Офтальмохирургия. 2021; : 40-47
Денситометрическая оценка прозрачности роговицы после коррекции миопии средней степени методом фемтосекундной экстракции лентикулы через малый разрез и с помощью лазерного кератомилеза in situ с фемтосекундным сопровождением
https://doi.org/10.25276/0235-4160-2021-3-40-47Аннотация
Актуальность. Исследование механизмов отсроченного восстановления некорригированной остроты зрения в раннем послеоперационном периоде при коррекции миопии методом SMILE является актуальным. Цель. Оценить изменение показателей денситометрии роговицы после операции SMILE и FS-LASIK у пациентов с миопией средней степени. Материал и методы. Проведено проспективное исследование 152 пациентов с миопией средней степени, 68 прооперированы методом SMILE и 84 – FS-LASIK. Все процедуры выполнялись с использованием фемтосекундного лазера VisuMax и эксимерного лазера MEL 80 (Carl Zeiss Meditec, Германия). Оценка остроты зрения, структуры роговицы (ОКТ, Optovue, США), денситометрия роговицы (Pentacam Scheimpflug, Германия) проводились до операции, на 1-е, 5-е сутки, через 3, 6, 12 месяцев после операции. ОКТ-сканы проанализированы с использованием программы ImageJ. Результаты. На 1-е сутки после SMILE острота зрения (р=0,01) и прозрачность переднего и среднего слоя роговицы были более снижены, чем после FS-LASIK, в зоне от 0 до 2 мм (р=0,045, р=0,001), от 2 до 6 мм (обе р=0,001). Данные различия стали статистически незначимыми к 5-му дню после операции. К 3 и 6 месяцам в группе FSLASIK прозрачность роговицы в средних слоях снизилась в зоне 0–2 мм и 2–6 мм (р=0,0001, р=0,001). В обеих группах к 12 месяцам обратное светорассеяние роговицы достигло значений предоперационного периода (р>0 05). Заключение. Рефракционные операции SMILE и FS-LASIK сопровождаются снижением прозрачности роговицы, которая к 12 месяцам восстанавливается до предоперационных значений. В раннем послеоперационном периоде повышение показателей денситометрии и более медленное восстановление остроты зрения после операции SMILE может быть обусловлено активным ремоделированием интерфейса, включающего в себя обломки коллагеновых фибрилл и клеточные компоненты внутри интрастромального пространства.
Список литературы
1. Blum M, Täubig K, Gruhn Ch, Sekundo W, Kunert KS. Five-year results of small incision lenticule extraction (ReLEx SMILE). Br J Ophthalmol. 2016;100(9): 1192–1195. doi: 10.1136/bjophthalmol-2015-306822
2. Ganesh S, Gupta R. Comparison of visual and refractive outcomes following femtosecond laser- assisted lasik with smile in patients with myopia or myopic astigmatism. J Refract Surg. 2014;30(9): 590–596. doi: 10.3928/1081597x-20140814-02
3. Li M, Zhou Z, Shen Y, Knorz MC, Gong L, Zhou X. Comparison of corneal sensation between small incision lenticule extraction (SMILE) and femtosecond laserassisted LASIK for myopia. J Refract Surg. 2014;30(2): 94–100. doi: 10.3928/1081597X-20140120-04
4. Romero-Diaz-de-Leon L, Serna-Ojeda JC, Navas A, Graue-Hernández EO, Ramirez-Miranda A. Intraoperative Flap Complications in LASIK Surgery Performed by Ophthalmology Residents. J Ophthalmic Vis Res. 2016;11(3): 263–267. doi: 10.4103/2008-322X.188393
5. Villa C, Gutiérrez R, Jiménez JR, González-Méijome JM. Night vision disturbances after successful LASIK surgery. Br J Ophthalmol. 2007;91(8): 1031–1037. doi: 10.1136/bjo.2006.110874
6. Chansue E, Tanehsakdi M, Swasdibutra S, McAlinden C. Efficacy, predictability and safety of small incision lenticule extraction (SMILE). Eye Vis (Lond). 2015;2: 14. doi: 10.1186/s40662-015-0024-4
7. Han T, Zhao J, Shen Y, Chen Y, Tian M, Zhou X. A Three-year observation of corneal backscatter after small incision lenticule extraction (SMILE). J Refract Surg. 2017;33(6): 377–382. doi: 10.3928/1081597X-20170420-01
