飞秒激光小切口透镜切除术与飞秒LASIK术后角膜后表面高度变化

目的　应用Ｏｒｂｓｃａｎ-Ⅱ眼前节分析系统探讨飞秒激光辅助的准分子激光原位角膜磨镶术（ｆｅｍｔｏｓｅｃｏｎｄｌａｓｅｒｉｎｓｉｔｕｋｅｒ-ａｔｏｍｉｌｅｕｓｉｓ，Ｆｓ-ＬＡＳＩＫ）和飞秒激光小切口透镜切除术（ｓｍａｌｌｉｎｃｉｓｉｏｎｌｅｎｔｉｃｕｌｅｅｘｔｒａｃｔｉｏｎ，ＳＭＩＬＥ）术后角膜后表面高度的变化。方法　前瞻性随机对照研究。选择２０１４年５月至１１月于我院行激光角膜屈光手术的近视患者（等效球镜度数≤ －６．００Ｄ）６０例（１１９眼），随机分成Ａ、Ｂ两组，每组３０例（Ａ组５９眼，Ｂ组６０眼）。Ａ组施行ＳＭＩＬＥ，Ｂ组施行Ｆｓ-ＬＡＳＩＫ，观察术后视力、屈光度等的变化。采用Ｏｒｂｓｃａｎ-Ⅱ眼前节分析仪，分别于术前、术后１个月对术眼进行眼前节图像采集，记录角膜后表面Ｄｉｆｆ值变化并进行对比。结果　术后１个月两组患者裸眼视力均比术前提高，但两组间相比差异无统计学意义（Ｐ＞０．０５）。术前最佳矫正视力与术后１个月相比差异均无统计学意义（均为Ｐ＞０．０５），术后最佳矫正视力两组间相比差异亦无统计学意义（Ｐ＞０．０５）。术前及术后１个月Ａ、Ｂ两组屈光度相比差异均无统计学意义（均为Ｐ＞０．０５）。两组后表面Ｄｉｆｆ值均较术前显著增加，其中Ａ组术前、术后分别为（０．０２７±０．００１）ｍｍ和（０．０５９±０．００１）ｍｍ（Ｐ＜０．０５）；Ｂ组术前、术后分别为（０．０２９±０．００１）ｍｍ和（０．０５４±０．００２）ｍｍ（Ｐ＜０．０５），但Ａ、Ｂ两组术后角膜后表面Ｄｉｆｆ值增加量相比差异无统计学意义（Ｐ＞０．０５）。结论　ＳＭＩＬＥ和Ｆｓ-ＬＡＳＩＫ矫正近视均安全有效，术后１个月角膜后表面高度均部分前移，其远期变化有待进一步探索。

Postoperative changes of posterior corneal surface height after small incision lenticule extraction and femtosecond LASIK

Objective To explore the posterior corneal surface elevation after small incision lenticule extraction ( SMILE ) and femtosecond LASIK ( Fs-LASIK) by Orbscan II anterior analysis system. Methods Randomized controlled study. Sixty cases of myopic patients ( 119 eyes) operated with laser corneal refractive in our hospital from May to November in 2014 ( spherical equivalent degree was《 - 6. 00 D) were selected and randomly divided into group A and group B,30 patients in each group (59 eyes rn group A and 60 eyes in group B) . Group A underwent SMILE , and group B with Fs-LASIK. The postoperative visual acuity and diopter were observed. With Orbscan-ll Scheimpflug imaging system ,the anterior segment image were collected at I month before and after the surgery respectively , the changes of the Diff value of posterior comeal surface were compared and analyzed. Results The postoperative uncorrected visual acuity in group A and group B at postoperative I month all improved, but no statistical difference between two groups was found (P > 0. 05 ) . The best corrected visual acuity at postoperative I month in two groups had no statistical difference compared with the pre-operation ( all P > 0. 05 ) , and the statistical difference between two groups was found (P > 0. 05). The preoperative and postoperative I month diopter between two groups had no statistical difference ( all P > 0. 05 ) . The postoperative Diff values of posterior corneal surface of the two groups were increased sigruficantly , which in group A were ( 0. 027 + 0. 001 ) mm and ( 0. 059 + 0. 001 ) mm ( P < 0. 05 ) , group B were ( 0. 029 + 0. 001 ) mm and ( 0. 054 + 0. 002 ) mm ( P < 0. 05 ) . The increased amount for postoperative posterior corneal height between group A and group B showed no statistical significance(P > 0. 05 ) . Conclusion SMILE and Fs-LASIK are safe and effective for myopia. The posterior corneal surface elevation is significantly increased at postoperative I month , and the changes later need to be explored further.