| 摘要: |
| 目的 探究飞秒激光小切口角膜基质透镜取出术（SMILE）治疗后眼压的预测和校正。方法 采用回顾性研究＋前瞻性研究设计。纳入2019年12月至2021月12月于我院眼科行SMILE的患者90例（180眼），随机抽取30眼为验证集，余150眼为训练集。前瞻性选择2022年1－9月于我院行SMILE治疗的患者51例（102眼）为测试集。分析训练集术前3 d及术后1周、1个月、3个月、6个月的眼压情况，确定眼压稳定期及与术前相比的眼压变化量（ΔIOP）。选取术前球柱镜代数和（SC）、球镜度、柱镜度、眼压、中央角膜厚度（CCT）、平均角膜曲率［Km，平坦角膜曲率（K1）与陡峭角膜曲率（K2）的平均值］、前房深度（ACD）与各参数在眼压稳定时相对术前的变化量（ΔCCT、ΔKm、ΔK1、ΔK2、ΔACD）及个体因素，纳入与ΔIOP相关的因素采用多元线性回归拟合回归模型。建立适合临床SMILE术后眼压预测及校正的公式并进行效能验证。结果 SMILE术后眼压均较术前降低，术后1周、3个月及6个月3个时间点之间眼压差异无统计学意义，而术后1个月与其余时段相比眼压差异均有统计学意义（P均＜0.05）。拟合出的的最佳回归方程为ΔIOP＝0.459×术前眼压（mmHg）－0.183× SC（D）－0.041×年龄（岁）＋1.292×ΔACD（mm）－1.270（调整R2＝0.533，P＜0.001）。仅纳入术前眼压和SC，拟合出简化方程为ΔIOP＝0.496×术前眼压（mmHg）－0.194×SC（D）－2.952（调整R2＝0.498，P＜0.001）；通过四舍五入法及截距校正推演得出预测和校正公式分别为：术后预测眼压（mmHg）＝0.5×术前眼压（mmHg）＋ 0.2×SC（D）＋3，术后校正眼压（mmHg）＝术后眼压（mmHg）＋0.5×术前眼压（mmHg）－0.2×SC（D）－3。经内部验证与外部测试，简化公式的预测性能良好。结论 SMILE术后3个月眼压趋于稳定，且ΔIOP与屈光度相关。SMILE术后眼压可通过简化公式进行快速临床预测和校正。 |
| 关键词: 飞秒激光小切口角膜基质透镜取出术 眼压 屈光度 校正 |
| DOI：10.16781/j.CN31-2187/R.20220859 |
| 投稿时间：2022-11-04修订日期：2022-12-22 |
| 基金项目: |
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| Role of diopter in prediction and correction of intraocular pressure after small incision lenticule extraction |
| ZHANG Peng-cheng,HAN Yang,JIANG Wen-shan*,WU Jin-tao,XU Chi |
(Department of Ophthalmology, General Hospital of Central Theater Command of PLA, Wuhan 430000, Hubei, China
*Corresponding author) |
| Abstract: |
| Objective To explore the prediction and correction methods of postoperative intraocular pressure (IOP) after small incision lenticule extraction (SMILE). Methods In this retrospective and prospective study, 90 patients (180 eyes) who underwent SMILE in the ophthalmology department of our hospital from Dec. 2019 to Dec. 2021 were enrolled. From them, 30 eyes were selected randomly as validation set, and the remaining 150 eyes were included as training set. A prospective selection of 51 patients (102 eyes) who received SMILE from Jan. to Sep. 2022 was included as test set. Firstly, IOP of the training set was analyzed 3 d before surgery, 1 week, 1 month, 3 months and 6 months after surgery to determine the IOP-stable phase and the amount of change in IOP (ΔIOP). Then, preoperative algebraic sum of sphero-cylinder (SC), spherical diopter, diopter of cylinder, IOP, central corneal thickness (CCT), mean corneal curvature (Km, the mean of flat corneal curvature ［K1］ and steep corneal curvature ［K2］), anterior chamber depth (ACD), amount of change of each parameter in postoperative IOP stability (ΔCCT, ΔKm, ΔK1, ΔK2, and ΔACD), and individual factors were selected, and the factors associated with ΔIOP were subsequently incorporated into the regression models. Finally, formulas suited for prediction and correction of IOP after clinical SMILE were developed and validated for efficacy. Results The postoperative IOP was all decreased after SMILE. There were no significant differences among 1-week, 3-month or 6-month postoperative IOP, but the differences of IOP between 1 month and the rest of time periods were statistically significant (all P＜0.05). Factors were selected and the following best regression equation was established: ΔIOP＝0.459×IOPpreoperative (mmHg)－0.183×SC (D)－0.041×age (year)＋1.292×ΔACD (mm)－1.270 (adjusted R2＝0.533, P＜0.001). Preoperative IOP and SC were included only, the simplified equation was: ΔIOP＝0.496×IOPpreoperative (mmHg)－0.194×SC (D)－2.952 (adjusted R2＝0.498, P＜0.001). Predictive and adjusted formulas obtained through rounding and intercept correction were as follows: IOPpostoperative (predicted) (mmHg)＝0.5×IOPpreoperative (mmHg)＋0.2×SC (D)＋3, IOPpostoperative (corrected) (mmHg)＝ IOPpostoperative (mmHg)＋0.5×IOPpreoperative (mmHg)－0.2×SC (D)－3. After internal validation and external testing, the prediction performance of the simplified formulas was good. Conclusion The IOP tends to stabilize at 3 months after SMILE, and the ΔIOP is correlated with diopter. Postoperative IOP can be rapidly predicted and corrected using simplified formulas. |
| Key words: small incision lenticule extraction intraocular pressure diopter correction |