8. Agca A, Ozgurhan EB, Yildirim Y, Cankaya KI, Guleryuz NB, Alkin Z, Ozkaya A, Demirok A, Yilmaz OF. Corneal backscatter analysis by in vivo confocal microscopy: fellow eye comparison of small incision lenticule extraction and femtosecond laserassisted LASIK. J Ophthalmol. 2014;2014: 265012. doi: 10.1155/2014/265012
9. Ağca A, Demirok A, Cankaya Kİ, Yaşa D, Demircan A, Yildirim Y, Ozkaya A, Yilmaz OF. Comparison of visual acuity and higher-order aberrations after femtosecond lenticule extraction and small-incision lenticule extraction. Cont Lens Anterior Eye. 2014;37(4): 292-296. doi: 10.1016/j.clae.2014.03.001
10. Dhubhghaill SN, Rozema JJ, Jongenelen S, Hidalgo IR, Zakaria N, Tassignon M–J. Normative values for corneal densitometry analysis by Scheimpflug optical assessment. Invest Ophthalmol Vis Sci. 2014;55(1): 162-168. doi: 10.1167/iovs.13-13236
11. Otri AM, Fares U, Al-Aqaba MA, Dua HS. Corneal densitometry as an indicator of corneal health. Ophthalmology. 2012;119(3): 501–508. doi: 10.1016/j.ophtha.2011.08.024
12. Elflein HM, Hofherr T, Berisha-Ramadani F, Weyer V, Lampe C, Beck M, Pitz S. Measuring corneal clouding in patients suffering from mucopolysaccharidosis with the Pentacam densitometry programme. Br J Ophthalmol. 2013;97(7): 829–833. doi: 10.1136/bjophthalmol-2012-302913
13. Lopes B, Ramos I, Ambrósio Jr R. Corneal densitometry in keratoconus. Cornea. 2014;33(12): 1282–1286. doi: 10.1097/ICO.0000000000000266
14. Koh Sh, Maeda N, Nakagawa T, Nishida K. Quality of vision in eyes after selective lamellar keratoplasty. Cornea. 2012;31(Suppl 1): S45–49. doi: 10.1097/ICO.0b013e318269c9cd
15. Uchino Y, Shimmura Sh, Yamaguchi T, Kawakita T, Matsumoto Y, Negishi K, Tsubota K. Comparison of corneal thickness and haze in DSAEK and penetrating keratoplasty. Cornea. 2011;30(3): 287–290. doi: 10.1097/ICO.0b013e3181eeafd6
16. Jain R, Dilraj G, Grewal SPS. Repeatability of corneal parameters with Pentacam after laser in situ keratomileusis. Indian J Ophthalmol. 2007;55(5): 341–347.
17. Minami K, Honbo M, Mori Y, Kataoka Y. Area densitometry using rotating Scheimpflug photography for posterior capsule opacification and surface light scattering analyses. J Cataract Refract Surg. 2015;41(11): 2444–2449. doi: 10.1016/j.jcrs.2015.05.038
18. Li M, Niu L, Qin B, Zhou Z, Ni K, Le Q, Xiang J, Wei A, Ma W, Zhou X. Confocal comparison of corneal reinnervation after small incision lenticule extraction (SMILE) and femtosecond laser in situ keratomileusis (FS-LASIK). PLoS ONE. 2013;8(12): e81435. doi: 10.1371/journal.pone.0081435
19. Shajari M, Wanner E, Rusev V, Sefat ShMM, Mayer WJ, Kohnen Th, Priglinger S, Kook D. Corneal densitometry after femtosecond laser-assisted in situ keratomileusis (Fs-LASIK) and small incision lenticule extraction (SMILE). Curr Eye Res. 2018;43(5): 605–610. doi: 10.1080/02713683.2018.1431288
20. Lazaridis A, Droutsas K, Sekundo W, Petrak M, Schulze S. Corneal clarity and visual outcomes after small-incision lenticule extraction and comparison to femtosecond laser-assisted in situ keratomileusis. J Ophthalmol. 2017;2017: 5646390. doi: 10.1155/2017/5646390
21. Soong HK, Malta JB. Femtosecond lasers in ophthalmology. Am J Ophthalmol. 2009;147(2): 189–197.e2G. doi: 10.1016/j.ajo.2008.08.026
22. Kymionis GD, Kankariya VP, Plaka AD, Reinstein DZ. Femtosecond laser technology in corneal refractive surgery: a review. J Refract Surg. 2012;28(12): 912– 920. doi: 10.3928/1081597X-20121116-01
23. Riau AK, Angunawela RI, Chaurasia ShS, Lee WS, Tan DT, Mehta JS. Early corneal wound healing and inflammatory responses after refractive lenticule extraction (ReLEx). Invest Ophthalmol Vis Sci. 2011;52(9): 6213–6221. doi: 10.1167/iovs.11-7439
24. Seiler T, Bende T, Winckler K, Wollensak J. Side effects in excimer corneal surgery. DNA damage as a result of 193 nm excimer laser radiation. Graefes Arch Clin Exp Ophthalmol. 1988;226(3): 273–276.
