全飞秒小切口角膜基质透镜取出术联合快速角膜交联治疗薄角膜中高度近视的临床观察

熊洁; 张辰星; 王科; 周青青; 周友惠

doi:10.16016/j.1000-5404.201907116

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全飞秒小切口角膜基质透镜取出术联合快速角膜交联治疗薄角膜中高度近视的临床观察

临床医学 | 更新时间：2026-01-09

- 全飞秒小切口角膜基质透镜取出术联合快速角膜交联治疗薄角膜中高度近视的临床观察
- Visual outcome at 2 years after small incision lenticule extraction combined with accelerated corneal cross-linking for high myopic eyes
- 第三军医大学学报 2019年41卷第24期页码：2438-2444
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院眼科
- 作者简介：
  
  [ 张辰星，E-mail:zcxhuihui2003@163.com ZHANG Chenxing, E-mail: zcxhuihui2003@163.com
- 基金信息：
- DOI：10.16016/j.1000-5404.201907116
  中图分类号： R778.11;R779.6
- 收稿：2019-07-15，
  
  修回：2019-09-22，
  
  纸质出版：2019-12-30
- 稿件说明：
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熊洁, 张辰星, 王科, 等. 全飞秒小切口角膜基质透镜取出术联合快速角膜交联治疗薄角膜中高度近视的临床观察[J]. 第三军医大学学报, 2019,41(24):2438-2444.

Jie XIONG, Chenxing ZHANG, Ke WANG, et al. Visual outcome at 2 years after small incision lenticule extraction combined with accelerated corneal cross-linking for high myopic eyes[J]. Journal of Third Military Medical University, 2019, 41(24): 2438-2444.
熊洁, 张辰星, 王科, 等. 全飞秒小切口角膜基质透镜取出术联合快速角膜交联治疗薄角膜中高度近视的临床观察[J]. 第三军医大学学报, 2019,41(24):2438-2444. DOI： 10.16016/j.1000-5404.201907116.

Jie XIONG, Chenxing ZHANG, Ke WANG, et al. Visual outcome at 2 years after small incision lenticule extraction combined with accelerated corneal cross-linking for high myopic eyes[J]. Journal of Third Military Medical University, 2019, 41(24): 2438-2444. DOI： 10.16016/j.1000-5404.201907116.

摘要

目的

探讨飞秒激光辅助小切口角膜基质透镜取出术(small incision lenticule extraction

SMILE)联合快速角膜胶原交联(accelerated corneal cross-linking system)巩固术(SMILE Xtra)治疗角膜较薄的中、高度近视患者的有效性、可预测性以及安全性。

方法

收集2016年9月至2017年1月到我院就诊的12例24眼中、高度近视伴角膜较薄的患者，所有患者术前屈光度数需稳定2年以上，通过眼前节分析系统排除圆锥角膜。对所有患者行SMILE Xtra手术，术后1、6、12个月及24个月随访所有患者裸眼视力(UCVA)、最佳矫正视力(BCVA)、等效球镜、角膜曲率、眼压、角膜内皮细胞计数、前节OCT交联线深度、术后角膜层间炎性反应及haze等并发症情况。

结果

术前检查12例24眼，术前等效球镜(-7.18±1.53)D，术前角膜曲率(43.56±3.43)D，角膜厚度(492.42±29.93)μm。手术切削厚度(116.92±28.70)μm，剩余基质厚度(284.92±9.71)μm。其术后24个月裸眼远视力UCVA(1.05±0.12)与术前最佳矫正远视力BCVA(0.99±0.03)比较无统计学差异，术后24个月BCVA(1.02±0.09)与术前BCVA相比无统计学差异，所有患者术后UCVA均等于或超过术前BCVA；术后24个月等效球镜与术前等效球镜比显著降低(

0.01)，术后6、12、24个月相比较无统计学差异。术后24个月角膜平均曲率与术前角膜平均曲率比较显著降低(

0.01)，与术后6、12、24个月比较角膜曲率均无统计学差异；术前内皮细胞计数与术后24个月内皮细胞计数比较无统计学差异。术后1个月16眼在(219.88±80.50)μm角膜深度查见明显交联线，8眼未见明显角膜交联线。4眼(16.7%)于术后出现0.5~1级haze，上述症状均经局部激素眼液规范使用后消失，未影响视力。

结论

SMILE Xtra手术能够治疗角膜较薄的中、高度近视患者，具有安全、有效、预测性好等优点，2年期观察中能有效防止近视回退。

Abstract

Objective

To evaluate the safety

effectiveness and outcome predictability of small incision lenticule extraction combined with accelerated cross-linking (SMILE Xtra) for high myopia with thin cornea.

Methods

This prospective non-randomized clinical study was conducted in 12 patients (24 eyes) with high myopia and thin corneas. All the patients were free of keratoconus as confirmed by the anterior chamber analysis system

and have stable refractive status for over 2 years. All the eyes underwent SMILE Xtra procedure by one surgeon

and the patients were followed up for 24 months to record the changes in uncorrected distant visual acuity (UCVA)

best corrected distant vision acuity (BCVA)

spherical equivalent (SEQ)

corneal curvature

intraocular pressure

corneal endothelial cell count

the depth of the cross-linking line detected by optical coherent tomography (OCT)

and corneal inflammations as well as the incidence of complications (such as haze) at 1

12 and 24 months after the procedures.

Results

In the preoperative examination

the patients had a mean SEQ of (-7.18±1.53) D

a corneal curvature of (43.56±3.43) D

and a central corneal thickness (CCT) of 510.42±38.98 μm. The thickness of lenticule was 116.92±28.70 μm with a residual stromal thickness of 284.92±9.71 μm after the surgery. No significant changes were found in the UCVA at 24 months after the surgery. Both the SEQ and corneal curvature were significantly reduced at 24 months after the surgery (

0.01)

and showed no significant variations at 6

12 and 24 months. Corneal endothelial cell count did not show significant changes at 24 months in these patients as compared with that before the surgery. The cross-linking line was detected by OCT in 16 eyes at 1 month after the surgery with a depth of 219.88±80.50 μm

and was not detected in the other eyes duri

ng the follow-up. Haze of grade 0.5-1 occurred in 4 eyes (16.7%) after the surgery

and the symptom disappeared after local treatment with prednisolone acetate.

Conclusion

SMILE Xtra is safe

predictable and effective for treatment of high myopia with thin corneal and can effectively prevent regression at 24 months after the surgery.

关键词

Keywords

references

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飞秒激光辅助LASIK联合快速角膜交联巩固术治疗中高度近视的2年期疗效观察