目的:观察SMILE术中角膜层间冲洗对高度近视治疗术后24小时内疗效。方法:回顾性分析在我院先后手术的近视患者50例100眼,其中根据是否进行层间冲洗分为未冲洗组25例50眼,冲洗组25例50眼。观察时间点为术后2 h、4 h、24 h。分别观察两组术后眼部刺激感、雾视感、裸眼视力。结果:两组术后2 h、4 h、24 h患者刺激感差异无统计学意义(P > 0.05);术后4 h两组雾视感差异无统计学意义(P > 0.05);术后24 h两组裸眼视力差异无统计学意义(P > 0.05)。结论:在术后24小时内SMILE术中层间冲洗与否不影响患者早期舒适感、雾视感及视力恢复,层间不冲洗可以减少手术步骤,节约手术时间。 Objective: To observe the surgical results of corneal interlayer flushing on the treatment of high mypia during smile operation in preliminary 24 hours. Methods: 100 eyes of 50 consecutive patients were enrolled in this retrospective study, which included 50 eyes of 25patients with no interlayer flushing group and 50 eyes of 25 patients with interlayer flushing group, divided into 2 groups depending on the interlayer flushing. We observed the postoperative results after 2 hours, 4 hours, 24 hours. The eye irritation, the foggy vision sense, Postoperative uncorrected visual acuity was observed. Results: There was no significant difference in stimulation between the two groups at 2 h, 4 h and 24 h after operation (P > 0.05). Four hours after operation, there was no significant difference in fog perception between the two groups (P > 0.05). There was no significant difference in naked-eye vision between the two groups 24 h after operation (P > 0.05). Conclusion: Whether the interlayer flushing is performed during the smile operation, which does not affect the patient’s early comfort, foggy vision sense and visual recovery. No layering flushing can reduce surgical steps and save surgical time.
目的:观察SMILE术中角膜层间冲洗对高度近视治疗术后24小时内疗效。方法:回顾性分析在我院先后手术的近视患者50例100眼,其中根据是否进行层间冲洗分为未冲洗组25例50眼,冲洗组25例50眼。观察时间点为术后2 h、4 h、24 h。分别观察两组术后眼部刺激感、雾视感、裸眼视力。结果:两组术后2 h、4 h、24 h患者刺激感差异无统计学意义(P > 0.05);术后4 h两组雾视感差异无统计学意义(P > 0.05);术后24 h两组裸眼视力差异无统计学意义(P > 0.05)。结论:在术后24小时内SMILE术中层间冲洗与否不影响患者早期舒适感、雾视感及视力恢复,层间不冲洗可以减少手术步骤,节约手术时间。
小切口基质内透镜取出术,层间冲洗,高度近视
Yanqiu Hu1, Qinghe Li1, Yuemei Li2, Shaowen Qi1, Xueying Song1*
1The Department of Ophthalmology, No. 989 Hospital of Chinese People’s Liberation Army, Pingdingshan Henan
2Pingdingshan Medical College, Pingdingshan Henan
Received: Nov. 8th, 2020; accepted: Nov. 24th, 2020; published: Dec. 1st, 2020
Objective: To observe the surgical results of corneal interlayer flushing on the treatment of high mypia during smile operation in preliminary 24 hours. Methods: 100 eyes of 50 consecutive patients were enrolled in this retrospective study, which included 50 eyes of 25patients with no interlayer flushing group and 50 eyes of 25 patients with interlayer flushing group, divided into 2 groups depending on the interlayer flushing. We observed the postoperative results after 2 hours, 4 hours, 24 hours. The eye irritation, the foggy vision sense, Postoperative uncorrected visual acuity was observed. Results: There was no significant difference in stimulation between the two groups at 2 h, 4 h and 24 h after operation (P > 0.05). Four hours after operation, there was no significant difference in fog perception between the two groups (P > 0.05). There was no significant difference in naked-eye vision between the two groups 24 h after operation (P > 0.05). Conclusion: Whether the interlayer flushing is performed during the smile operation, which does not affect the patient’s early comfort, foggy vision sense and visual recovery. No layering flushing can reduce surgical steps and save surgical time.
