切口水润法与常规分离方法对SMILE手术患者角膜上皮损伤、角膜主观感受、视力恢复以及对比敏感度影响的比较研究

目的　对比分析切口水润法与常规分离方法对飞秒激光小切口角膜基质透镜取出术（SMILE）后患者角膜上皮损伤、角膜主观感受、视力恢复及对比敏感度的影响。方法　随机选取2015年6月至2018年6月在我院眼科屈光中心行SMILE手术的患者60例（120眼）。将患者随机对等分成两组:常规分离组30例（60眼）和切口水润组30例（60眼）。常规分离组分离方法:用吸血海绵擦净结膜囊水分，用透镜分离铲起瓣，先后分离基质透镜的上下表面，再用微透镜镊取出角膜基质透镜。切口水润组辅助分离技术:用吸血海绵擦净结膜囊水分，透镜分离铲细头蘸1滴乳酸钠林格注射液浸润切口后起瓣，用透镜分离铲钝头蘸1滴平衡盐溶液浸润切口后，再分别分离基质透镜的上下表面，最后用微透镜镊头部蘸1滴平衡盐溶液浸润切口，之后取出角膜基质透镜。对比分析两组患者术后角膜上皮损伤、角膜主观感受、视力恢复以及对比敏感度。结果　术后1 d常规分离组发生切口周边角膜上皮损伤者21眼，切口水润组3眼，常规分离组术后切口角膜上皮损伤发生率高于切口水润组，差异有统计学意义（P<0.05）。常规分离组患者术后当天、术后1 d及术后3 d角膜主观感受评分均高于切口水润组，差异均有统计学意义（t=12.276、11.294、5.065，均为P＜0.05）。术后1 d～1 a，两组患者裸眼视力差异均无统计学意义（均为P>0.05）。术后1个月，0.05～0.80干涉条纹视力下两组对比敏感度差异均无统计学意义（均为P>0.05）。结论　在SMILE手术中使用切口水润法辅助分离技术,不仅能达到和常规分离方法一样的临床效果,还能减少切口角膜上皮损伤，改善患者舒适度。

Comparative analysis of the effects of incision hydration technology and conventional separation method on corneal epithelial injury,corneal subjective perception,visual acuity recovery and contrast sensitivity in patients undergoing SMILE surgery

Objective　To compare and analyze the effects between incision hydration technology and conventional separation method on corneal epithelial injury, corneal subjective perception, visual acuity recovery and contrast sensitivity in patients undergoing femtosecond laser small incision lenticule extraction (SMILE).Methods　A total of 60 patients (120 eyes) who underwent SMILE surgery in the optometric center of our hospital from June 2015 to June 2018 were randomly selected. The patients were randomly divided into two groups: conventional separation group (30 patients, 60 eyes) and incision hydration group (30 patients, 60 eyes). In the conventional separation group, we wiped the water of the conjunctival sac with blood sucking sponge, separated the flap with shovel, successively separated the upper and lower surfaces of the stromal lens, and then removed the stromal lens with microlens forceps, while in the incision hydration group, we cleaned the conjunctival sac with blood sponge, after the incision was infiltrated with 1 drop of sodium lactate injection by the thin head of the shovel, we spitted the flap, and subsequently, we used the blunt head of the shovel to infiltrate the incision with 1 drop of balance salt water, then separated the top and bottom surface of the lens, and infiltrated the incision with 1 drop of balance salt water from microlens forceps, and finally, removed the corneal stromal lens. Postoperative corneal epithelial injury, corneal subjective perception, visual acuity recovery and contrast sensitivity were compared between the two groups.Results　There were 21 eyes with corneal epithelial injury around the incision in the conventional separation group and 3 eyes in the incision hydration group. The incidence of corneal epithelial injury in the conventional separation group was higher than that in the incision hydration group, and the difference was statistically significant (P<0.05). The corneal subjective perception scores of the conventional separation group were higher than those of the incision hydration group on the day after surgery, 1 day after surgery and 3 days after surgery, with statistical significance (t=12.276,11.294,5.065, all P<0.05). There was no significant difference in visual acuity between the two groups from 1 day to 1 year after surgery (P>0.05). One month after operation, there was no significant difference in contrast sensitivity between the two groups at different spatial frequencies from 0.05 IVA to 0.80 IVA (all P<0.05).Conclusion　The use of incision hydration technology in SMILE surgery can not only achieve the same clinical effect as the conventional separation method, but also reduce the injury of corneal epithelium around the incision and improve the comfort of patients.