25. Netto MV, Mohan RR, Medeiros FW, Dupps Jr WJ, Sinha S, Krueger RR, Stapleton WM, Rayborn M, Suto Ch, Wilson SE. Femtosecond laser and microkeratome corneal flaps: comparison of stromal wound healing and inflammation. J Refract Surg. 2007;23(7): 667–676.
26. Shah R, Shah S. Effect of scanning patterns on the results of femtosecond laser lenticule extraction refractive surgery. J Cataract Refract Surg. 2011;37(9): 1636–1647. doi: 10.1016/j.jcrs.2011.03.056
27. Resan M, Vukosavljevic M, Vojvodic D, Pajic-Eggspuehler B. The acute phase of inflammatory response involved in the wound-healing process after excimer laser treatment. Clin Ophthalmol. 2016;10: 993–1000. doi: 10.2147/OPTH.S105880
28. Dong Z, Zhou X–T, Wu J, Zhang Zh, Li T, Zhou Z, Zhang Sh, Li G. Small incision lenticule extraction (SMILE) and femtosecond laser LASIK: Comparison of corneal wound healing and inflammation. Br J Ophthalmol. 2014;98(2): 263–269. doi: 10.1136/bjophthalmol-2013-303415
29. Leonardi A, Tavolato M, Curnow SJ, Fregona IA, Violato D, Alió JL. Cytokine and chemokine levels in tears and in corneal fibroblast cultures before and after excimer laser treatment. J Cataract Refract Surg. 2009;35(2): 240–247. doi: 10.1016/j.jcrs.2008.10.030
30. Liu Y-Ch, Ang M, Teo E, Lwin NCh. Wound healing profiles of hyperopic-small incision lenticule extraction (SMILE). Scientific Reports. 2016;6: 29802. doi: 10.1038/srep29802
Fyodorov Journal of Ophthalmic Surgery. 2021; : 40-47
Densitometric assessment of corneal transparency after correction of moderate myopia by femtosecond extraction of the lenticule through a small incision and using laser keratomilesis in situ with femtosecond assistance
https://doi.org/10.25276/0235-4160-2021-3-40-47Abstract
Relevance. The study of the mechanisms of insufficiently rapid achievement of high visual acuity in the early postoperative period in the correction of myopia by the SMILE method is relevant. Purpose. To evaluate changes in corneal densitometry parameters after SMILE and FS-LASIK surgery in patients with moderate myopia. Material and methods. A study of 152 patients with moderate myopia was conducted, 68 were operated by SMILE and 84 – FS-LASIK. All procedures were performed using a VisuMax femtosecond laser and a MEL 80 excimer laser (Carl Zeiss Meditec, Germany). Assessment of visual acuity, corneal structure (OCT, Optovue, USA), corneal densitometry (Pentacam Scheimpflug, Germany) were performed before the operation, on the 1st, 5th day, 3, 6, 12 months after the operation. OCT scans were analyzed using the ImageJ program. Results. Оn the 1st day after SMILE, visual acuity (p=0.01) and transparency of the anterior and middle layers of the cornea were reduced than after FS-LASIK in the zone from 0 to 2 mm (p=0.045, p=0.001), from 2 to 6 mm (both p=0.001). These differences became statistically insignificant 5 days after surgery. By three and six months in the FS-ERASER group, the corneal transparency in the middle layers were reduced in the 0–2 mm and 2–6 mm zones (p=0.0001, p=0.001). In both groups, by 12 months, the corneal backscattering reached the values of the preoperative period (p>0,05). Conclusion. Refractive operations SMILE and FS-LASIK are accompanied by a decrease in corneal transparency, which is restored to preoperative values by 12 months. In the early postoperative period, an increase in densitometry indicators and a slower recovery of visual acuity after SMILE surgery may be due to active remodeling of the interface, which includes fragments of collagen fibrils and cellular components i nside the intrastromal space.
