小切口透镜取出术和Q值引导角膜屈光术的生物力学比较

摘要

目的：：比较全飞秒小切口透镜取出术( small-incision lenticule extraction,SMILE)与Q值引导飞秒辅助原位角膜磨镶术( femtosecond laser - assisted laser in situ keratomileusis,FS-LASIK)治疗近视眼术后患者角膜生物力学特性的变化,以探讨两种术式的生物力学稳定性,为临床术式的选择提供客观依据。方法：采用前瞻性临床研究方法,选择我院进行SMILE或Q值引导 FS-LASIK 的近视及近视散光患者102例200眼,其中SMILE组51例100眼,Q值引导FS-LASIK组51例100眼,分别于术前及术后1d,2wk,1、3mo使用眼反应分析仪( ocular response analyzer, ORA )测量角膜黏滞力( corneal hysteresis,CH)和角膜阻力因子( corneal resistance factor,CRF)。结果：SMILE组与Q值引导FS-LASIK组手术前后CH和CRF均较术前降低(P<0.01),然而术后各时间点间差异无统计学意义( P>0.05)。 SMILE 组与 Q 值引导 FS-LASIK组手术前与术后各时间点CH和CRF变化量的差异无统计学意义(P>0.05)。结论：SMILE与Q值引导FS-LASIK都会引起角膜生物力学特性的降低,且术后1d生物力学特性即趋于稳定。此外,Q值引导FS-LASIK与无瓣SMILE对角膜生物力学特性的改变无显著差异。%AlM: By comparing the changes of biomechanical properties of the cornea after small- incision lenticule extraction ( SMlLE ) and those after Q value guided femtosecond laser-assisted laser in situ keratomileusis ( FSLASlK ) , to study the stability of biomechanical properties of the cornea after these two kinds of surgery and provide objective data for clinical operation. METHODS: Prospective comparative cases. One hundred and two cases ( 200 eyes ) with myopia and myopic astigmatism were divided into 2 groups, 51 cases (100 eyes) for SMlLE, and 51 cases (100 eyes) for Q value guided FS-LASlK. Corneal hysteresis ( CH) and the corneal resistance factor ( CRF ) were quantitatively assessed with the Ocular Response Analyzer ( ORA ) preoperatively and 1d, 2wk, 1 and 3mo postoperatively.RESULTS: The decrease in CH and the CRF were statistically significant in both groups ( P < 0. 01 ). However, the changes subsequently stabilized with no further deterioration (P>0. 05). There were no statistically significant differences between the biomechanical changes in the two groups at any time (P>0. 05).CONCLUSlON: Both SMlLE and Q value guided FS-LASlK can cause biomechanical decreases in the cornea. After 1d postoperatively, the decreases are nearly stable. There are no significant differences between the effect of SMlLE and Q value guided FS - LASlK on the biomechanical properties of the cornea.