Hu Liang, Xie Wenjia, Tang Lei, Chen Jia, Zhang Dong, Yu Peng, Qu Jia
School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, China.
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Zhonghua Yan Ke Za Zhi. 2015 Jan;51(1):39-44.
To compare the corneal subbasal nerve density (SND) changes after laser in situ keratomileusis (LASIK) with a microkeratome and a femtosecond laser.
Prospective clinical study. Sixty eyes of thirty myopes were included. Fifteen patients (30 eyes) underwent LASIK with the Moria II microkeratome, and the other 15 patients (30 eyes) with the 60 k Hz IntraLase femtosecond laser. Central, temporal and nasal corneal SNDs were measured by confocal microscopy and compared before surgery, 1 month, and 3 months after surgery. Analysis of variance and t test were used for comparing the differences between different time points and two groups.
Preoperatively and 1 month, 3 months postoperatively, the SNDs were (16 728.30 ± 4 300.30), (1 875.42 ± 300.50) and (1 701.55 ± 194.11) µm/mm(2) in the central cornea, (11 379.70 ± 1 833.92), (1 341.20 ± 288.68) and (1 860.87 ± 147.60) µm/mm(2) in the temporal cornea, and (8 506.79 ± 662.83), (7 428.96 ± 712.99) and (8 044.32 ± 1 077.54) µm/mm(2) in the nasal cornea, respectively, in the microkeratome group, and (16 351.59 ± 3 503.88), (1 859.38 ± 452.93) and (2 043.67 ± 377.76) in the central cornea, (12 328.22 ± 2 007.43), (1 483.85 ± 371.28) and (2 126.31 ± 279.87) µm/mm(2) in the temporal cornea, and (8 347.91 ± 789.44), (1 475.53 ± 293.98) and (2 022.10 ± 282.89) µm/mm(2) in the nasal cornea, respectively, in the femtosecond laser group. The SNDs at three positions all decreased significantly at each time point postoperatively compared to the baseline values in both groups (1 and 3 months in the microkeratome group: central t = 18.981 and 18.912, temporal t = 30.121 and 27.921, and nasal t = 6.456 and 2.126; in the femtosecond laser group: central t = 22.667 and 22.379, temporal t = 29.000 and 28.376, and nasal t = 46.329 and 41.751; all P < 0.01, except 3 months at the nasal in the microkeratome group, P = 0.042). The nasal SND increased significantly from month 1 to month 3 (t = -3.921, P < 0.01) in the microkeratome group, and the temporal and nasal SNDs both increased significantly from month 1 to month 3 (t = -9.629 and -6.645, both P < 0.01) in the femtosecond group. There were no significant differences in the central SND between the two groups (F = 0.002, P = 0.96). Significant differences were found in the nasal SND between the groups at 1 month and 3 months (t = 42.281 and 29.608, both P < 0.01), and in the temporal SND at 3 months after surgery (t = -4.595, P < 0.01).
Peripheral corneal nerve recovery occurred at 1 month after LASIK surgery. Patients with a femtosecond laser showed better corneal regeneration than those with a microkeratome.
比较使用微型角膜刀和飞秒激光行准分子原位角膜磨镶术（LASIK）后角膜基质层下神经密度（SND）的变化。
前瞻性临床研究。纳入30例近视患者的60只眼。15例患者（30只眼）使用Moria II微型角膜刀行LASIK手术，另外15例患者（30只眼）使用60kHz IntraLase飞秒激光。术前、术后1个月和3个月通过共聚焦显微镜测量中央、颞侧和鼻侧角膜SND，并进行比较。采用方差分析和t检验比较不同时间点及两组之间的差异。
微型角膜刀组术前、术后1个月、3个月中央角膜SND分别为（16728.30±4300.30）、（1875.42±300.50）和（1701.55±194.11）µm/mm²，颞侧角膜分别为（11379.70±1833.92）、（1341.20±288.68）和（1860.87±147.60）µm/mm²，鼻侧角膜分别为（8506.79±662.83）、（7428.96±712.99）和（8044.32±1077.54）µm/mm²；飞秒激光组中央角膜分别为（16351.59±3503.88）、（1859.38±452.93）和（2043.67±377.76），颞侧角膜分别为（12328.22±2007.43）、（1483.85±371.28）和（2126.31±279.87）µm/mm²，鼻侧角膜分别为（8347.91±789.44）、（1475.53±293.98）和（2022.10±282.89）µm/mm²。两组术后各时间点三个位置的SND均较基线值显著降低（微型角膜刀组1个月和3个月：中央t=18.981和18.912，颞侧t=30.121和27.921，鼻侧t=6.456和2.126；飞秒激光组：中央t=22.667和22.379，颞侧t=29.000和28.376，鼻侧t=46.329和41.751；均P<0.01，微型角膜刀组鼻侧3个月除外，P=0.042）。微型角膜刀组鼻侧SND从术后1个月到3个月显著增加（t=-3,921，P<0.01），飞秒激光组颞侧和鼻侧SND从术后1个月到3个月均显著增加（t=-9.629和-6.645，均P<0.01）。两组中央SND无显著差异（F=0.002，P=0.96）。两组在术后1个月和3个月鼻侧SND有显著差异（t=42.281和29.608，均P<0.01），术后3个月颞侧SND有显著差异（t=-4.595，P<0.01）。
LASIK术后1个月角膜周边神经开始恢复。飞秒激光手术患者角膜再生情况优于微型角膜刀手术患者。
