高度近视行不同激光角膜屈光术后角膜神经纤维的修复情况比较

doi:10.3760/cma.j.cn115909-20210415-00156

摘要
图/表
参考文献(18)
相关文章 (15)

全文: PDF 6980KB HTML (1 KB)
输出: BibTeX | EndNote (RIS) 背景资料

文章导读

摘要目的：探讨高度近视患者行飞秒激光小切口角膜基质透镜取出术（ SMILE）、飞秒激光制瓣的准分子
激光原位角膜磨镶术（ FS-LASIK）以及准分子激光角膜上皮瓣下磨镶术（ LASEK）后早中期角膜各区
域上皮下神经纤维的修复情况。方法：前瞻性临床研究。选择2018年6月至2020年12月在青岛大学
附属医院眼科就诊并进行屈光手术矫正的高度近视患者55 例（ 110 眼），按手术方式不同分为SMILE
组22 例（ 44 眼）、 FS-LASIK组18 例（ 36 眼）、 LASEK组15 例（ 30 眼）。各组于术后1、 3、 6 个月行激光
共聚焦显微镜检查，观察角膜各区域神经纤维的修复情况。对术后不同时间各组间的神经纤维各
参数的比较采用随机区组设计的单因素方差分析。结果：高度近视患者行SMILE术后早期不同区
域的角膜神经密度、分支密度、长度及宽度较FS-LASIK和LASEK术后更佳，修复速度也更快，较
早达到术前水平。而FS-LASIK术后包括角膜瓣在内的不同区域的角膜神经修复情况居于SMILE和
LASEK之间， LASEK术后早期特别是中央区白色瘢痕样混浊明显，且不同区域的角膜修复速度最慢、
质量最差。术后1 个月， SMILE组和FS-LASIK组术后中央的角膜神经密度（ CNFD）、神经纤维长度
（ CNFL）、神经分叉节点密度（ CTBD）明显优于LASEK组，差异均有统计学意义（均P<0.05）； SMILE
组的主要神经分叉节点密度（ CNBD）明显优于FS-LASIK组和LASEK组（ HSD=4.367， P=0.005；
HSD=4.237， P=0.008）。术后3 个月， SMILE组中央CNFD、 CNBD、 CNFL明显优于FS-LASIK和
LASEK组（均P<0.05）； LASEK组神经纤维宽度（CNFW）明显优于SMILE和FS-LASIK组（HSD=3.457，
P=0.003； HSD=3.668， P=0.004）。术后6 个月， SMILE组中央CNFD、 CNBD以及CNFL均优于FSLASIK和LASEK组（均P<0.05）。结论：高度近视患者行激光角膜屈光术后早中期， SMILE各区域的
神经修复情况较FS-LASIK和LASEK均有显著的领先优势。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	李江峰
	李慧
	李金键
	等

关键词 ：高度近视, 激光角膜屈光手术, 角膜神经, 神经修复, 共聚焦显微镜

Abstract：

Objective: To investigate the repair of corneal subepithelial nerve fibers in the early and middle stages

after small incision lenticule extraction (SMILE), femtosecond flap excimer laser in situ keratomileusis

(FS-LASIK) or laser epithelial keratomileusis (LASEK) in patients with high myopia. Methods: This

was a prospective clinical study. Fifty-five patients (110 eyes) with high myopia who were treated in the
Department of Ophthalmology at the Affiliated Hospital of Qingdao University were divided into a SMILE

group (44 eyes), FS-LASIK group (36 eyes) and LASEK group (30 eyes). The repair of corneal nerve

fibers was observed by laser confocal microscopy at 1, 3 and 6 months after the operations. Parameters

of nerve fibers at different time periuds after the operations was used one-way ANOVA of random block

design. Results: The corneal nerve distribution density, branch density, and length and width of different

areas in patients with high myopia were best in the early stage after SMILE compared with the other two

groups. The repair speed was also the fastest and reached the preoperative level earlier. Comparisons of

corneal nerve repair in different areas, including the corneal flap, showed that the repair rate for FS-LASIK

was between SMILE and LASEK. In the early stage after LASEK, especially in the central area, the

white scar turbidity was obvious, and the speed and quality of corneal repair in different areas were the

worst. The results of image analysis at the different time periods in each group suggested that the levels of

corneal nerve fiber density (CNFD), corneal nerve fiber length (CNFL) and corneal nerve fiber total branch

density (CTBD) in the center of the SMILE and FS-LASIK groups were significantly better than those

in the LASEK group at 1 month after the operation (all P<0.05). The CNBD of SMILE was significantly

better than that of both the FS-LASIK and LASEK groups (HSD=4.367, P=0.007; HSD=4.237, P=0.008).

Three months after the operation, the CNFD, CNBD, CNFL in the center of the SMILE operation were

significantly better than for both the FS-LASIK and LASEK groups (all P<0.05). The CNFW of the

LASEK operation was significantly better than that of both the SMILE and FS-LASIK groups (HSD=3.457,

P=0.003; HSD=3.668, P=0.004). Six months after the operation, the central CNFD, CNBD and CNFL

of the SMILE operation were better than those of both the FS-LASIK and LASEK groups, and the

difference was statistically significant (all P<0.05). Conclusions: In the early and middle stages after laser

keratomileusis, SMILE is significantly superior to FS-LASIK and LASEK for nerve repair in all regions.

