术前IOP对SMILE术后IOP检测的影响

Effect of Preoperative IOP on Postoperative IOP Detection of SMILE

摘要: 目的：探讨术前不同范围的基线眼压(IOP)对飞秒激光小切口角膜基质透镜取出术(SMILE)术后角膜形态的影响，并进一步分析其对IOP检测的影响。方法：前瞻性系列病例分析。收集从2020年5月至2020年12月在青岛大学附属医院眼科行SMILE手术治疗的近视和(或)散光的患者52例共100眼的资料，其中男27例、女25例，要求术前中央角膜厚度(CCT)在545~565 μm之间，等效球镜度(SE)在−3.00D~−6.00D之间。根据患者术前IOP分为两组：A组10 ≤ IOP ≤ 15 mmHg，B组15 < IOP ≤ 21 mmHg。使用非接触眼压计(NCT)测量IOP、Pentacam眼前节分析系统测量CCT及角膜切削量(CV)、可视化生物力学分析仪(Corvis ST)测量角膜变形幅度(DA)，采用独立样本t检验、配对t检验、Pearson相关性进行数据分析。结果：1) A组手术前与术后6个月时IOP为：12.80 ± 1.24、8.04 ± 1.35 mmHg，B组手术前与术后6个月时IOP为：17.02 ± 1.37、13.95 ± 1.58 mmHg，两组术后IOP均较术前明显降低，差异具有统计学意义(P < 0.05)；A组手术前与术后6个月时DA为：1.05 ± 0.11 mm、1.29 ± 0.12 mm，B组手术前与术后6个月时DA为：1.06 ± 0.12、1.24 ± 0.14，两组术后DA均较术前增加，差异具有统计学意义(P < 0.001)；2) 两组手术前后ΔIOP分别为4.76 ± 0.76、3.07 ± 0.84 mmHg，比较差异具有统计学意义(P < 0.001)，ΔDA分别为−0.23 ± 0.12、−0.18 ± 0.15 mm，比较差异具有统计学意义(P = 0.046)；3) A组中ΔIOP与ΔDA之间呈中度负相关(r = −0.347, P < 0.01)，B组中呈无相关性(r = −0.217, P < 0.01)。结论：术前不同范围的基线IOP对SMILE术后IOP的检测的影响具有差异性，对术前基线眼压偏低的眼的影响更加明显。

Abstract: Objective: To investigate the effect of preoperative baseline intraocular pressure (IOP) in different ranges on corneal morphology after femtosecond laser small incision corneal stromal lens extraction (SMILE), and further analyze its effect on IOP detection. Methods: Prospective series of case analysis. 52 patients (100 eyes) with myopia astigmatism, including 27 males and 25 female, who underwent SMILE surgery at the Affiliated Hospital of Qingdao University from May 2020 to December 2020 were enrolled, requiring preoperative central corneal thickness (CCT) between 545 and 565 μm and equivalent sphere microscopy (SE) between −3.00D~−6.00D. Patients were divided into two groups according to preoperative IOP: group A 10 ≤ IOP ≤ 15 mmHg and group B 15 < IOP ≤ 21 mmHg. IOP was measured by non-contact tonometer (NCT), CCT and Corneal cutting volume (CV) was measured by Pentacam anterior segment analysis system, and corneal deformation amplitude (DA) was measured by visual biomechanical analyzer (Corvis ST). The data were analyzed by independent sample t-test, paired t-test and Pearson correlation. Results: 1) The IOPs of group A before operation and 6 months after operation were 12.80 ± 1.24 and 8.04 ± 1.35 mmHg, and those of group B before operation and 6 months after operation were 17.02 ± 1.37 and 13.95 ± 1.58 mmHg. The postoperative IOPs of the two groups were significantly lower than those before operation (P < 0.05); the DA of group A before operation and 6 months after operation were 1.05 ± 0.11 mm and 1.29 ± 0.12 mm, and that of group B before operation and 6 months after operation were 1.06 ± 0.12 mm and 1.24 ± 0.14 mm. The DA of the two groups increased significantly compared with that before operation (P < 0.001); 2) Before and after operation, the ΔIOP of the two groups were 4.76 ± 0.76 and 3.07 ± 0.84 mmHg respectively, and the difference was statistically significant (P < 0.001). The ΔDA were −0.23 ± 0.12 and −0.18 ± 0.15 mm respectively, and the difference was statistically significant (P = 0.046); 3) There was a moderate negative correlation between ΔIOP and ΔDA in group A (r = −0.347, P < 0.01), but there was no correlation in group B (r = −0.217, P < 0.01). Conclusion: Different ranges of preoperative baseline IOP have different effects on the detection of postoperative IOP of SMILE, especially in the eyes with low preoperative baseline IOP.