References
1. Blum M, Täubig K, Gruhn Ch, Sekundo W, Kunert KS. Five-year results of small incision lenticule extraction (ReLEx SMILE). Br J Ophthalmol. 2016;100(9): 1192–1195. doi: 10.1136/bjophthalmol-2015-306822
2. Ganesh S, Gupta R. Comparison of visual and refractive outcomes following femtosecond laser- assisted lasik with smile in patients with myopia or myopic astigmatism. J Refract Surg. 2014;30(9): 590–596. doi: 10.3928/1081597x-20140814-02
3. Li M, Zhou Z, Shen Y, Knorz MC, Gong L, Zhou X. Comparison of corneal sensation between small incision lenticule extraction (SMILE) and femtosecond laserassisted LASIK for myopia. J Refract Surg. 2014;30(2): 94–100. doi: 10.3928/1081597X-20140120-04
4. Romero-Diaz-de-Leon L, Serna-Ojeda JC, Navas A, Graue-Hernández EO, Ramirez-Miranda A. Intraoperative Flap Complications in LASIK Surgery Performed by Ophthalmology Residents. J Ophthalmic Vis Res. 2016;11(3): 263–267. doi: 10.4103/2008-322X.188393
5. Villa C, Gutiérrez R, Jiménez JR, González-Méijome JM. Night vision disturbances after successful LASIK surgery. Br J Ophthalmol. 2007;91(8): 1031–1037. doi: 10.1136/bjo.2006.110874
6. Chansue E, Tanehsakdi M, Swasdibutra S, McAlinden C. Efficacy, predictability and safety of small incision lenticule extraction (SMILE). Eye Vis (Lond). 2015;2: 14. doi: 10.1186/s40662-015-0024-4
7. Han T, Zhao J, Shen Y, Chen Y, Tian M, Zhou X. A Three-year observation of corneal backscatter after small incision lenticule extraction (SMILE). J Refract Surg. 2017;33(6): 377–382. doi: 10.3928/1081597X-20170420-01
8. Agca A, Ozgurhan EB, Yildirim Y, Cankaya KI, Guleryuz NB, Alkin Z, Ozkaya A, Demirok A, Yilmaz OF. Corneal backscatter analysis by in vivo confocal microscopy: fellow eye comparison of small incision lenticule extraction and femtosecond laserassisted LASIK. J Ophthalmol. 2014;2014: 265012. doi: 10.1155/2014/265012
9. Ağca A, Demirok A, Cankaya Kİ, Yaşa D, Demircan A, Yildirim Y, Ozkaya A, Yilmaz OF. Comparison of visual acuity and higher-order aberrations after femtosecond lenticule extraction and small-incision lenticule extraction. Cont Lens Anterior Eye. 2014;37(4): 292-296. doi: 10.1016/j.clae.2014.03.001
10. Dhubhghaill SN, Rozema JJ, Jongenelen S, Hidalgo IR, Zakaria N, Tassignon M–J. Normative values for corneal densitometry analysis by Scheimpflug optical assessment. Invest Ophthalmol Vis Sci. 2014;55(1): 162-168. doi: 10.1167/iovs.13-13236
11. Otri AM, Fares U, Al-Aqaba MA, Dua HS. Corneal densitometry as an indicator of corneal health. Ophthalmology. 2012;119(3): 501–508. doi: 10.1016/j.ophtha.2011.08.024
12. Elflein HM, Hofherr T, Berisha-Ramadani F, Weyer V, Lampe C, Beck M, Pitz S. Measuring corneal clouding in patients suffering from mucopolysaccharidosis with the Pentacam densitometry programme. Br J Ophthalmol. 2013;97(7): 829–833. doi: 10.1136/bjophthalmol-2012-302913
13. Lopes B, Ramos I, Ambrósio Jr R. Corneal densitometry in keratoconus. Cornea. 2014;33(12): 1282–1286. doi: 10.1097/ICO.0000000000000266
14. Koh Sh, Maeda N, Nakagawa T, Nishida K. Quality of vision in eyes after selective lamellar keratoplasty. Cornea. 2012;31(Suppl 1): S45–49. doi: 10.1097/ICO.0b013e318269c9cd
15. Uchino Y, Shimmura Sh, Yamaguchi T, Kawakita T, Matsumoto Y, Negishi K, Tsubota K. Comparison of corneal thickness and haze in DSAEK and penetrating keratoplasty. Cornea. 2011;30(3): 287–290. doi: 10.1097/ICO.0b013e3181eeafd6
16. Jain R, Dilraj G, Grewal SPS. Repeatability of corneal parameters with Pentacam after laser in situ keratomileusis. Indian J Ophthalmol. 2007;55(5): 341–347.
