FS-LASIK与SMILE术后角膜上皮重塑的比较

目的观察飞秒激光制瓣联合准分子激光原位角膜磨镶术(femtosecond laser in situ keratomileusis,FS-LASIK)与飞秒激光小切口角膜基质透镜取出术(small incision lenticular extraction,SMILE)术后角膜上皮重塑的特征。方法按照手术方式分为两组,FS-LASIK组29例(58眼),SMILE组31例(61眼),年龄(26±6.5)岁,术前等效球镜度数为(-5.25±2)D,分别于术前,术后1个月、3个月及6个月应用眼前节OCT对患者角膜中央2 mm、2~5 mm上皮厚度进行测量。结果术后1个月FS-LAISK组角膜中央2 mm与角膜2~5 mm范围内的平均角膜上皮增厚差异存在统计学意义(P=0.036);术后3个月2~5 mm范围,角膜上皮在上方、鼻上方、颞上方与下方、颞下方、鼻下方相比,增厚更轻微,差异均有统计学意义(P=0.042,P=0.031,P=0.049);术后6个月SMILE组角膜中央2 mm、角膜2~5 mm的角膜上皮增厚差异存在统计学意义(P=0.047),2~5 mm范围内,角膜上皮在上方、鼻上方、颞上方与下方、颞下方、鼻下方相比,增厚更轻微,差异均有统计学意义(P=0.012,P=0.035,P=0.009),上方与鼻侧、颞侧相比,增厚更少,差异有统计学意义(P=0.045,P=0.017);FS-LASIK组,术后1至6个月角膜上皮增厚在0~2 mm内逐渐下降,差异有统计学意义(P=0.035);术后各个时间段中,FS-LASIK组与SMILE组角膜上皮厚度在0~5 mm范围内各个位点差异均有统计学意义(P<0.05)。结论FS-LASIK术后角膜上皮增厚较SMILE术后更加明显。FS-LASIK术后角膜上皮增厚在角膜切削中央区域变化更加明显,SMILE术后角膜上皮增厚在角膜切除周边区域变化更加明显。随着时间推移,两种手术术后均出现与切口位置相反的角膜上皮局部继续增厚的表现。

Comparison of corneal epithelial remodeling after FS-LASIK and SMILE treatment for myopia and astigmatism

Objective To compare the characteristics of corneal epithelial remodeling after FS-LASIK and SMILE. Methods There were 33 males(65 eyes)and 27 females(54 eyes)with an average age of 26±6.5years. The mean spherical equivalent was -5.25±2 D. Patients were divided into two groups: the FS-LASIK group(29 patients, 58 eyes)or SMILE group(31 patients, 61 eyes). The RTvue-OCT system was used to measure the epithelium thickness within 0-2 mm and 2-5 mm from the central cornea of patients before and 1, 3, and 6 months after surgery. Results One month after surgery, however, there was a statistical difference between the average corneal epithelium thickness within 2 mm and 2-5 mm from the cornea in the FS-LASIK group (P=0.036). In the superior, nasal superior, temporal superior region, the thickness of the corneal epithelium within 2-5 mm increased less than the inferior, nasal inferior, and temporal inferior regions. These differences were statistically significant (P=0.042, P=0.031, P=0.049, respectively). There was a statistically significant difference between the average corneal epithelium thickness within 2 mm and 2-5 mm of the cornea in the SMILE group at 6 months after operation (P=0.047). In the range of 2-5 mm, the corneal epithelium thickness increased less in the superior, nasal superior, temporal superior regions than the thickness in the inferior, nasal inferior, and temporal inferior regions. These differences were statistically significant (P=0.012, P=0.035, P=0.009, respectively). Compared with the nasal and temporal sides, the thickness of the superior part was less, and the difference was statistically significant (P=0.045, P=0.017, respectively). For the FS-LASIK group, the corneal epithelium thickened from 1 to 6 months after surgery. It gradually decreased within 2 mm, and this difference was statistically significant (P=0.035). During this time period, the corneal epithelial thickness of the FS-LASIK group and the SMILE group was statistically significant at each position within a range of 0-5 mm (P<0.05). Conclusion Corneal epithelium thickening is more pronounced in FS-LASIK than in SMILE post-operation. The corneal epithelium thickening in FS-LASIK changes more obviously in the central area of the corneal resection. The corneal epithelium thickening in SMILE changes more obviously in the peripheral area of the corneal resection. Over time, the localized thickening of the corneal epithelium, which is located opposite to the incision location, continued after both procedures.