FS-LASIK联合胶原交联术后的早期临床观察

目的：探讨飞秒激光辅助准分子激光原位角膜磨镶术(femtosecond laser-assisted excimer laser in situ keratomileusis，FS-LASIK)联合胶原交联术后的早期安全性和有效性。

方法：选取2016-07/2017-08我院接受飞秒辅助LASIK联合胶原交联术近视患者30例60眼，分别于术前、术后1、3mo检查裸眼视力。应用角膜地形图(TMS)测量陡峭K值(Ks)、平坦K值(Kf)、角膜规则指数(SRI)、角膜非对称指数(SAI)。眼反应分析仪(ocular response analyzer，ORA)检测角膜补偿眼压(corneal compensated intraocular pressure，IOPcc)、模拟Goldmann眼压(Goldmann correlated IOP value，IOPg)、角膜阻力因子(corneal resistance factor，CRF)、角膜滞后量(corneal hysteresis，CH)。伽利略眼前节分析值包括前后表面屈光度和角膜厚度分布。角膜内皮细胞计数仪器进行内皮计数检查，比较手术前后各指标的差异。

结果：术后1d 26眼(43%)、1mo 55眼(92%)、3mo 50眼(83%)裸眼视力保持0.8以上。术后1mo与术前比较，IOPcc、IOPg、CRF、CH较术前显著降低，差异均有统计学意义(P<0.01)。术后3mo与1mo比较，IOPcc、IOPg、CRF、CH值无统计学差异(P>0.05)。角膜地形图参数：术后1mo与术前比较，Ks、Kf显著下降(P<0.01)，SRI、SAI显著上升(P<0.01)； 术后3mo与1mo比较，Ks有显著升高(P<0.05)，Kf变化无统计学差异(P>0.05)，SRI、SAI有显著下降(P<0.05)。伽利略眼前节分析中：模拟角膜曲率计陡峭K值(Sim Ks)、模拟角膜曲率计平坦K值(Sim Kf)在3mo较1mo有0.94D和0.95D的增长。另外，前后表面Kf值3mo较1mo明显增加，差异有统计学意义(P<0.01)； 而Ks值差异无统计学意义(P>0.05)。同时，中心点、厚度最薄点，术后3mo与1mo角膜厚度差异无统计学意义(P>0.05)。角膜内皮计数检查：术前(3059.95±247.87/mm²)与术后1mo(3052.87±267.71/mm²)比较，差异无统计学意义(t=0.279，P>0.05)。

结论：屈光角膜手术联合胶原交联术对于度数高和角膜薄、角膜厚度分布不均、地形图异常(除外圆锥角膜)的患者治疗安全有效。

Efficacy at early stage after FS-LASIK with accelerated corneal collagen cross-linking

AIM:To evaluate the safety and efficacy at early stage after femtosecond laser-assisted excimer laser in situ keratomileusis(FS-LASIK)combined with collagen cross-linking.

METHODS: Totally 30 myopia patients(60 eyes)received FS-LASIK combined with collagen cross-linking from July 2016 to August 2017 in our hospital were tested the uncorrected visual acuity(UCVA), Ks, Kf, surface regular index(SRI), surface asymmetry index(SAI)by corneal topography(TMS)preoperatively, 1, 3mo after operation. The corneal compensated intraocular pressure(IOPcc), Goldmann correlated IOP value(IOPg), corneal resistance factor(CRF), corneal hysteresis(CH)tested by ocular response analyzer(ORA)were also observed. Ziemer Galilei Dual Scheimpflug Analyzer detected the anterior diopter and the corneal thickness. Endothelial cell density were examined.

RESULTS:The postoperative UCVA remained beyond 0.8 including 26 eyes(43%)of 1d, 55 eyes(92%)of 1mo, 50 eyes(83%)of 3mo. IOPcc, IOPg, CRF, CH at postoperative 1mo significantly decreased comparing with preoperative(P<0.01). IOPcc, IOPg, CRF, CH at postoperative 3mo did not change significantly comparing with 1mo(P>0.05). The corneal topographic map parameters of Ks and Kf significantly decreased at postoperative 1mo(P<0.01), while SRI and SAI increased significantly(P<0.01)on comparison of 1mo and preoperative. Ks of postoperative 3mo was significantly higher than that of 1mo(P<0.05), while Kf did not change significantly(P>0.05). There was a significant decrease in SRI and SAI between 3mo and 1mo after operation(P<0.05). In Galileo analysis on comparison of 3mo and 1mo, Sim Ks, Sim Kf had 0.94D, 0.95D growth and the front and back surface value of Kf increased more at 3mo postoperative(P<0.01), while Ks was no significant difference(P>0.05). There was no statistically significant difference in corneal thickness between the central point and the thinnest point(P>0.05). There was no significant endothelial cell loss throughout follow up(3059.95±247.87/mm² vs 3052.87±267.71/mm²; t=0.279, P>0.05).

CONCLUSION: Refractive corneal surgery combined with collagen cross linking for high degree, thin cornea, uneven thickness of the cornea, topographic anomalies except for the patients with keratoconus, play a role in stabilizing corneal shape and increasing corneal biomechanics early.