【摘要】 目的 应用 Pentacam眼前节分析系统研究准分子激光原位角膜磨镶术(laser in situ keratomileusis，LASIK)和准分子激光上皮下角膜磨镶术(laser subepithelial keratomileusis, LASEK)术后角膜后表面高度、前房深度的变化，探讨准分子激光手术对眼前段结构变化的影响。方法 对69例(138眼)施行LASIK或LASEK手术的患者资料进行回顾性分析，分别于术前,术后1个月、3个月应用Pentacam眼前节分析系统检测角膜厚度、角膜后表面高度、前房深度的变化。结果 LASIK、LASEK术后1个月、3个月角膜后表面高度均略微增高，LASIK术后1个月与3个月的前凸量分别为(1.89±3.24) μm与(1.18±2.33) μm，LASEK术后1个月与3个月的前凸量分别为(1.07±2.27) μm与(1.12±2.05) μm;术中切削比例对后表面高度的变化影响达到66.18%，术前屈光度对后表面高度的变化影响达到29.31%;LASIK术前、术后1个月和术后3个月前房深度分别为(3.24±0.27) mm、(3.18±0.26) mm和(3.18±0.27) mm;LASEK术前、术后1个月和术后3个月前房深度分别为(3.20±0.27) mm、(3.16±0.26) mm和(3.15±0.27) mm;LASIK、LASEK术后1个月、3个月前房深度变浅。结论 LASIK、LASEK术后均表现为角膜后表面微量前移，LASEK术后角膜后表面高度变化较LASIK更小;切削比例是影响角膜后表面变化最大的因素，两种手术方式术后前房变浅。
【关键词】 Pentacam眼前节分析系统;准分子激光原位角膜磨镶术(LASIK);准分子激光上皮下角膜磨镶术(LASEK);角膜后表面;前房
Clinical study of the changes in the posterior corneal elevation and anteriorchamber of the eyes after LASIK and LASEK
ZHU Ran1, LIU Qinghuai2*
(1. Nanjing Medical University, Nanjing, Jiangsu 210029, China; 2.Department of Ophthalmology,
The First School of Clinical Medicine, Nanjing Medical Uninersity, Nanjing, Jiangsu 210029)
Abstract： Objective To investigate the postoperative changes in the parameters of posterior corneal elevation, anterior chamber depth after laser in situ keratomileusis (LASIK) and laser subepithelial keratomileusis (LASEK) with the application of Pentacam system and accordingly to further analyze the influences of LASIK and LASEK on the anterior segment of the eye. Methods A retrospective anaysis was conducted on 69 patients (138 eyes) of LASIK and LASEK by randomized sampling. The changes in parameters in corneal thickness, posterior corneal elevation, central anterior chamber depth were analyzed with the Pentacam system preoperatively, 1 month and 3 months postoperatively. Results Posterior corneal elevation slightly increased one and three months after LASIK and LASEK operations. The forward shift of posterior corneal surface after LASIK surgery were (1.89±3.24) μm and (1.18±2.33) μm at one month and three month respectively and the according values were (1.07±2.27) μm and (1.12±2.05) μm after LASEK. Posterior corneal elevation variations were influenced for 66.18% and 29.31% by cutting proportions and refractive error respectively. The anterior chamber depths were (3.24±0.27) mm pre LASIK, (3.18±0.26) mm one month after LASIK and (3.18±0.27) mm three months postoperatively. The corresponding values for surgery LASEK were (3.20±0.27) mm, (3.16±0.26) mm and (3.15±0.27) mm. The anterior chamber depth became slightly thinner. Conclusions Corneal posterior surface moves slightly forward in both LASIK and LASEK, with smaller variations in posterior corneal elevation for LASEK. Corneal posterior surface is most influenced by cutting proportions while anterior chamber depth becomes thinner after either LASIK or LASEK.
Key words： Pentacam system; laser in situ keratomileusis (LASIK); laser subepithelial keratomileusis (LASEK); corneal posterior surface; anterior chamber depth
现代角膜屈光手术学的发展，以20世纪70年代出现的放射状角膜切开术(radial keratectomy，RK)为开端，经历了以准分子激光屈光性角膜切削术(PRK)为代表的单纯表层激光手术、以准分子激光原位角膜磨镶术(laser in situ keratomileusis，LASIK)为代表的角膜基质手术、以准分子激光上皮下角膜磨镶术(laser subepithelial keratomileusis, LASEK)、机械刀准分子激光上皮下角膜磨镶术(epipolis laser in situ keratomileusis, Epi-LASIK)、前弹力层下准分子激光角膜磨镶术(Sub-Bowmans Keratomileusis，SBK)、地形图/波前像差引导、飞秒激光制瓣LASIK等为代表的多元化优化表层手术三个阶段。在准分子激光治疗近视的临床应用中，LASIK和LASEK以其显著的疗效在诸多角膜屈光手术中脱颖而出，成为临床应用最广泛的矫正近视的手术方法,但又因其自身的优缺点引起眼科医师的广泛争论。无论是LASIK手术还是LASEK手术，都存在不尽相同的术中术后并发症，这些并发症基本可以通过手术技巧的提高和及时的处理减少患者视力的损失，但LASIK和LASEK术后角膜扩张甚至圆锥角膜的发生却是难以预计且对视力和视觉质量严重影响的并发症。随着手术的逐步开展，术后角膜形态的变化越来越受到重视，特别是对角膜后表面形态的研究尤为重要，因为它较角膜前表面更能准确地反映术后角膜的变化。目前，LASIK术后角膜后表面的变化规律及其相关影响因素已有较多报道,LASEK采取表层切削，至今未有术后发生角膜扩张的报道。有关两种手术后角膜后表面变化规律的比较及与之相应的前房深度变化以往研究较少。本研究通过Pentacam眼前节分析系统对LASIK和LASEK术后的角膜形态改变以及前房变化进行观察分析，明确两种手术后角膜后表面和前房变化规律及相关影响因素，探究术后屈光回退和继发性圆锥角膜等问题的真正原因，对两种手术方式的安全性、有效性、稳定性做进一步的研究，为手术方式的选择提供依据，
1 资料和方法
1.1 一般资料 随机选取2010年1月—2010年6月在徐州市第一人民医院眼科准分子激光中心接受LASIK和LASEK手术的近视及近视散光69例(138只眼)患者的病例资料，其中男性39例，女性30例，年龄18～39岁，平均(25.2±4.5)岁。LASIK手术33例(66眼)，LASEK手术36例(72眼)。术前等效球镜为-1.75～-8.50 D，平均(-4.66±1.62)D。术前眼压12～24 mmHg (1 mmHg=0.133 kPa)，平均(15.83±3.13 )mmHg。硬性角膜接触镜配戴者停戴1个月以上，软性角膜接触镜配戴者停戴1周以上，2年内屈光度数稳定(增长≤0.50 D)，无其他眼病及全身病史。
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