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棋牌问答 EVOICL安全性文献解读之ICL不增加术后干眼症状一项不同屈光手术后515年的横断面病例对照研究

发布日期:2022-03-11 10:57    点击次数:85
原文引自微信公众号:ICL技术培训中国 3月5日导语 干眼病(DED)是一种多因素的眼表疾病,其特征是泪膜内稳态丧失,并伴有眼部症状,病因包括泪膜不稳定和泪液高渗透压、眼表炎症和损伤以及神经感觉异常5。另外,干眼病也可能是由医源性干预措施引起,包括全身或局部药物,隐形眼镜,眼科手术(例如角膜屈光手术和白内障手术)8等。 干眼病是LASIK手术后最常报告的问题11,12。ICL术后偶见干眼报道,但因为ICL手术与白内障或屈光性晶状体置换术(RLE)的相似性,可能也存在一些相同的干眼危险因素8。但大部分记录了激光视力矫正(LVC)手术或ICL手术后干眼症状的文章观察时间有限,没有研究评估屈光手术后长达5年或更长时间的干眼症状。 因此,挪威东南大学团队进行了相关研究,比较5到15年前接受LVC或ICL的患者与没有屈光手术史的类似人群的干眼病体征以及干眼病的患病率,该研究结果于2020年发表在Clinical Ophthalmology。研究设计 这是一项横断面病例对照研究。研究纳入共257名受试者,包括5 - 15年前接受LVC(LASIK或Femto-LASIK)手术或ICL(V4型)手术的患者和对照组,对照组为无屈光手术史的年龄匹配组,随机选择一只测试眼。采用泪液渗透压(双眼测量)、眼表疾病指数(OSDI)、客观散射指数(OSI)、非侵入性泪膜破裂时间(NIKBUT)、睑板腺照相和SchirmerⅠ试验等标准评估干眼病。研究结果 研究共纳入257位患者:LVC组94位(45位女性,49位男性),ICL组80位(57位女性,23位男性),对照组83位(41位女性,42位男性)。 与LVC组相比,ICL组的女性患者明显多于对照组,并且手术后的时间明显更长。两组之间的术前验光存在显着差异。(表1) LVC组的高泪液渗透压的比例明显高于对照组(73%vs 50%,p = 0.002)。相反,LVC组的主观症状发生率往往低于对照组(19%对比31%;p = 0.06)。在ICL和对照组之间未发现这些差异。ICL组的VBUT≤10 s的频率明显高于对照组(33%vs 17%)。(表3,图1)讨论 研究发现,LVC组的高泪液渗透压的比例明显高于对照组和ICL组。这可能是由于泪液渗透压的差异性是DED的标志42。在所有组中,DED的患病率较高可能是因为,当患者因干眼而导致不能佩戴隐形眼镜时,更可能考虑接受屈光手术作为解决方案。据报道,多达73%的LVC患者寻求手术是因为隐形眼镜配戴困难14,45。另外,年龄是DED的危险因素,本研究中,LVC和ICL组患者的平均年龄分别比手术时大8岁和10岁6。 LVC组的主观症状倾向于减少。研究表明,由于年龄,耐受性,环境甚至是长期干眼的差异,主观和客观症状可能会不一致,这会降低患者的敏感性3,43。在LASIK术后患者中,症状减轻可能是由于敏感性降低所致。Take home message:ICL不增加术后干眼症状 与无屈光手术史的年龄匹配对照组相比,ICL术后5-15年的患者的高泪液渗透压的比例和DED主观症状发生率均无明显差异。LVC术后5-15年的患者高泪液渗透压的比例明显高于对照组,干眼病主观症状发生率低于对照组,可能与主观症状的敏感性降低有关。文献来源:http://doi.org/10.2147/OPTH.S236749参考文献:1. 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