眼科 ›› 2021, Vol. 30 ›› Issue (5): 360-366.doi: 10.13281/j.cnki.issn.1004-4469.2021.05.007

• 论著 • 上一篇    下一篇

飞秒激光制瓣LASIK术中产生前房气泡对角膜内皮的影响

王兴存  张广峰  朱立强  何皎   

  1. 解放军中部战区空军医院眼科,山西大同 037047
  • 收稿日期:2020-03-12 出版日期:2021-09-25 发布日期:2021-09-24
  • 通讯作者: 王兴存,Email:wxceye3221979@sohu.com

The influence on corneal endothelial cells of anterior chamber bubbles during femtosecond laser in situ keratomileusis

Wang Xingcun, Zhang Guangfeng, Zhu Liqiang, He Jiao     

  1. Department of Ophthalmology, the Central Theater Command Air-Force Hospital of PLA, Datong Shanxi 037047, China 

  • Received:2020-03-12 Online:2021-09-25 Published:2021-09-24
  • Contact: Wang Xingcun, Email: wxceye3221979@sohu.com

摘要: 目的 探讨飞秒激光制瓣LASIK术中前房气泡对角膜内皮细胞的影响。设计 回顾性病例系列。研究对象 2012年2月-2017年11月解放军中部战区空军医院接受飞秒激光LASIK手术且发生前房气泡的23例(23眼)患者。方法 将IntraLase飞秒激光制瓣LASIK术中发生前房气泡的眼作为观察组,对侧未发生前房气泡的眼作为对照组。将前房气泡量分为三级:Ⅰ级气泡量较少均位于瞳孔缘内,Ⅱ级气泡量中等已遮挡瞳孔缘,Ⅲ级气泡量多无法暴露瞳孔。于术前及术后1天、1周、1个月、3个月、6个月用非接触角膜内皮显微镜(TOPCON SP-2000P)测量两组的角膜中央区单位面积内角膜内皮细胞密度(CED)、六角形角膜内皮细胞(HEX)比率、角膜内皮细胞面积变异系数(CV)。主要指标 CED、HEX比率、角膜内皮细胞面积CV。结果 前房气泡产生自鼻侧房角11眼(47.83%)、颞侧8眼(34.78%)、下方3眼(13.04%)、上方1眼(4.35%)。所有眼气泡均由房角移向瞳孔区。Ⅰ级、Ⅱ级、Ⅲ级气泡分别为15眼(65.22%)、7眼(30.43%)、1眼(4.35%)。观察组术前及术后1天、1周、1个月、3个月、6个月各时间点CED分别为(2901±180)个/mm2、(2833±153)个/mm2、(2852±149)个/mm2、(2835±171)个/mm2、(2863±117)个/mm2、(2854±88)个/mm2;HEX比率分别为(45.2±5.4)%、(46.5±5.4)%、(46.2±5.4)%、(47.3±5.5)%、(47.6±4.7)%、(47.7±4.5)%;角膜内皮细胞面积CV分别为(45.17±5.39)%、(46.50±5.43)%、(46.22±5.43)%、(47.32±5.50)%、(47.62±4.68)%、(47.72±4.52)%。对照组术前及术后各时间点的CED分别为(2989±349)个/mm2、(2948±246)个/mm2、(2958±331)个/mm2、(2972±321)个/mm2、(2958±342)个/mm2、(2962±355)个/mm2;HEX比率分别为(46.3±7.5)%、(44.1±8.2)%、(43.9±7.3)%、(43.7±7.4)%、(44.3±6.9)%、(43.9±7.1)%;角膜内皮细胞面积CV分别为(43.81±8.15)%、(46.41±6.37)%、(46.58±6.67)%、(46.73±7.12)%、(46.81±6.12)%、46.76±7.06)%。CED组间差异有统计学意义(F=2.486, P=0.022),组内各时间点比较差异无统计学意义(F=1.342,P=0.260)。HEX比率组间差异无统计学意义(F=0.469,P=0.497),组内各时间点比较差异有统计学意义(F=5.966,P=0.004)。角膜内皮细胞面积CV组间差异无统计学意义(F=0.4106,P=0.746),组内各时间点差异有统计学意义(F=21.248,P=0.000)。结论 飞秒激光LASIK术中产生的前房气泡短期内对角膜内皮细胞密度有一定影响,但对六角形角膜内皮细胞比率、角膜内皮细胞面积变异系数无明显影响。(眼科, 2021, 30: 360-366)


