LASIK和LASEK术后角膜神经损伤恢复情况比较

doi:10.3760/cma.j.issn.1674-845X.2014.08.010

摘要
图/表
参考文献(0)
相关文章 (15)

全文: PDF 1402KB HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要

目的通过测定LASIK和LASEK术后角膜上皮下神经丛密度、角膜知觉变化，评估2种手术方式对角膜神经损伤的情况。方法前瞻性临床病例研究。选取河北省沧州市中心医院LASIK手术患者102例（204眼），LASEK手术患者34例（68眼）。测定2组术前，术后1周、1个月、3个月、6个月、1年、2年时角膜上皮下神经丛密度和角膜知觉，对上述2个指标采用重复测量方差分析进行比较。结果术前LASIK组角膜上皮下神经丛密度和角膜知觉分别为（1 582±175）µm、（58.82±0.53）mm。术后1周[（208±32）µm]、1个月[（254±32）µm]、3个月[（588±65）µm]、6个月[（648±65）µm]、1年[（938±119）µm]时角膜上皮下神经丛密度均较术前降低（F＝7.13，P<0.05）；术后2年时恢复到术前水平（t＝0.147，P>0.05）。术后1周[（0.59±0.40）mm]、1个月[（15.59±2.67）mm]、3个月[（41.18±3.44）mm]、6个月[（52.88±2.58）mm]时角膜知觉均较术前降低（F＝78.13，P<0.05）；术后1年时恢复到术前水平（t＝1.144，P>0.05）。术前LASEK组角膜上皮下神经丛密度和角膜知觉分别为（1 406±195）μm、（58.82±0.53）mm。术后1周[（182±33）µm]、1个月[（538±83）µm]、3个月[（784±74）µm]、6个月[（1024±74）µm]时角膜上皮下神经丛密度均较术前降低（F＝34.51，P<0.05）；术后1年时恢复到术前水平（t＝1.906，P>0.05）；术后1周[（1.18±0.53）mm]、1个月[（38.82±3.11）mm]、3个月[（55.29±1.00）mm]时角膜知觉均较术前降低（F＝361.98，P<0.05）；术后6个月时恢复到术前水平（t＝0.899，P>0.05）。LASEK组在术后1个月、3个月、6个月时角膜知觉恢复优于LASIK组，其余时间点差异无统计学意义。LASEK组在术后6个月和1年时角膜上皮下神经丛密度恢复优于LASIK组，其余时间点差异无统计学意义。结论 LASIK和LASEK术后角膜上皮下神经丛密度、角膜知觉均较术前降低；LASEK术后角膜上皮下神经丛密度、角膜知觉恢复均优于LASIK。

	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
	牛广增
	范玉香
	高瑞新
	王连丰
	苏蕊
	白东升

关键词 ：角膜上皮下神经丛密度, 角膜知觉, 角膜磨镶术, 激光原位, 角膜切削术, 上皮下, 激光

Abstract：

Objective To study corneal nerve damage by observing the corneal subepithelial nerve plexus density and corneal sensitivity after LASIK and LASEK. Methods In this prospective clinical study， 102 LASIK （204 eyes） and 34 LASEK （68 eyes） postoperative patients from the Central Hospital of Cangzhou City were enrolled. Nerve plexus density under corneal epithelium basal cells and corneal sensitivity were examined in both groups 1 day preoperatively and 1 week， 1 month， 3 months， 6 months， 1 year， and 2 years after the surgery. Repeat measured ANOVA was used to statistically analyze and compare the above two indicators. Results The LASIK group： corneal subepithelial nerve plexus density was 1 582±175 μm preoperatively and 208±32 μm at 1 week， 254±32 μm at 1 month， 588±65 μm at 3 months， 648±65 μm at 6 months， and 938±119 μm at 1 year. All measurements had decreased significantly after surgery （F＝7.13， P<0.05）. However， the measurements had almost returned to preoperative levels 2 years after surgery （t＝0.147， P>0.05）. Corneal sensitivity was 58.82±0.53 mm preoperatively and 0.59±0.40 mm at 1 week， 15.59±2.67 mm at 1 month， 41.18±3.44 mm at 3 months and 52.88±2.58 mm at 6 months. All measurements had decreased significantly after the surgery （F＝78.13， P<0.05）. However， the measurements had almost returned to preoperative levels at 1 year after surgery （t＝1.144， P>0.05）. The LASEK group： corneal subepithelial nerve plexus density was 1 406±195 μm preoperatively and was 182±33 μm at 1 week， 538±83 μm at 1 month， 784±74 μm at 3 months， and 1 024±74 μm at 6 months. All measurements had decreased significantly after surgery （F＝34.51， P<0.05）. However， the measurements had almost returned to preoperative levels at 1 year after surgery （t＝1.906， P>0.05）. Corneal sensitivity was 58.82±0.53 mm preoperatively and 1.18±0.53 mm at 1 week， 38.82±3.11 mm at 1 month， and 55.29±1.00 mm at 3 months. All measurements had decreased significantly after the surgery （F＝361.98， P<0.05）. However， measurements had almost returned to preoperative levels 6 months after surgery

