摘要目的 探讨飞秒激光小切口角膜基质透镜取出术(SMILE)术后前房形态的变化特点及其可能的影响因素.方法 采用病例观察研究设计.收集2015年4―12月在天津市眼科医院屈光手术中心接受SMILE手术的近视及近视散光患者31例59眼,分别于SMILE术前和术后1、3和6个月应用Pentacam三维眼前节分析系统测量前房形态参数,包括中央前房深度(ACD)、前房容积(ACV)和水平位前房角度(ACA)等,分析各参数间的相关关系并比较各参数在不同时间点的差异.结果 手术前后不同时间点中央角膜厚度(CCT)总体比较,差异有统计学意义(F=628.625,P<0.001),其中术后1、3和6个月CCT较术前明显下降,差异均有统计学意义(均P<0.05);与术后1个月比较,术后3个月、6个月CCT增加,差异均有统计学意义(P<0.001),并达到稳定状态.手术前后不同时间点角膜后表面高度(PCE)总体比较,差异有统计学意义(F=19.249,P<0.001),其中术后1、3和6个月顶点处PCE与术前相比,角膜顶点略向后移,差异均有统计学意义(均P<0.05).SMILE术前和术后1、3和6个月ACD分别为(3.33±0.25)、(3.31±0.25)、(3.30±0.25)和(3.30±0.25)mm,ACV分别为(217.46±31.55)、(214.71±33.09)、(211.14±33.65)和(210.08±32.19)mm3,手术前后不同时间点ACD、ACV总体比较,差异均有统计学意义(F=12.477、12.205,均P<0.001),其中术后1、3和6个月ACD均较术前减小,术后3个月和6个月ACV均较术前明显减小,差异均有统计学意义(均P<0.05).术前,术后1、3和6个月ACD与ACV间均呈显著正相关(r=0.870、0.893、0.886、0.884,均P<0.001);术前ACD与CCT间呈负相关(r=-0.286,P<0.05).结论 SMILE术后ACD变浅,术后6个月内基本稳定在(3.30±0.25)mm,满足有晶状体眼人工晶状体植入术所要求的ACD条件,ACD这种稳定状态对于SMILE术后继发圆锥角膜检测也有重要意义.

abstractsObjective To investigate the changes of anterior chamber profiles after small incision lenticule extraction ( SMILE ) and analyze the possible influencing factors. Methods A case observation study was designed. Thirty-one patients(59 eyes) with myopia and myopic astigmatism who underwent SMILE surgery at the Refractive Surgery Center of Tianjin Eye Hospital from April to December 2015 were enrolled and examined preoperatively and at 1 month, 3 and 6 months postoperatively. The anterior chamber profiles, including anterior chamber depth (ACD),anterior chamber volume (ACV) and anterior chamber angle (ACA) were measured using the Pentacam. The correlations between parameters were analyzed and the differences of the parameters at different time points were compared. This study followed the Declaration of Helsinki. This study protocol was approved by Ethic Committee of Tianjin Eye Hospital ( No. TJYYLL-2015-20) . Written informed consent was obtained from each subject before the operation. Results Compared with pre-operation,the central corneal thickness ( CCT) was significantly decreased at 1 month,3 and 6 months postoperatively (all at P<0. 05). Three months after surgery,the CCT was significantly higher than that at one month after surgery ( P<0. 001 ) , and no significant change of CCT was found between 3 months and 6 months after surgery (P>0. 05). The posterior corneal elevation (PCE) at different time points before and after surgery was significantly different ( F=19. 249,P<0. 001) ,compared with the preoperation,the PCE at 1 month,3 and 6 months postoperatively moved slightly backward ( all at P<0. 05) . The preoperative ACD was (3. 33±0. 25)mm,the preoperative ACV was (217. 46±31. 55)mm3,and the ACD was (3. 31±0. 25),(3. 30±0. 25) and (3. 30±0. 25)mm,the ACV was (214. 71±33. 09),(211. 14±33. 65) and (210. 08±32. 19)mm3,respectively at 1 month,3 and 6 months postoperatively,with significant differences at different time points before and after surgery ( F=12. 477,12. 205;both at P<0. 001 ) , compared with the preoperation, the ACD at 1 month, 3 and 6 months postoperatively and ACV at 3 months and 6 months postoperatively were obviously decreased, with a significant difference between them ( all at P<0. 05 ) . There was a significant positive correlation between ACD and ACV at different time points before and after surgery (r=0. 870,0. 893,0. 886,0. 884;all at P<0. 001). The preoperative ACD was negatively correlated with CCT ( r = -0. 286, P<0. 05 ) . Conclusions The ACD is decreased postoperatively,it is basically stable at (3. 30±0. 25)mm,which satisfies the requirements of the ACD required for implantable collamer lens. And the stable state of ACD is also important for keratoconus detection.