Sirius眼前节分析仪测量飞秒激光制瓣LASIK术后角膜后表面的变化

doi:DOI:10.3760/cma.j.issn.1674-845X.2016.06.010

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摘要

目的使用Sirius眼前节分析仪测量飞秒激光制瓣LASIK术后角膜后表面形态，并分析其影响因素。方法前瞻性非随机临床研究。73例（146眼）近视患者纳入本研究。其中，男35例，女38例。年龄19~36岁，平均（25.7±5.1）岁。等效球镜度（SE）-10.25～-4.50 D，平均（-6.95±1.97）D。使用Sirius眼前节分析仪测量术前及术后1个月3、5、7 mm区域角膜后表面曲率。将术后1个月角膜后表面曲率变化值（ΔK）与切削百分比（AD/CT）、切削深度（AD）、残留基质厚度（RBT）及SE进行Pearson相关分析，并进一步采用逐步回归法对ΔK的影响因素行多元线性回归分析。结果术后1个月，3、5 mm直径区域角膜后表面曲率均比术前增加，差异有统计学意义（t=3.58、3.36，P<0.01）。ΔK3 mm、ΔK5 mm、ΔK7 mm与AD/CT（r=0.845、0.833、0.753，P<0.01）和AD（r=0.725、0.727、0.603，P<0.05）呈正相关，而与SE（r=-0.762、-0.756、-0.674，P<0.05）和RBT（r=-0.784、-0.733、-0.864，P<0.01）呈负相关。多元线性回归分析发现AD/CT、RBT为ΔK3 mm的影响因素（β=2.048、-0.002，95%CI：0.489~3.607、-0.003~0，P<0.1）； AD/CT为ΔK5 mm的影响因素（β=2.005，95%CI：1.068~3.942，P<0.1）；RBT、SE为ΔK7 mm的影响因素（β=-0.003、-0.325，95%CI：-0.004~0.002、-0.786~0.428，P<0.1）。结论飞秒激光制瓣LASIK术后角膜后表面微量前凸，在保证手术效果的前提下，控制切削比，保留足量残留基质厚度，可以尽量避免术后角膜扩张、屈光回退等并发症的发生。

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	王世明
	李小萍
	顾林丹
	傅蒋伟

关键词 ：角膜地形图, 飞秒激光, 角膜磨镶术, 激光原位, 角膜后表面

Abstract：

Objective To investigate changes in posterior corneal curvature (ΔK) in post-femtosecond LASIK patients using Sirius topography, and to analyze its relationship with ablation percentage (AD/CT) and depth (AD), residual bed thickness RBT, and spherical equivalent (SE). Methods This was a prospective nonrandomized study. Seventy-three post-femtosecond LASIK patients were recruited for this study (146 eyes; aged 19 to 36 years, mean 25.7±5.1 years; spherical equivalent -10.25 to -4.50 D, mean -6.95±1.97 D). Posterior corneal curvature was measured by Sirius topography pre-surgery and at 1 month post-surgery. The correlations between ΔK and AD/CT, AD, RBT, and SE were analyzed. Results One month post-surgery, the posterior corneal curvatures of the 3 mm and 5 mm diameter range were higher than those for pre-surgery (t=3.58, 3.36; P<0.01). Univariate regression analyses showed that the ΔK3 mm, ΔK5 mm, and ΔK7 mm were positively correlated with their AD/CT (r=0.845, 0.833, 0.753; P<0.01) and AD (r=0.725, 0.727, 0.603; P<0.05). The ΔK3 mm, ΔK5 mm, and ΔK7 mm were negatively correlated with the SE (r=-0.762, -0.756, -0.674; P<0.05) and RBT (r=-0.784, -0.733, -0.864; P<0.01). A stepwise multiple linear analysis was used to determine the factors associated with ΔK. AD/CT and RBT were the factors that influenced ΔK3 mm (β=2.048, -0.002; 95%CI: 0.489~3.607, -0.003~0; P<0.1); AD/CT was the factor that influenced ΔK5 mm (β=2.005; 95%CI: 1.068~3.942; P<0.1); RBT and SE were the factors that influenced ΔK7 mm (β=-0.003, -0.325; 95%CI: -0.004~0.002, -0.786~0.428; P<0.1). Conclusion This research shows that the corneal posterior surface has a slightly forward shift in post-femtosecond LASIK patients. The ΔK is related to ablation percentage and depth, spherical equivalent, and residual bed thickness.

Key words： Corneal topography Femtosecond laser Keratomileusis, laser in situ Posterior corneal curvature

收稿日期: 2016-02-01

通讯作者: 王世明，Email：wsm1981711@163.com

引用本文:

王世明,李小萍,顾林丹,傅蒋伟. Sirius眼前节分析仪测量飞秒激光制瓣LASIK术后角膜后表面的变化[J]. 中华眼视光学与视觉科学杂志, 2016, 18(6): 368-372. Wang Shiming,Li Xiaoping,Gu Lindan,Fu Jiangwei. The changes in posterior corneal curvature measured by Sirius topography in post-femtosecond LASIK patients. Chinese Journal of Optometry Ophthalmology and Visual science, 2016, 18(6): 368-372.

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