Key words： high myopia laser corneal refractive surgery corneal nerve fiber nerve recovery microscope

收稿日期: 2021-04-15

PACS:

基金资助:山东省自然科学基金（ZR2019MH115）

通讯作者: 王青（ ORCID： 0000-0003-1341-6104）， Email： wangqing6836@sina.com

引用本文:

李江峰，李慧，李金键，等. 高度近视行不同激光角膜屈光术后角膜神经纤维的修复情况比较[J]. 中华眼视光学与视觉科学杂志, 2021, 23(12): 887-895. Jiangfeng Li, Hui Li, Jinjian Li,et al. A Comparative Study of the Repair of Nerve Fibers after Different Laser Keratomileusi Procedures. Chinese Journal of Optometry Ophthalmology and Visual science, 2021, 23(12): 887-895. DOI: 10.3760/cma.j.cn115909-20210415-00156

链接本文:

https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20210415-00156 或 https://www.cjoovs.com/CN/Y2021/V23/I12/887

[1]	Ikeda T, Shimizu K, Igarashi A, et al. Twelve-year follow-up oflaser in situ keratomileusis for moderate to high myopia. Biomed Res Int, 2017, 2017: 9391436. DOI: 10.1155/2017/9391436.
[2]	Marfurt CF, Cox J, Deek S, et al. Anatomy of the human cornealinnervation. Exp Eye Res, 2010, 90(4): 478-492. DOI: 10.1016/j.exer.2009.12.010.
[3]	Kheirkhah A, Syed ZA, Satitpitakul V, et al. Sensitivity andspecificity of laser-scanning in vivo confocal microscopy for filamentous fungal keratitis: Role of Observer Experience.Am J Ophthalmol, 2017, 179(7): 81-89. DOI: 10.1016/j.ajo.2017.04.011.
[4]	Patel DV, McGhee CN. In vivo laser scanning confocalmicroscopy confirms that the human corneal sub-basal nerve plexus is a highly dynamic structure. Invest Ophthalmol Vis Sci,2008, 49(8): 3409-3412. DOI: 10.1167/iovs.08-1951.
[5]	Erie JC, McLaren JW, Hodge DO, et al. Recovery of cornealsubbasal nerve density after PRK and LASIK. Am J Ophthalmol,2005, 140(6): 1059-1064. DOI: 10.1016/j.ajo.2005.07.027.
[6]	王力翔, 李莹. SMILE、FS-LASIK及T-PRK术后角膜神经纤维的恢复情况及其与主观视觉质量的相关性研究. 中华眼科杂志, 2018, 54(10): 737-743. DOI: 10.3760/cma.j.issn.0412-4081.2018.10.004.
[7]	Al-Aqaba MA, Fares U, Suleman H, et al. Architecture anddistribution of human corneal nerves. Br J Ophthalmol, 2010,94(6): 784-789. DOI: 10.1136/bjo.2009.173799.
[8]	Marfurt CF, Cox J, Deek S, et al. Anatomy of the human cornealinnervation. Exp Eye Res, 2010, 90(4): 478-492. DOI: 10.1016/j.exer.2009.12.010.
[9]	张琳, 王雁, 崔彤, 等. 飞秒激光小切口角膜基质透镜取出术后角膜透明度的临床观察. 中华眼科杂志, 2018, 54(1): 27-32.DOI: 10.3760/cma.j.issn.0412-4081.2018.01.006.
[10]	Dong Z, Zhou X, Wu J, et al. Small incision lenticule extraction(SMILE) and femtosecond laser LASIK: comparison of corneal wound healing and inflammation. Br J Ophthalmol, 2014, 98(2):263-269. DOI: 10.1136/bjophthalmol-2013-303415.
[11]	Netto MV, Mohan RR, Ambrósio R Jr, et al. Wound healing inthe cornea: a review of refractive surgery complications and new prospects for therapy. Cornea, 2005, 24(5): 509-522. DOI:10.1097/01.ico.0000151544.23360.17.
[12]	Jeon KI, Hindman HB, Bubel T, et al. Corneal myofibroblastsinhibit regenerating nerves during wound healing. Sci Rep,2018, 8(1): 12945. DOI: 10.1038/s41598-018-30964-y.
[13]	陈冲达. 通过Epi-LASIK与LASEK术的实验研究探讨术后haze形成的机制. 复旦大学, 2007.
[14]	Hindman HB, DeMagistris M, Callan C, et al. Impact of topicalanti-fibrotics on corneal nerve regeneration in vivo. Exp Eye Res, 2019, 181: 49-60. DOI: 10.1016/j.exer.2019.01.017.
[15]	Wei S, Wang Y. Comparison of corneal sensitivity between FSLASIKand femtosecond lenticule extraction (ReLEx flex) or small-incision lenticule extraction (ReLEx smile) for myopic eyes. Graefes Arch Clin Exp Ophthalmol, 2013, 251(10): 2495-2497. DOI: 10.1007/s00417-013-2272-0.
[16]	Calvillo MP, McLaren JW, Hodge DO, et al. Cornealreinnervation after LASIK: prospective 3-year longitudinal study. Invest Ophthalmol Vis Sci, 2004, 45(11): 3991-3996.DOI: 10.1167/iovs.04-0561.
[17]	刘君华, 王愉思. 周围神经损伤修复的新进展. 中国实用医药,2009, 4(35): 220-222. DOI: 10.3969/j.issn.1673-7555.2009.35.179.
[18]	Kanellopoulos AJ, Asimellis G. Three-dimensional LASIKflap thickness variability: topographic central, paracentral and peripheral assessment, in flaps created by a mechanical microkeratome (M2) and two different femtosecond lasers(FS60 and FS200). Clin Ophthalmol, 2013, 7: 675-683. DOI:10.2147/OPTH.S40762.