Visumax飞秒激光辅助制瓣LASIK术中不透明气泡层及相关因素

摘要

目的:研究Visumax飞秒激光辅助的准分子激光原位角膜磨镶术(LASIK)术中不透明气泡层(OBL)产生的类型、相关影响因素及其临床意义.方法:回顾性分析.收集2016年7月1日至8月20日在南京医科大学附属眼科医院行飞秒LASIK的患者154例(300眼)的临床资料,等效球镜度为(-5.88±1.51)D.飞秒激光采用Zeiss公司Visumax飞秒激光仪,将术中产生的OBL分为瓣外OBL、瓣内快速OBL和瓣内慢速OBL.300眼按角膜曲率平均K值分为A组(＜42 D)、B组(42～46 D)和C组(＞46 D);按角膜瓣的厚度分为D组(100 μm)、E组(110μm)和F组(120μm);按角膜厚度分为G组(＜500 μm)、H组(500～ 540 μm)和I组(＞540 μm).统计不同角膜曲率、角膜瓣厚度、角膜厚度情况下3种OBL产生的比例,并采用多元Logistic回归模型进行统计分析.结果:300眼均发生OBL.以瓣外OBL作为参照,角膜瓣越薄,越容易出现瓣内快速OBL(r=-0.719,P=0.034)和瓣内慢速OBL(r=-0.875,P=0.044).以瓣内慢速OBL作为参照,角膜曲率越高,越容易出现瓣内快速OBL(r=0.923,P=0.046);角膜瓣越厚,越容易出现瓣外OBL(r=0.897,P=0.044).结论:OBL的产生与角膜曲率、角膜瓣厚度、角膜厚度均存在一定的相关性,但瓣外OBL、瓣内快速OBL和瓣内慢速OBL对Visumax飞秒激光辅助的LASIK术后视觉质量的影响及远期疗效仍有待进一步观察研究.%Objective:To study the types,related factors and clinical significance of opaque bubble layer (OBL)produced by Visumax femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK).Methods:A total of 154 patients (300 eyes) who underwent FS-LASIK in the Affiliated Eye Hospital of Nanjing Medical University from July 1,2016 to August 20,2016 were analyzed retrospectively.Eighty-seven males and 67 females were included,with an equivalent spherical refractive error of-5.88±1.51 D.A Zeiss Visumax was used for the surgery.The OBL created during surgery were classified into three categories,including OBL outside flap,rapid OBL within flap,and slow OBL within flap.Three hundred eyes were divided into three groups based on the average K value of the corneal curvature:Group A (＜42 D),Group B (42-46 D) and Group C (＞46 D);On the basis of the thickness of the corneal flap:Group D (100 μm),Group E (110 μm) and Group F (120 μm);and corneal thickness:Group G (＜500 μm),Group H (500-540 μm)and Group I (＞ 540 μm).The composition ratio of the 3 types of OBL was calculated on the basis of corneal curvature,corneal flap thickness and corneal thickness,and a multiple logistic regression model was used for statistical analysis.Results:All 300 eyes developed OBL.With the OBL outside flap as a reference,the thinner the corneal flap was,the easier the rapid OBL within flap developed (r=-0.719,P=0.034) and the easier the slow OBL within flap developed (r=-0.875,P=-0.044).With the slow OBL within flap as a reference,the higher the corneal curvature was,the easier the rapid OBL within flap developed (r=0.923,P=0.046);a thicker corneal flap had a greater tendency to develop an OBL outside flap (r=0.897,P=0.044).Conclusions:There is a specific correlation between the generation of OBL and corneal curvature,corneal flap thickness,and corneal thickness.The visual quality and long-term effect influenced by the three types of OBL produced by Visumax FS-LASIK need further study.