17. Minami K, Honbo M, Mori Y, Kataoka Y. Area densitometry using rotating Scheimpflug photography for posterior capsule opacification and surface light scattering analyses. J Cataract Refract Surg. 2015;41(11): 2444–2449. doi: 10.1016/j.jcrs.2015.05.038
18. Li M, Niu L, Qin B, Zhou Z, Ni K, Le Q, Xiang J, Wei A, Ma W, Zhou X. Confocal comparison of corneal reinnervation after small incision lenticule extraction (SMILE) and femtosecond laser in situ keratomileusis (FS-LASIK). PLoS ONE. 2013;8(12): e81435. doi: 10.1371/journal.pone.0081435
19. Shajari M, Wanner E, Rusev V, Sefat ShMM, Mayer WJ, Kohnen Th, Priglinger S, Kook D. Corneal densitometry after femtosecond laser-assisted in situ keratomileusis (Fs-LASIK) and small incision lenticule extraction (SMILE). Curr Eye Res. 2018;43(5): 605–610. doi: 10.1080/02713683.2018.1431288
20. Lazaridis A, Droutsas K, Sekundo W, Petrak M, Schulze S. Corneal clarity and visual outcomes after small-incision lenticule extraction and comparison to femtosecond laser-assisted in situ keratomileusis. J Ophthalmol. 2017;2017: 5646390. doi: 10.1155/2017/5646390
21. Soong HK, Malta JB. Femtosecond lasers in ophthalmology. Am J Ophthalmol. 2009;147(2): 189–197.e2G. doi: 10.1016/j.ajo.2008.08.026
22. Kymionis GD, Kankariya VP, Plaka AD, Reinstein DZ. Femtosecond laser technology in corneal refractive surgery: a review. J Refract Surg. 2012;28(12): 912– 920. doi: 10.3928/1081597X-20121116-01
23. Riau AK, Angunawela RI, Chaurasia ShS, Lee WS, Tan DT, Mehta JS. Early corneal wound healing and inflammatory responses after refractive lenticule extraction (ReLEx). Invest Ophthalmol Vis Sci. 2011;52(9): 6213–6221. doi: 10.1167/iovs.11-7439
24. Seiler T, Bende T, Winckler K, Wollensak J. Side effects in excimer corneal surgery. DNA damage as a result of 193 nm excimer laser radiation. Graefes Arch Clin Exp Ophthalmol. 1988;226(3): 273–276.
25. Netto MV, Mohan RR, Medeiros FW, Dupps Jr WJ, Sinha S, Krueger RR, Stapleton WM, Rayborn M, Suto Ch, Wilson SE. Femtosecond laser and microkeratome corneal flaps: comparison of stromal wound healing and inflammation. J Refract Surg. 2007;23(7): 667–676.
26. Shah R, Shah S. Effect of scanning patterns on the results of femtosecond laser lenticule extraction refractive surgery. J Cataract Refract Surg. 2011;37(9): 1636–1647. doi: 10.1016/j.jcrs.2011.03.056
27. Resan M, Vukosavljevic M, Vojvodic D, Pajic-Eggspuehler B. The acute phase of inflammatory response involved in the wound-healing process after excimer laser treatment. Clin Ophthalmol. 2016;10: 993–1000. doi: 10.2147/OPTH.S105880
28. Dong Z, Zhou X–T, Wu J, Zhang Zh, Li T, Zhou Z, Zhang Sh, Li G. Small incision lenticule extraction (SMILE) and femtosecond laser LASIK: Comparison of corneal wound healing and inflammation. Br J Ophthalmol. 2014;98(2): 263–269. doi: 10.1136/bjophthalmol-2013-303415
29. Leonardi A, Tavolato M, Curnow SJ, Fregona IA, Violato D, Alió JL. Cytokine and chemokine levels in tears and in corneal fibroblast cultures before and after excimer laser treatment. J Cataract Refract Surg. 2009;35(2): 240–247. doi: 10.1016/j.jcrs.2008.10.030
30. Liu Y-Ch, Ang M, Teo E, Lwin NCh. Wound healing profiles of hyperopic-small incision lenticule extraction (SMILE). Scientific Reports. 2016;6: 29802. doi: 10.1038/srep29802
