Influence of Changes in Anterior Segment Parameters on Intraocular Pressure Measurement after SMILE
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目的： 探讨飞秒激光小切口角膜基质透镜取出术（SMILE）后眼压（IOP）检测的影响因素，分析眼前节参数变化与IOP的关系。 方法： 前瞻性临床研究。收集2020年6—11月在青岛大学附属医院眼科接受SMILE手术患者141例（258眼)的资料。根据剩余基质床厚度（RST）分为3组，分别为A组（280 μm<RST≤320 μm）、B组（320 μm<RST≤360 μm）、C组（RST>360 μm）。采用Pentacam测量眼前节形态参数，非接触眼压计（NCT）测量IOP，Corvis ST测量角膜生物力学参数。观察患者术前，术后1、3、6个月不同时间点参数的变化。数据采用方差分析、Pearson线性相关、配对t检验进行分析。 结果： 除前房角（ACA）外，各组术后CCT、中央前房深度（ACD）、前房容积（ACV）等眼前节形态学参数均较术前降低，差异均有统计学意义（P<0.05）；3组术后6个月与术前相比，第一压平时间（A1T）、角膜硬度参数（SP-A1）降低，变形幅度（DA）、峰距（PD）、水平方向Ambrosio相关厚度（ARTh）增加；组间比较A组中△A1T、第一压平速率的变化量（△A1V）、△DA及△PD高于B、C组，差异均有统计学意义（P<0.05）；各组△IOP与|SE|、术前IOP、△CCT、△ACD、△ACV呈正相关关系（P<0.05），与△ACA无相关性（P>0.05）；A组中△ACD、△ACV与△A1T、△SP-A1、△ARTh呈正相关，与△DA呈负相关（P<0.05）；3组分别建立△IOP的线性回归方程，进而得出术后IOP的校正方程：A组IOP术后校正值=IOP术后测量值+0.572×IOP术前+15.759×△ACD-2.401（调整后R2=0.55，P<0.001）；B组IOP术后校正值=IOP术后测量值+0.471×IOP术前+0.54×SE-1.099×△CV-3.551（调整后R2=0.50，P<0.001）；C组IOP术后校正值=IOP术后测量值+0.553×IOP术前+0.304×SE-4.013（调整后R2=0.38，P<0.001）。 结论： SMILE术后ACD、ACV变化与△IOP呈正相关关系，RST在280~320 μm范围时，IOP的测量需要考虑前房参数变化的影响。 Objective: To discuss the factors that influence intraocular pressure (IOP) after small incision lenticule extraction (SMILE), and to analyze the anterior segment parameters that influence changes in IOP. Methods: In this prospective clinical study, 141 patients (258 eyes) with myopic astigmatism who underwent SMILE surgery at the Affiliated Hospital of Qingdao University from June to November 2020 were enrolled. They were divided into three groups according to the residual stromal thickness (RST): 280 μm -320 μm in group A, 320 μm -360 μm in group B, >360 μm in group C. Tomography and biomechanical parameters of all eyes were obtained with Pentacam and Corvis ST, respectively. The changes in parameters were observed preoperatively and at 1, 3 and 6 months postoperatively. The data were analyzed by a measurement analysis of variance, Pearson linear correlation and paired t-test. Results: Except for the anterior chamber angle (ACA), the postoperative CCT, anterior chamber depth (ACD), anterior chamber volume (ACV) and other anterior segment morphological parameters in each group were generally lower than those before surgery, with statistically significant differences (all P<0.05). The first applanation time (A1T) and stiff parameter (SP-A1) decreased, the deformation amplitude (DA) and the peak distance (PD) at 6 months after the operation in the three groups were compared with those before the operation and Ambrosio relational thickness horizonal (ARTh) increase. For pairwise comparison between the groups, the ranges in the changes in ∆ A1T, ∆ A1V, ∆ DA, and ∆ PD in group A were greater than those for the other two groups, with statistically significant differences (allP<0.05). ∆ IOP and spherical equivalent (SE), preoperative IOP (IOPpre), ∆ CCT, changes in corneal volume (∆ CV), changes in central anterior chamber depth (∆ ACD) and changes in anterior chamber volume (∆ ACV) were positively correlated (all P<0.05). However, there was no correlation with the change in the anterior chamber angle (∆ ACA) (all P>0.05). In group A, ∆ ACD and ∆ ACV had a medium and low positive correlation with ∆ A1T, ∆ SP-A1, and ∆ ARTh, and a low negative correlation with ∆ DA (allP<0.05). A multiple linear regression equation of ∆ IOP was established for each group, and the corrected equation for the postoperative IOP was obtained: Group A, IOPpost corrected=IOPpost measured+0.572×IOPpre+15.759× ∆ ACD-2.401 (after adjustment R2=0.55, P<0.001) Group B, IOPpost corrected=IOPpost measured+0.471×IOPpre+0.54×SE-1.099× ∆ CV-3.551 (after adjustment R2=0.50, P<0.001) Group C, IOPpost corrected=IOPpost measured+0.447×IOPpre+0.304×SE-4.013 (after adjustment R2=0.38, P<0.001). Conclusions: The changes in ACD and ACV have a positive correlation with ∆ IOP after SMILE. When the RST is in the range of 280-320 μm, the change in anterior chamber parameters should be considered in the measurement of IOP.
