TransPRK、SMILE及FS-LASIK术后早期角膜光密度的对比研究

Comparison of Early Postoperative Corneal Densitometry Changes in TransPRK, SMILE, and FS-LASIK for Myopia Patients

摘要: 目的：对比TransPRK、SMILE、FS-LASIK术后早期患者角膜光密度变化。方法：回顾性对照研究，收集2020年1月至2023年6月205名行近视激光手术的患者右眼资料(TransPRK 76眼、SMILE 66眼、FS-LASIK 63眼)，包括术前、术后1月及3月用Pentacam测角膜光密度(corneal densitometry, CD)，使用重复测量方差分析对比三个不同层次(前、中、后层)、三个直径范围(0~2 mm、2~6 mm及6~10 mm) CD值差异。结果：TransPRK组术后1月比较术前的角膜前层2~6 mm及中层0~2 mm范围CD值增加(p均<0.001)，且中层0~2 mm范围CD高于FS-LASIK组(p = 0.012)，术后3月相较术前的角膜中、后层的0~2 mm、2~6 mm范围的CD均增加(p均<0.01)，此时中层0~2 mm范围CD高于其他两手术组(p均<0.01)，后层0~2 mm范围CD高于FS-LASIK组(p = 0.025)。SMILE组术后1月相较术前，前层2~6 mm范围及中层0~2 mm、2~6 mm范围CD增加(p均<0.05)。FS-LASIK组术后3月前层全范围及中层2~6 mm范围CD均增加(p均<0.05)。结论：TransPRK对角膜中层0~2 mm CD影响显著，需加强术后早期管理。角膜中层0~2 mm CD值可作为观察术后角膜透明度改变的敏感指标。

Abstract: Objective: To compare the changes in corneal densitometry (CD) in patients following TransPRK, SMILE, and FS-LASIK surgeries in the early postoperative period. Methods: A retrospective controlled study was conducted to collect data from the right eyes of 205 patients who underwent refractive laser surgery from January 2020 to June 2023, including 76 eyes for TransPRK, 66 eyes for SMILE, and 63 eyes for FS-LASIK. Pentacam was used to measure corneal densitometry (CD) preoperatively, one month postoperatively, and three months postoperatively. Repeated measures analysis of variance was applied to compare the differences in CD values across three different layers (anterior, middle, and posterior) and three diameter ranges (0~2 mm, 2~6 mm, and 6~10 mm).Results: In the TransPRK group, there was a significant increase in CD values in the anterior layer (2~6 mm) and middle layer (0~2 mm) one month postoperatively compared to preoperative values (both p < 0.001). Additionally, the CD in the middle layer (0~2 mm) was higher than that in the FS-LASIK group (p = 0.012). At three months postoperatively, the CD values in the middle and posterior layers (0~2 mm and 2~6 mm) were significantly increased compared to preoperative values (both p < 0.01). Notably, the CD in the middle layer (0~2 mm) was higher than that in the other two surgical groups (both p < 0.01), and the CD in the posterior layer (0~2 mm) was higher than that in the FS-LASIK group (p = 0.025). In the SMILE group, there was an increase in CD values in the anterior layer (2~6 mm) and middle layer (0~2 mm and 2~6 mm) one month postoperatively compared to preoperative values (all p < 0.05). In the FS-LASIK group, there was a significant increase in CD values in the full range of the anterior layer and the middle layer (2~6 mm) three months postoperatively (all p < 0.05).Conclusion: TransPRK has a significant impact on the CD in the middle layer (0~2 mm) of the cornea, necessitating enhanced management in the early postoperative period. The CD value in the middle layer (0~2 mm) can serve as a sensitive indicator for observing changes in corneal transparency following surgery.