近视患者SMILE术后NCT测量值昼夜波动变化和校正公式的临床研究

Clinical Study on theDiurnal Fluctuations and Correction Formulas of NCT Measurement Values after SMILE in Myopia Patients

摘要: 目的：探讨低度、中度及高度近视患者的飞秒激光小切口角膜基质透镜取出术(SMILE)术后非接触式眼压计(NCT)测量值的正常眼压波动范围变化，并探索术后眼压(IOP)校正的新方法。方法：前瞻性病例研究。将2018年5月至2019年5月在青岛大学附属医院接受SMILE治疗近视和(或)散光的患者71例(142眼)纳入研究，分别分为低度近视(1)、中度近视(2)、高度近视(3)组，分别测量并记录手术前3天及术后6月24小时IOP、等效球镜度(SE)、中央角膜厚度(CCT)、角膜曲率(K)、3 mm与角膜横径(WTW)之比、角膜体积(CV)、中央直径3 mm范围内角膜体积(CCV_3mm)与CV之比、切削体积(ΔCV)，将术前与术后IOP、Pentacam校正眼压进行比较，统计术后NCT测量值与各因素的相关性，并通过阶段性多元线性回归分析建立术后IOP的表达模型。结果：术后眼压范围1组8~17 mmHg、2组7~15 mmHg、3组7~14 mmHg，双眼差为0~4 mmHg，昼夜IOP波动 < 6 mmHg，均较术前有统计学意义上的降低(P < 0.05)。建立阶段性多元回归模型：1组术后NCT校正IOP值 = 0.374 × IOP_术后 + 4.955 × CCV_3mm术后 − 7.331 (F = 26.150, P < 0.01)，调整R² = 0.528；2组术后NCT校正IOP值 = 0.496 × IOP_术后 + 4.005 × CCV_3mm术后 − 4.698 (F = 42.370, P < 0.01)，调整R² = 0.584；3组术后NCT校正IOP值 = 0.597 × IOP_术后 + 4.498 × CCV_3mm术后 − 3.302 (F = 40.019, P < 0.01)，调整R² = 0.690。结论：SMILE术后NCT所测得IOP值及昼夜波动范围、双眼差均较术前偏低。CCV3mm对SMILE术后IOP值的校正、指导术后用药具有重要意义，为SMILE术后IOP测值评价的重要指标。

Abstract: Objective: To study changes of the normal intraocular pressure (IOP) fluctuation range measured by non-contact tonometry (NCT) after the small incision lenticule extraction (SMILE) in patients with low, moderate and high myopia and to explore new methods for postoperative IOP (IOPpost) correction. Methods: In this prospective case series study, 71 patients (142 eyes) who underwent SMILE at the Affiliated Hospital of Qingdao University from May 2018 to May 2019 were involved, and they were divided into low myopia (1), moderate myopia (2), and high myopia (3) groups. The 24-hour IOP, spherical equivalent (SE), central corneal thickness (CCT), corneal curvature, 3 mm/ the horizontal corneal diameter (WTW), corneal volume (CV), the central 3-mm diameter CV (CCV3 mm), CCV3 mm/CV, the cutting CV (ΔCV) and ΔCV/CV were measured and recorded on 3 days preoperatively and 6 months postoperatively. The 24-hour IOP changes in both eyes and every group were observed preoperatively and postoperatively. The correlation between the postoperative NCT measurements (NCT_post) and various factors was statistically analysed, and the IOP post expression model was established by phased multiple linear regression analysis. Results: The IOP post range was 8 - 17 mmHg in group 1, 7 - 15 mmHg in group 2, and 7 - 14 mmHg in group 3. The binocular IOP post difference was 0 - 4 mmHg. The IOP post fluctuation was <6 mmHg. All were significantly lower than those before surgery (P < 0.05). A staged multivariate regression model was established: NCT_{post corrected(1)} = 0.374 × NCT_post + 4.955 × CCV_post3mm − 7.331; NCT_{post cor-rected(2)} = 0.496 × NCT_post + 4.005 × CCV_post3mm − 4.698; NCT_{post corrected(3)} = 0.597 × NCT_post + 4.498 × CCV_post3mm − 7.197. Conclusion: The IOP value, diurnal fluctuation range, and binocular difference measured by NCT after SMILE were lower than those before surgery. CCVpost3mm is of great signifi-cance to the correction of IOP after SMILE and to guide the postoperative medication. It is an im-portant indicator for the evaluation of IOP after SMILE.