Objective: To discuss the factors that influence intraocular pressure (IOP) after small incision lenticule extraction (SMILE), and to analyze the anterior segment parameters that influence changes in IOP. Methods: In this prospective clinical study, 141 patients (258 eyes) with myopic astigmatism who underwent SMILE surgery at the Affiliated Hospital of Qingdao University from June to November 2020 were enrolled. They were divided into three groups according to the residual stromal thickness (RST): 280 μm -320 μm in group A, 320 μm -360 μm in group B, >360 μm in group C. Tomography and biomechanical parameters of all eyes were obtained with Pentacam and Corvis ST, respectively. The changes in parameters were observed preoperatively and at 1, 3 and 6 months postoperatively. The data were analyzed by a measurement analysis of variance, Pearson linear correlation and paired t-test. Results: Except for the anterior chamber angle (ACA), the postoperative CCT, anterior chamber depth (ACD), anterior chamber volume (ACV) and other anterior segment morphological parameters in each group were generally lower than those before surgery, with statistically significant differences (all P<0.05). The first applanation time (A1T) and stiff parameter (SP-A1) decreased, the deformation amplitude (DA) and the peak distance (PD) at 6 months after the operation in the three groups were compared with those before the operation and Ambrosio relational thickness horizonal (ARTh) increase. For pairwise comparison between the groups, the ranges in the changes in ∆ A1T, ∆ A1V, ∆ DA, and ∆ PD in group A were greater than those for the other two groups, with statistically significant differences (allP<0.05). ∆ IOP and spherical equivalent (SE), preoperative IOP (IOPpre), ∆ CCT, changes in corneal volume (∆ CV), changes in central anterior chamber depth (∆ ACD) and changes in anterior chamber volume (∆ ACV) were positively correlated (all P<0.05). However, there was no correlation with the change in the anterior chamber angle (∆ ACA) (all P>0.05). In group A, ∆ ACD and ∆ ACV had a medium and low positive correlation with ∆ A1T, ∆ SP-A1, and ∆ ARTh, and a low negative correlation with ∆ DA (allP<0.05). A multiple linear regression equation of ∆ IOP was established for each group, and the corrected equation for the postoperative IOP was obtained: Group A, IOPpost corrected=IOPpost measured+0.572×IOPpre+15.759× ∆ ACD-2.401 (after adjustment R2=0.55, P<0.001) Group B, IOPpost corrected=IOPpost measured+0.471×IOPpre+0.54×SE-1.099× ∆ CV-3.551 (after adjustment R2=0.50, P<0.001) Group C, IOPpost corrected=IOPpost measured+0.447×IOPpre+0.304×SE-4.013 (after adjustment R2=0.38, P<0.001). Conclusions: The changes in ACD and ACV have a positive correlation with ∆ IOP after SMILE. When the RST is in the range of 280-320 μm, the change in anterior chamber parameters should be considered in the measurement of IOP.
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