飞秒激光小切口角膜基质透镜取出术后非接触眼压变化的相关因素分析及公式验证

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目的：分析飞秒激光小切口角膜基质透镜取出术（SMILE）后非接触眼压变化的相关因素，在此基础上得出手术前后眼压变化量的预测公式，并对预测公式的效能进行检验。方法：收集2016年6月至2017年8月在温州医科大学附属眼视光医院行SMILE手术并符合要求的患者共154例（304眼），随机分为组1（150眼）和组2（154眼）。获取患者术前的等效球镜度（SE）、中央角膜厚度（CCT）、切削深度（AD）、切削比（AR）、剩余基质床厚度（RSBT），术前、术后3个月的非接触眼压测量值（NCTpre、NCT3mo）、平均角膜曲率（Ave K）、陡峭角膜曲率（Steep K）、平坦角膜曲率（Flat K）。对组1的SMILE手术前后眼压变化量（ΔNCT）与各因素行Spearman相关和多元线性回归分析，建立预测眼压变化量的回归公式，将组2数据代入所得公式进行效能验证。结果：SMILE术前和术后3个月的NCT分别为（15.72±2.86）mmHg（1 mmHg= 0.133 kPa）和（9.94±2.32）mmHg，差异有统计学意义（P＜0.05），ΔNCT为（5.78±2.59）mmHg。SE与AD、AR呈高度负相关（r=-0.956、-0.949，P＜0.001），NCTpre与NCT3mo呈中度正相关（r=0.559，P＜0.01）。通过对组1数据中的手术前后眼压变化量与各因素行Spearman相关和多元线性回归分析，得到回归公式A：ΔNCT=NCTpre×0.502-SE×0.385-3.951（矫正R2=0.489，F=72.329，P＜0.001）；回归公式B：ΔNCT= NCTpre×0.509+AR×0.179-5.545（矫正R2=0.489，F=72.423，P＜0.001）。将组2数据代入公式验证，公式A、B及公式Schallhorn（简易）所得到的ΔNCT预测值与实际测量值差值差异均无统计学意义（P＞0.05），但公式A（r=0.638，P＜0.001）和公式B（r=0.650，P＜0.001）所得的预测值与实际测量值的相关性都大于公式Schallhorn（简易）计算值（r=0.637，P＜0.001），且公式B大于公式A。结论：SMILE手术前后NCT的变化量与术前眼压测量值及术中AR密切相关，基于此建立的预测ΔNCT的回归公式，可能可用于临床上术后NCT值的估计。

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关键词 ：飞秒激光小切口角膜基质透镜取出术, 非接触眼压, 线性回归

Abstract：Objective: To analyze the relative factors of changes of intraocular pressure (IOP) measured by noncontact tonometer (NCT) before and after small incision lenticule extraction (SMILE) and evaluate regression equations for predicting ΔNCT. The efficacy of regression equations was validated. Methods: This study included 154 patients (304 eyes) with myopia and myopic astigmatism receiving SMILE in Eye Hospital Wenzhou Medical University from June 2016 to August 2017. These eyes were randomly divided into group 1 (150 eyes) and group 2 (154 eyes). The spherical equivalent (SE), central corneal thickness (CCT), ablation depth (AD), ablation rate (AR), residual stromal bed thickness (RSBT), preoperative NCT (NCTpre), NCT at 3 months after operation (NCT3mo), average keratometry (Ave K), steep keratometry (Steep K) and flat keratometry (Flat K) were obtained. Two multivariate linear regression equations were established by analyzing ΔNCT and relative factors for group 1 after Spearman correlation analysis. Data of group 2 were used for validation. Results: There was significant difference in NCT before (15.72±2.86) mmHg and after SMILE (9.94±2.32) mmHg (P<0.05). The NCT had a decline of (5.78±2.59) mmHg. SE was highly correlated with AD and AR (r=-0.956, -0.949, P<0.001). NCTpre was moderately correlated with NCT3mo (r=0.559, P<0.01). The Spearman correlation analysis was performed to evaluate the relationship between relative factors and ΔNCT and the following multivariate linear regression equations were established: Equation A: ΔNCT=NCTpre×0.502–SE×0.385–3.951 (Adjusted R2=0.489, F=72.329, P<0.001); Equation B: ΔNCT=NCTpre×0.509+AR×0.179–5.545 (Adjusted R2=0.489, F=72.423, P<0.001). There was no significant difference between the predicted ΔNCT and measured values through equations A, B and equation Schallhorn (Simplified) for group 2 (P>0.05). A higher correlation was shown between the predicted ΔNCT and measured values obtained by equations B (r=0.650, P<0.001) and A (r=0.638, P<0.001) than equation Schallhorn (Simplified) (r=0.637, P<0.001). Conclusion: NCTpre and AR were closely correlated with changes of NCT before and after SMILE. The regression equation of ΔNCT might be clinically applied to acquire the real postoperative NCT.

Key words： small incision lenticule extraction noncontact tonometry linear regression

收稿日期: 2017-12-22

基金资助:国家自然科学基金青年基金资助项目（81400374）；浙江省医药卫生科研项目（2018KY543，2017KY113）；温州市公益性科技计划项目（Y20150265）。

通讯作者: 余野，副教授，Email：yuye80@msn.com。

作者简介: 崔乐乐（1983-），女，浙江临海人，主治医师，博士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I6/413

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