Нейротрофическая эпителиопатия у пациентов, длительно пользующихся контактными линзами до и после операций ReLEx SMILE и Фемто-ЛАЗИК

摘要

Long-term wearing of contact lenses leads to the development of hypoxic keratopathy (HK), moderately manifested in neurotrophic epitheliopathy (NE) and signs of aseptic inflammatory reaction. HK is one of the main risk factors for the development of dysregenerative conditions after corneal refractive surgery (CRS). Purpose. To study the features of NE in patients with moderate HK before and after correction of refractive disorders using ReLEx SMILE and Femto-LASIK, to evaluate the effectiveness of pathogenetically oriented pharmaceutical correction of NE. Material and methods. 56 patients (56 eyes) with moderate myopia, long-term (more than 5 years) contact lenses (CL) using. The mean age of patients was 27.3±1.9 years. In addition to the standard exams was performed staining of the cornea fluorescein solution and confocal microscopy of the cornea with a rating of epithelium and Bowman’s mebrane status. Pharmaseutical correction of HK was carried out with use of steroid anti-inflammatory drugs, complex artificial tears (Artelac?- Balance) and reparative gel (Corneregel). Correction of refractive errors was performed by ReLEx SMILE technology (group 1) and Femto-LASIK technology (group 2). Results and discussion. It was shown that the signs of modarte HK can be fixed by pathogenetically oriented correction with the restoration of architectonics of the epithelium, reducing the number of inflammatory elements and relief of biomicroscopic signs of NE. Conclusion. 1. It was noted that preoperative detection of signs of HK, their pathogenetic-oriented correction and the choice of methods of CRS based on the condition of the ocular surface is necessary. 2. CRS in patients with HK and peripherical corneal neovascularization by ReLEx SMILE carries a lower risk compared to Femto-LASIK in the aspect of vascular damage, however, requires caution in the manipulation of the epithelium of the region of incision. 3. A smaller degree and faster involution of reactive changes after the ReLEx SMILE was revealed, which is probably caused by the preservation of the Raiser subepithelial plexus.