关键词: 近视眼, 小切口角膜基质透镜取出术, 角膜上皮重塑

Abstract:  Objective To analyze the characteristics of early corneal epithelial thickness changes after femtosecond laser small incision corneal stromal lens extraction (SMILE) with anterior segment OCT. Design Retrospective case series. Participants 70 patients (140 eyes) with mean age (27.03±5.55) years old of moderate or high myopia and myopic astigmatism were underwent SMILE surgery from May to August 2020 by a single surgeon in Beijing Tongren Hospital. Method The patients’ medical records were reviewed, including the preoperative refractive diopter, preoperative and postoperative corneal epithelial thickness by anterior segment OCT. Main Outcome Measures Preoperative refraction diopter, Ks, Kf value of the cornea anterior surface and the central corneal thickness(CCT). The corneal epithelial thicknesses of 0-2 mm in the center of the cornea, the superior (S), inferior (I), nasal (N), temporal (T), superior-nasal (SN), superior-temporal (ST), inferior-nasal (IN) and inferior-temporal (IT) positions within the range of 2-5 mm and 5-6 mm before and 1 month after the operation. Results At 1 month after SMILE, the corneal epithelial of moderate myopia group had statistically significant thickening (all P<0.05) at 0-2 mm (t=3.956); 2-5 mm S (t=5.898), I (t=7.333), T (t=8.011), IN (t=3.878), ST (t=5.803), IT (t=9.160); and 5-6 mm I (t=4.668), T (t=7.470), IN (t=2.285), ST (t=5.389) and IT (t=6.805) compared with preoperation. And the corneal epithelialum of high myopia group had statistically significant thickening (all P<0.05) at all locations compared with preoperation [0-2 mm（t=6.144）; 2-5 mm（tS=7.770, tI=7.399, tN=5.294, tT=8.902, tSN=5.599, tIN=6.413, tST=7.628, tIT=8.055）; 5-6 mm（tS=3.373, tI=2.927, tN=5.373, tT=5.847, tSN=3.770, tIN=4.166, tST=4.826，tIT=4.219）]. Conclusion At 1 month after SMILE, the corneal epithelium thickness increased unevenly in the high myopia group, especially in the temporal and inferiorside. The corneal epithelium thickened much more in high myopia group than moderate myopia group. The central corneal epithelial thickness increment was negatively correlated with preoperative SE and postoperative corneal Km, and positively correlated with intraoperative corneal ablation depth. (Ophthalmol CHN, 2021, 30: 270-274)

Key words:  myopia, small incision lenticule extraction, corneal epithelium remodeling