approximately 5-10% of T-cell non-Hodgkin lymphomas diagnosed in the United States each year. Patients with advanced stage III/IV ENKL and relapsed refractory ENKL have a poor prognosis even despite aggressive therapy and stem cell transplantation (SCT). We conducted a review of the management of 37 patients with advanced-stage and relapsed/refractory ENKL in a predominantly non-Asian cohort evaluating both chemotherapy and SCT outcomes.

Effects of early treatment with zofenopril in patients with myocardial infarction and metabolic syndrome: the SMILE Study

Objective

To evaluate the clinical efficacy of the early administration of zofenopril in a group of patients with and without metabolic syndrome (MS+ and MS−) and anterior myocardial infarction enrolled in the Survival of Myocardial Infarction Long-Term Evaluation (SMILE) Study.

Methods

Patients were randomized double-blind to zofenopril (n = 719) or placebo (n = 699) for 6 weeks. The primary end point was the effect of treatment on the 6-week combined occurrence of death and severe congestive heart failure. The secondary end point was the 1-year mortality rate.

Results

Of the 1418 patients included in this post-hoc analysis, 686 (48.3%) had MS. After 6 weeks of treatment zofenopril significantly reduced the incidence of all-cause death and severe congestive failure (risk reduction: 69%, 95% CI: 7–78; 2p = 0.002) in MS+ patients. This was the case for 1-year mortality, too (29%, 95% CI: 4–41; 2p = 0.048). Zofenopril was effective also in MS− patients but the amount of relative risk reduction was less than in MS+ for both the primary (−11%; 2p = 0.61) and secondary endpoint (−19%; 2p = 0.025).

Conclusions

Results of this post-hoc analysis of the SMILE Study demonstrate the striking benefit of early administration of zofenopril in MS+ patients with acute anterior myocardial infarction.