SMILE术后角膜上皮重塑的早期临床观察

Early Clinical Observation of Corneal Epithelial Remodeling after SMILE

摘要: 目的：使用前节OCT观察飞秒激光小切口角膜基质透镜取出手术(SMILE)术后早期角膜上皮厚度变化的规律。方法：前瞻性队列研究。对接受SMILE的近视及近视散光患者的40例(78眼)，采用眼前节光学相干断层扫描仪(AS-OCT)，于术前、术后1天、1周、2周及4周、10周测量角膜0-2、2-5、及5-7 mm范围内的角膜上皮厚度，比较不同时间及不同区域间角膜上皮厚度的差异，分析角膜上皮厚度的变化规律。应用SPSS27.0统计软件对数据进行统计分析。结果：在术前及术后2-7 mm范围内，下方的角膜上皮厚度总是高于相对应的上方角膜上皮厚度(如颞下高于颞上、颞下外侧高于颞上外侧)且差异具有统计学意义(P < 0.05)，在术后2~5 mm范围内，颞侧区域角膜上皮厚度总是高于鼻侧区域角膜上皮厚度，差异具有统计学意义(P < 0.05)。术后10周较术前角膜上皮变化以2~5 mm颞侧及颞下方增长最多较其他区域差异具有统计学意义(P < 0.05)；在0~2 mm、2~5 mm、5~7 mm区域内术后10周较术前角膜上皮厚度变化量间具有差异具有统计学差异(P < 0.05)，其中0~2 mm增厚最多。结论：SMILE术后角膜上皮因重塑随时间而发生增厚，下方角膜上皮厚度高于上方角膜上皮厚度，2~5 mm区域颞侧高于鼻侧，以2~5 mm区域颞侧和颞下增厚最多，整体增厚趋势呈凸透镜改变，在角膜中心区域增厚较多，边缘区增厚较少，在术后一周时增长速率达到顶峰，之后随时间下降。

Abstract: Objective: To observe the early changes in corneal epithelial thickness after femtosecond laser small incision corneal stromal lens extraction (SMILE) using AS-OCT. Method: Prospective cohort study. Forty cases (78 eyes) of myopic and myopic astigmatism patients who received SMILE were subjected to anterior segment optical coherence tomography (AS-OCT). Corneal epithelial thickness was measured in the range of 0~2, 2~5, and 5~7 mm before surgery, 1 day, 1 week, 2 weeks, 4 weeks, and 10 weeks after surgery. The differences in corneal epithelial thickness between different times and regions were compared, and the changes in corneal epithelial thickness were analyzed. Use SPSS27.0 statistical software to perform statistical analysis on the data. Result: Within the range of 2-7 mm before and after surgery, the thickness of the lower corneal epithelium is always higher than the corresponding thickness of the upper corneal epithelium (such as lower temporal than upper temporal, and lower temporal lateral than upper temporal lateral), and the difference is statistically significant (P < 0.05). Within the range of 2-5 mm after surgery, the thickness of the corneal epithelium in the temporal region is always higher than that in the nasal region, and the difference is statistically significant (P < 0.05). After 10 weeks of surgery, the corneal epithelial changes showed a significant increase of 2-5mm in the temporal and infratemporal regions, which was statistically significant compared to other areas (P < 0.05); There was a statistically significant difference (P < 0.05) in the changes in corneal epithelial thickness between the 0~2 mm, 2~5 mm, and 5~7 mm regions 10 weeks after surgery compared to preoperative values, with the highest thickening observed in the 0~2 mm region. Conclusion: Following SMILE surgery, the corneal epithelium undergoes a gradual thickening process as a result of remodeling. Notably, the epithelium of the lower cornea becomes thicker than that of the upper cornea. Specifically, within the 2~5 mm zone, the temporal aspect exhibits greater thickening than the nasal aspect. The most pronounced thickening occurs in the temporal and infratemporal regions of this zone. Overall, the thickening pattern resembles a convex lens, with the central cornea experiencing more thickening and the peripheral regions less so. The peak growth rate is observed one week post-surgery, after which it diminishes over time.