Key words： Nerve plexus density under corneal epithelium basal cells Corneal sensation Keratomileusis laser in situ Keratectomy subepithelial laser-assisted

通讯作者: 范玉香，Email：fyx13932798599@139.com

引用本文:

牛广增,范玉香,高瑞新,王连丰,苏蕊,白东升. LASIK和LASEK术后角膜神经损伤恢复情况比较[J]. 中华眼视光学与视觉科学杂志, 2014, 16(8): 487-492. Niu Guangzeng*,Fan Yuxiang,Gao Ruixin,Wang Lianfeng,Su Rui,Bai Dongsheng. Comparison of corneal nerve damage recovery after LASIK and LASEK surgery. Chinese Journal of Optometry Ophthalmology and Visual science, 2014, 16(8): 487-492. DOI: 10.3760/cma.j.issn.1674-845X.2014.08.010

链接本文:

https://www.cjoovs.com/CN/10.3760/cma.j.issn.1674-845X.2014.08.010 或 https://www.cjoovs.com/CN/Y2014/V16/I8/487

[1]	高莎莎，吕勇. LASIK和LASEK术后角膜神经再生情况的比较[J]. 眼外伤职业病杂志，2008，30：285-288.
[2]	刘畅，辛冰，万汇娟，等. LASIK与LASEK术后角膜神经和修复的实验研究[J]. 中国实用眼科杂志，2010，28：1365-1368.
[3]	Wilson SE， Ambrósio R. Laser in situ keratomileusis-induced neurotrophic epitheliopathy[J]. Am J Ophthalmol，2001，132：405-406.
[4]	Lee JB， Seong GJ， Lee JH， et al. Comparison of laser epithelial keratomileusis and photorefractive keratectomy for low to moderate myopia[J]. J Cataract Reract Surg，2001，27：565-570.
[5]	Horwath-Winter J， Vidie B， Schwantzer G. Early changes in corneal sensation， ocular surface integrity， and tear-film function after laser-assisted subepithelial keratectomy[J]. J Cataract Refract Surg，2004，30：2316-2321.
[6]	Lee BH， McLaren JW， Erie JC， et al. Reinnervation in the cornea after LASIK[J]. Invest Ophthalmol Vis Sci，2002，43：3660-3664.
[7]	Calvillo MP， McLaren JW， Hodge DO， et al. Corneal reinnervation after LASIK： prospective 3-year longitudinal study[J]. Invest Ophthalmol Vis Sci，2004，45：3991-3996.
[8]	Darwish T， Brahma A， Efron N， et al. Subbasal nerve regeneration after LASEK measured by confocal microscopy[J]. J Refract Surg，2007，23：709-715.
[9]	吴莹，褚仁远，周行涛，等. 准分子激光原位角膜磨镶术与准分子激光角膜上皮下磨镶术后角膜知觉恢复的研究[J]. 中华眼科杂志，2005，41：972-976.
[10]	李凯，周行涛，牛凌凌. 小牛血去蛋白提取物眼用凝胶对准分子激光手术后角膜知觉的影响[J]. 中华眼视光学与视觉科学杂志，2010，12：19-22.
[11]	Stachs O， Zhivov A， Kraak R， et al. Structural-functional correlations of corneal innervation after LASIK and penetrating keratoplasty[J]. J Refract Surg，2010，26：159-167.
[12]	丁冬梅，陈辉，桑爱民，等. 准分子原位角膜磨镶术后角膜神经损伤和再生的实验研究[J]. 眼科研究，2007，25：98-101.
[13]	Herrmann WA， Shah C， Gabler B， et al. Corneal sensation after laser epithelial keratomileusis for the correction of myopia[J]. Graefes Arch Clin Exp Ophthalmol，2005，243：33-37.