【摘要】 目的 探讨飞秒激光小切口角膜基质透镜取出术（SMILE）术后患者早期角膜生物力学的变化，分析角膜生物力学变化与角膜体积变化、角膜高阶像差变化之间的关系。方法 选取2021年1月至8月在佛山市第二人民医院视光学中心拟行SMILE的近视及近视散光患者72例（72眼）作为研究对象，取患者的右眼作为观测眼。术前和术后3个月分别应用新一代Corvis^? ST测量患者角膜生物力学新型参数[非接触生物力学校正眼压（bIOP）、2 mm处变形幅度的比值（DA ratio）、综合半径（IR）、最薄点厚度/厚度变化率（ARTh;用来评估角膜的形态和质量）、第一次压平时角膜硬度参数（SP-A1）、Corvis生物力学指数（CBI）和应力和应变参数（SSI）];应用Pentacam测量患者角膜生物力学参数，包括：角膜体积(CV_{3 mm}、CV_{5 mm}、CV_{7 mm}和CV_{10 mm});全角膜、角膜前表面、角膜后表面总均方根[RMS（Cornea、CF、CB）];全角膜、角膜前表面、角膜后表面高阶像差均方根[RMS HOA （Cornea、CF、CB）]。采用配对t检验或Wilcoxon符号秩检验分析各项参数的变化；采用偏最小二乘回归分析和Spearman相关性分析研究SMILE术后角膜生物力学新型参数变化量与角膜体积变化量、角膜高阶像差参数变化量之间的相关性。结果 术后3个月，患者角膜bIOP、ARTh、SP-A1和SSI较术前明显下降；DA ratio、IR和CBI较术前明显升高，差异均有统计学意义（均为P<0.05）。术后3个月，患者角膜CV_{3 mm}、CV_{5 mm}、CV_{7 mm}和CV_{10 mm}均较术前显著降低，差异均有统计学意义（均为P<0.05）。角膜体积变化量从小到大依次为CV_{3 mm}、CV_{5 mm}、CV_{7 mm}、CV_{10 mm},越往周边减少量增加。术后3个月，患者RMS（Cornea、CF、CB）、RMS HOA （Cornea、CF、CB）均较术前显著增加，差异均有统计学意义（均为P<0.05）;相对于角膜前表面高阶像差的变化，角膜后表面高阶像差的变化相对稳定。相关分析结果显示，△ARTh与△CV_{3 mm}、△CV_{5 mm}均呈正相关，与△CV_{10 mm}呈负相关（均为P<0.05）;△bIOP与△CV_{3 mm}、△CV_{5 mm}、△RMS HOA（CF）、△RMS HOA（Cornea）均呈负相关，与△CV_{10 mm}呈正相关（均为P<0.05）;△IR与△CV_{10 mm}呈负相关（P<0.05）;△SP-A1与△CV_{10 mm}呈正相关（P<0.05）;△CBI与△CV_{3 mm}、△CV_{5 mm}均呈负相关，与△CV_{10 mm}、△RMS（CF）均呈正相关（均为P<0.05）。结论 SMILE术后患者早期角膜生物力学发生了一些变化，这些角膜生物力学变化与不同区域角膜体积变化、角膜高阶像差参数变化存在一定的相关性。更多还原

【Abstract】 Objective To observe the corneal biomechanical changes of patients in the early stage after small incision lenticule extraction（SMILE）, and to analyze the correlation between the corneal biomechanical changes and changes in corneal volumes and higher-order aberrations. Methods A total of 72 patients（72 eyes） with myopia or myopic astig-matism who were scheduled for SMILE in the Optometric Center of Second People’s Hospital of Foshan from January to August 2021 were included. The right eye was selected for observation. Before and 3 months after the SMILE, novel corneal biomechanical parameters, such as biomechanical intraocular pressure（bIOP）, DA ratiomax（2 mm）（DA2 ratio）, integrated radius（IR）, Ambrósio’s relational thickness（for evaluation of the morphology and quality of the cornea, ARTh）, stiffness parameter applanation 1（SP-A1）, Corvis biomechanical index（CBI） and stress-strain index（SSI）, were measured by the new generation of Corvis^? ST. The Pentacam anterior segment analysis system was used to measure corneal biomechanical parameters, including corneal volume(CV_{3 mm}, CV_{5 mm}, CV_{7 mm} and CV_{10 mm}); total root mean square of whole cornea, anterior and posterior corneal surface [RMS（Cornea, CF, CB）]; root mean square of high-order aberrations of total cornea, anterior and posterior corneal surface [RMS HOA（Cornea, CF, CB）]. Paired t-test or Wilcoxon singed-rank test was used to compare the changes in parameters before and after SMILE. Spearman correlation analysis and partial least squares regression were used to study the correlation between changes in novel corneal biomechanical parameters with corneal volume changes and high-order corneal aberration changes after the SMILE. Results Three months after SMILE, the bIOP, ARTh, SP-A1 and SSI decreased significantly, while the DA2 ratio, IR and CBI increased significantly（all P<0.05）. Three months after SMILE, CV_{3 mm}, CV_{5 mm}, CV_{7 mm} and CV_{10 mm} decreased significantly（all P<0.05）. The corneal volume changes from small to large were CV_{3 mm}, CV_{5 mm}, CV_{7 mm} and CV_{10 mm}, with a maximum decrease in the outmost periphery. The RMS（Cornea, CF, CB） and RMS HOA（Cornea, CF, CB） increased significantly（all P<0.05）; compared with the changes in high-order aberration on the anterior corneal surface, the changes in higher-order aberration on the posterior corneal surface were relatively stable. Correlation analysis shows that △ARTh was positively correlated with △CV_{3 mm} and △CV_{5 mm}, and negatively correlated with △CV_{10 mm}（all P<0.05）; △bIOP was negatively correlated with △CV_{3 mm}, △CV_{5 mm}, △RMS HOA（CF） and △RMS HOA（Cornea） and positively correlated with △CV_{10 mm}（all P<0.05）; △IR was negatively correlated with △CV_{10 mm}（P<0.05）; △SP-A1 was positively correlated with △CV_{10 mm}（P<0.05）; △CBI was negatively correlated with △CV_{3 mm} and △CV_{5 mm}, and positively correlated with △CV_{10 mm} and △RMS（CF）（all P<0.05）. Conclusion The changes in corneal biomechanical parameters occur in the early stage after SMILE, with a certain correlation with the corneal volume changes in different regions and high-order corneal aberration changes.更多还原