关键词:  , 飞秒激光;准分子激光原位角膜磨镶术;前房气泡;并发症

Abstract:  Objective To explore the influence on corneal endothelial cell of anterior chamber bubbles during femtosecond laser in situ keratomileusis (LASIK). Design Retrospective cases series. Participants Twenty-three patients (23 eyes with anterior chamber bubbles) in The Central Theater Command Air-Force Hospital of PLA from February 2012 to November 2017 who accept LASIK surgeries using femtosecond leaser. Methods The eyes with anterior chamber bubbles during IntraLase femtosecond laser LASIK were included in observation group, and the eyes without anterior chamber bubbles during LASIK were included in the control group. Anterior chamber bubbles based on the number of bubbles divided into first-level (a little bubbles in pupil area), second-level (medium dose bubbles covering pupil area) and third-level (a lot of bubbles covering completely pupil area). The mean central corneal endothelial cell density(CED), percentage of hexagonal endothelium (HEX) and coefficient of variation(CV) of corneal endothelial cell area measured by Topcon SP-2000P noncontact specular microscope of two groups were compared at preoperation, and at 1 day, 1 week, 1 month, 3 months, 6 months after operation.  Main Outcome Measures CED, percentage of HEX and CV of corneal endothelial cell area. Results Anterior chamber bubbles located on nasal side in 11 eyes (47.83%), on bitamporal side in 8 eyes (34.78%), on below side in 3 eyes (13.04%) and on upward side in 1 eye (4.35%). All anterior chamber bubbles moved from anterior chamber angle to pupil. 15 eyes (65.22%) were the first-level anterior chamber bubbles, 7 eyes (30.43%) were the second-level and 1 eye (4.35%) was the third-level. The CED of observation group at preoperative and postoperative 1day, 1 week, 1 month, 3 months, 6 months was 2901±180 cells/mm2, 2833±153 cells/mm2, 2852±149/mm2, 2835±171 cells/mm2, 2863±117 cells/mm2 and 2854±88 cells/mm2, respectively. The percentage of HEX of observation group at preoperative and postoperative 1 day, 1 week, 1 month, 3 months, 6 months was 45.2%±5.4%, 46.5%±5.4%, 46.2%±5.4%, 47.3%±5.5%, 47.6%±4.7% and 47.7%±4.5%, respectively. The CV of corneal endothelial cell area of observation group at preoperative and postoperative 1 day, 1 week, 1 month, 3 months, 6 months was 45.17%±5.39%, 46.50%±5.43%, 46.22%±5.43%, 47.32%±5.50%, 47.62%±4.68% and 47.72%±4.52%, respectively. The CED of control group at preoperative and postoperative 1 day, 1 week, 1 month, 3 months, 6 months was 2989±349 cells/mmm2, 2948±246 cells/mm2, 2958±331 cells/mm2, 2972±321 cells/mm2, 2958±342 cells/mm2 and 2962±355 cells/mm2, respectively. The percentage of HEX of control group at preoperative and postoper-ative 1 day, 1 week, 1 month, 3 months, 6 months was 46.3%±7.5%, 44.1%±8.2%, 43.9%±7.3%, 43.7%±7.4%, 44.3%±6.9% and 43.9%±7.1%, respectively. The CV of corneal endothelial cell area of control group at preoperative and postoperative 1 day, 1 week, 1 month, 3 months, 6 months was 43.81%±8.15%, 46.41%±6.37%, 46.58%±6.67%, 46.73%±7.12%, 46.81%±6.12% and 46.76%±7.06%, respectively. The difference of CED between control group and observation group was statistically significant (F=2.486, P=0.022), and the difference between postoperative and preoperative parameters of CED in the same group was not statistically significant (F=1.342, P=0.260). The difference of percentage of HEX between control group and observation group was not statistically significant (F=0.469, P=0.497), and the difference between postoperative and preoperative parameters of percentage of HEX in the same group was statistically significant (F=5.966, P=0.004). The difference of CV of corneal endothelial cell area between control group and observation group was not statistically significant (F=0.4106, P=0.746), and the difference between postoperative and preoperative parameters of CV of corneal endothelial cell area in the same group was statistically significant (F=21.248, P=0.000). Conclusion The anterior chamber bubbles produced in femtosecond laser LASIK have a certain effect on CED in a short time. However, it had no significant effect on percentage of HEX and CV of corneal endothelial cell area. (Ophthalmol CHN, 2021, 30: 360-366)


Key words: femtosecond laser, laser in situ keratomileusis, anterior chamber bubbles, complication