Keywords:Small Incision Lenticule Extraction, Interlayer Flushing, High Myopia
Copyright © 2020 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
http://creativecommons.org/licenses/by/4.0/
飞秒激光微小切口角膜基质透镜取出术(small incision lenticule extraction, SMILE)近年已成为治疗屈光不正的主要方式之一,其治疗近视、散光的有效性、安全性、可预测性等方面已经得到证实 [
回顾性分析2018~2019年就诊于我院眼科,并手术的高度近视患者50例100眼。男24例,女26例,年龄17~38岁。未冲洗组25例50眼,冲洗组25例50眼,术前等效球镜分别为−7.19 ± 0.65D、−7.3 ± 0.59D,其差异无统计学意义(P > 0.05);角膜厚度分别为539.95 ± 23.40、536.69 ± 21.30,其差异无统计学意义(P > 0.05)。无其它眼部疾病或手术史。排除圆锥角膜及顿挫型圆锥角膜,排除干眼症患者,均取得患者知情同意,签署知情同意书。获医院伦理委员会批准。
采用VisuMax飞秒激光系统(德国蔡司公司)。手术设计:手术切口长度为2 mm,位于120˚,角膜帽的厚度为均110 μm,边切角90˚,透镜直径6.4~6.7 mm,帽直径为7.4~7.7 mm。
术前10分钟用0.4%盐酸奥布卡因滴眼液行角膜表面麻醉。层间冲洗组:嘱患者注视绿色指示灯,并将绿色指示灯置于角膜反光环中央,逐渐接触角膜至80%,启动负压(如绿色灯SMILE组按预定程序行透镜下层、透镜边切、透镜上层、边切口扫描后,水浸润法分离并完整取出透镜,自切口注入适量生理盐水冲洗囊袋。未冲洗组:激光扫描完成后,清除结膜囊及角膜表面水分,分离并完整取出透镜,整个分离过程层间无任何水分进入囊袋,囊袋内未行冲洗。
两组术后用药相同,术毕妥布霉素地塞米松滴眼液点术眼。术后1 h开始,0.3%左氧氟沙星滴眼液点术眼;10分钟后,0.1%氟米龙滴眼液点术眼;10分钟后,玻璃酸钠滴眼液,然后至10 pm,均分时间,分别各点用3次;术1日始6 am~10 pm,0.3%左氧氟沙星滴眼液、0.1%氟米龙滴眼液、玻璃酸钠滴眼液,每4小时1次点术眼,共用2周。
分别在术后2 h、4 h、24 h观察两组术后眼部刺激感(疼痛、异物感、畏光);于术后24小时观察雾视感、裸眼视力,并记录。患者不适感(疼痛、异物感、畏光) [
应用SPSS 13.0统计软件进行统计学处理,术后24 h雾视感采用X2检验及两组裸眼视力比较采用独立样本t检验进行统计学分析,术后各时间点角膜刺激症状采用重复测量资料方差分析,检验标准为(p = 0.05)。
术中未见负压丢失,术中无切口出血、层间异物、角膜帽切口撕裂,无术后DLK。
术后24小时,未冲洗组和冲洗组的裸眼logMAR视力分别为0.01 ± 0.04、0.00 ± 0.05,差异无统计学意义(t = 0.497, P = 0.25);有效指数分别为1.06 ± 0.22、1.05 ± 0.19,差异无统计学意义(t = 0.320, P = 0.45)。
观察术后2 h、4 h、24 h角膜刺激症状综合评分,未冲洗组和冲洗组分别为4.80 ± 0.93、4.98 ± 1.05;2.00 ± 1.01、2.36 ± 1.03;0.16 ± 0.42、0.18 ± 0.44,两组各时间点刺激症状差异均无统计学意义(P > 0.05)。术后不同时间点两组之间角膜刺激症状差异均无统计学意义(F = 27.38, P = 0.18),各组内术后不同时间点角膜刺激症状差异有统计学意义(F = 42.33, P = 0.00)。
通过询问术后24 h患者是否有雾视感并记录,未冲洗组和冲洗组分别有35眼(70%)和37眼(74%),两组有雾视感的差异无统计学意义(X2 = 0.31, P = 0.578)。
SMILE手术为患者角膜屈光手术中采用飞秒激光新的突破,可维持角膜前表面完整,进而避免存在角膜瓣所造成的并发症 [
Agca [
有人推测SMILE术中层间冲洗使角膜帽微水肿是否有利于角膜帽的锲合,有没有可能减少患者术后早期的雾视感。关于囊袋内冲洗,各方观点亦不同,有人在透镜取出术后囊袋内冲洗 [
SMILE尽管切口微小,但还是会对角膜表面的结构造成破坏,导致眼涩不适 [
总之,在术后24小时内SMILE取出透镜后层间冲洗与否不影响患者早期舒适感及视力恢复,与患者术后雾视感并无关系,角膜层间不冲洗可以减少手术步骤,节约手术时间。患者雾视感具体机制及解决方案有待进一步研究。本研究仍存在一定局限性如观察例数偏少、缺少角膜的客观检查情况等,有待进一步观察。
胡彦秋,李庆和,李岳美,齐绍文,宋学英. SMILE术中角膜层间冲洗对高度近视治疗术后24小时内疗效分析The Analysis of the Therapeutic Effect of Corneal Interlayer Flushing on the Treatment of High Mypia during Smile Operation in Preliminary 24 Hours[J]. 眼科学, 2020, 09(04): 260-264. https://doi.org/10.12677/HJO.2020.94037