SMILE术后眼前节变化对眼压测量值的影响

目的：探讨飞秒激光小切口角膜基质透镜取出术（SMILE）后眼压（IOP）检测的影响因素，分析眼前 节参数变化与IOP的关系。方法：前瞻性临床研究。收集2020年6—11月在青岛大学附属医院眼科 接受SMILE手术患者141例（258眼)的资料。根据剩余基质床厚度（RST）分为3组，分别为A组（280 μm

Influence of Changes in Anterior Segment Parameters on Intraocular Pressure Measurement after SMILE

Objective: To discuss the factors that influence intraocular pressure (IOP) after small incision lenticule extraction (SMILE), and to analyze the anterior segment parameters that influence changes in IOP.Methods: In this prospective clinical study, 141 patients (258 eyes) with myopic astigmatism who underwent SMILE surgery at the Affiliated Hospital of Qingdao University from June to November 2020 were enrolled. They were divided into three groups according to the residual stromal thickness (RST): 280 μm -320 μm in group A, 320 μm -360 μm in group B, >360 μm in group C. Tomography and biomechanical parameters of all eyes were obtained with Pentacam and Corvis ST, respectively. The changes in parameters were observed preoperatively and at 1, 3 and 6 months postoperatively. The data were analyzed by a measurement analysis of variance, Pearson linear correlation and paired t-test. Results: Except for the anterior chamber angle (ACA), the postoperative CCT, anterior chamber depth (ACD), anterior chamber volume (ACV) and other anterior segment morphological parameters in each group were generally lower than those before surgery, with statistically significant differences (all P<0.05). The first applanation time (A1T) and stiff parameter (SP-A1) decreased, the deformation amplitude (DA) and the peak distance (PD) at 6 months after the operation in the three groups were compared with those before the operation and Ambrosio relational thickness horizonal (ARTh) increase. For pairwise comparison between the groups, the ranges in the changes in ? A1T, ? A1V, ? DA, and ? PD in group A were greater than those for the other two groups, with statistically significant differences (all P<0.05). ? IOP and spherical equivalent (SE), preoperative IOP (IOPpre), ? CCT, changes in corneal volume (? CV), changes in central anterior chamber depth (? ACD) and changes in anterior chamber volume (? ACV) were positively correlated (all P<0.05). However, there was no correlation with the change in the anterior chamber angle (? ACA) (all P>0.05). In group A, ? ACD and ? ACV had a medium and low positive correlation with ? A1T, ? SP-A1, and ? ARTh, and a low negative correlation with ? DA (all P<0.05). A multiple linear regression equation of ? IOP was established for each group, and the corrected equation for the postoperative IOP was obtained: Group A, IOPpost corrected=IOPpost measured+0.572×IOPpre+15.759× ? ACD-2.401 (after adjustment R2 =0.55, P<0.001); Group B, IOPpost corrected=IOPpost measured+0.471×IOPpre+0.54×SE-1.099× ? CV-3.551 (after adjustment R2 =0.50, P<0.001); Group C, IOPpost corrected=IOPpost measured+0.447×IOPpre+0.304×SE-4.013 (after adjustment R2 =0.38, P<0.001). Conclusions: The changes in ACD and ACV have a positive correlation with ? IOP after SMILE. When the RST is in the range of 280-320 μm, the change in anterior chamber parameters should be considered in the measurement of IOP.