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

Abstract
Figure/Table
References (18)
Related Citation (15)

Download: PDF (6980 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS) Supporting Info

Guide

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

Received: 15 April 2021

PACS:

Fund: Natural Science Foundation of Shandong Province (ZR2019MH115)

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	Jiangfeng Li
	Hui Li
	Jinjian Li
	et al

Cite this article:

Jiangfeng Li,Hui Li,Jinjian Li等. A Comparative Study of the Repair of Nerve Fibers after Different Laser Keratomileusi Procedures[J]. Chinese Journal of Optometry Ophthalmology and Visual science, 2021, 23(12): 887-895.

URL:

https://www.cjoovs.com/EN/10.3760/cma.j.cn115909-20210415-00156 OR https://www.cjoovs.com/EN/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.

[1]

Chinese Optometric Association, Chinese Ophthalmological Society; Ophthalmology and Optometry Committee, Ophthalmologists Association, Chinese Doctor Association; et al. Expert Consensus on Prevention and Control of High Myopia (2023)[J]. Chinese Journal of Optometry Ophthalmology and Visual science, 2023, 25(6): 401-407.