陈晨;龙琴;
CHEN Chen;LONG Qin;Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &Peking Union Medical College;

• 1:中国医学科学院北京协和医院眼科

摘要(Abstract)：

目的 探究飞秒激光小切口角膜基质透镜取出术(small incision lenticule extraction, SMILE)后配戴绷带型角膜接触镜(bandage contact lens, BCL)对患者临床症状和生活质量的影响。方法 回顾性收集2019年1—5月北京协和医院眼科行SMILE术的近视或近视散光患者。根据术后处理方式分为研究组和对照组。研究组于SMILE术后立即配戴BLC,对照组常规配戴透明眼罩，并均于术后第1天摘除。比较两组术后疼痛、畏光、流泪、视物模糊等临床症状严重程度及其持续时间，疼痛对生活质量的影响程度，术后裸眼视力、非接触眼压、等效球镜度数，总体手术满意度，并记录BCL相关不良反应。结果 研究组术后24 h疼痛[0.2(0,1.1)分比1.1(0.5,2.1)分，P=0.007]、畏光[1.0(0,2.0)分比2.0(0.8,2.3)分，P=0.032]严重程度评分以及疼痛[0(0,1.0)h比2.0(0,6.3)h,P=0.014]、畏光[0(0,1.0)h比2.0(0,4.3)h,P=0.006]持续时间均明显低于对照组，两组术后24 h流泪、视物模糊严重程度评分及其持续时间均无显著性差异(P均>0.05)。术后24 h,疼痛对“活动能力”“和他人的关系”“睡眠”的影响程度在研究组小于对照组(P均<0.05)。术后7 d,研究组对手术的总体满意度评分与对照组无显著性差异[10.0(9.0,10.0)分比10.0(9.0,10.0)分，P=0.617]。两组术后第1、2、7天裸眼视力，非接触眼压，等效球镜度数均无统计学差异(P均>0.05)。研究组2例患者出现BCL相关不良反应(球结膜充血),摘除BCL后症状逐渐改善，术后第7天裸眼视力恢复至术前最佳矫正视力。结论 BCL可减轻SMILE术后疼痛和畏光程度及其持续时间，一定程度上改善患者术后生活质量。
Objective To explore the effect of wearing bandage contact lenses(BCL) on the clinical symptoms and quality of life of patients after small incision lenticule extraction(SMILE). Methods Patients with myopic or myopic astigmatism who underwent SMILE in Peking Union Medical College Hospital from Januaryto May 2019 were collected. According to the postoperative treatment methods, they were divided into the study group and the control group. The study group wore BCL immediately after SMILE, while the control group wore transparent eye patches routinely. BLC or the transparent eye patch was removed on the first day after surgery. The severity and duration of postoperative pain, photophobia, tearing, blurred vision and other clinical symptoms, the impact of pain on quality of life, postoperative uncorrected visual acuity, non-contact intraocular pressure, spherical equivalent, overall surgical satisfaction were compared between the two groups. Meanwhile, BCL adverse reactions was recorded.Results Severity scores of pain [0.2(0, 1.1) vs. 1.1(0.5, 2.1), P=0.007] and photophobia [1.0(0, 2.0) vs. 2.0(0.8, 2.3), P=0.032] as well as the duration of pain [0(0,1.0) h vs. 2.0(0,6.3) h, P=0.014] and photophobia [0(0,1.0) h vs. 2.0(0,4.3) h, P=0.006] at 24 h after surgery were significantly lower in the study group than those in the control group. There were no significant differences in the severity scores and duration of tears and blurred vision at 24 h postoperatively between the two groups(all P>0.05). At 24 h after SMILE, the effects of pain on activity, sleep and the relationship with others were lower in the study group than those in the control group(all P<0.05). At 7 d postoperatively, the score of overall satisfaction to the surgery of the study group was not significantly different from that of the control group[10.0(9.0, 10.0) vs. 10.0(9.0, 10.0), P=0.617]. There were no significant differences in postoperative uncorrected visual acuity, non-contact intraocular pressure, and spherical equivalent on days 1, 2, and 7 days after SMILE between the two groups(all P>0.05). BCL related adverse effects(bulbar conjunctival hyperemia) occurred in two patients. The symptoms gradually improved after BCL removal, and the postoperative uncorrected visual acuity recovered to the best-corrected preoperative visual acuity at 7 d after surgery. Conclusions The application of BCL after SMILE can reduce the degree and duration of postoperative pain and photophobia, and improve the postoperative quality of life to a certain extent.

关键词(KeyWords)： 飞秒激光小切口角膜基质透镜取出术;绷带型角膜接触镜;疼痛;畏光
small incision lenticule extraction;bandage contact lens;pain;photophobia

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金(81870685);; 北京市自然科学基金(7172173)~~

作者(Authors): 陈晨;龙琴;
CHEN Chen;LONG Qin;Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &Peking Union Medical College;

参考文献(References)：

• [1] Titiyal JS,Kaur M,Shaikh F,et al.Small incision lenticule extraction (SMILE) techniques:patient selection and perspectives[J].Clin Ophthalmol,2018,12:1685- 1699.
• [2] 侯杰，雷玉琳，饶丰，等.角膜地形图与调制传递函数测量SMILE矫治近视术后有效光学区的比较[J].中华实验眼科杂志，2021,39:126- 132.
• [3] Zheng Z,Zhang M,Jhanji V,et al.Comparison between aberration-free transepithelial photorefractive keratectomy and small incision lenticule extraction for correction of myopia and myopic astigmatism[J].Int Ophthalmol,2021,41:303- 314.
• [4] Ganesh S,Brar S,Arra RR.Refractive lenticule extraction small incision lenticule extraction:A new refractive surgery paradigm[J].Indian J Ophthalmol,2018,66:10- 19.
• [5] 张文文，蔡剑茹，程新梁，等.SMILE和SBK术后角膜前表面形态的变化[J].中华眼视光学与视觉科学杂志，2017,19:421- 427.
• [6] Liu T,Dan T,Luo Y.Small Incision Lenticule Extraction for Correction of Myopia and Myopic Astigmatism:First 24-Hour Outcomes[J].J Ophthalmol,2017,2017:5824534.
• [7] Zhao LQ,Li LM,Liu J,et al.Bandage Contact Lens Application Reduces Fibrotic Wound Healing of Flap Margins after FS-LASIK:A Prospective Randomized Clinical Trial[J].J Ophthalmol,2019,2019:3074659.
• [8] Wu YT,Ho A,Naduvilath T,et al.The risk of vision loss in contact lens wear and following LASIK[J].Ophthalmic Physiol Opt,2020,40:241- 248.
• [9] 中华医学会眼科学分会眼视光组.我国飞秒激光小切口角膜基质透镜取出手术规范专家共识(2018年)[J].中华眼科杂志，2018,54:729- 736.
• [10] Porela-Tiihonen S,Kaarniranta K,Kokki M,et al.A prospective study on postoperative pain after cataract surgery[J].Clin Ophthalmol,2013,7:1429- 1435.
• [11] 毕婷，张会君.生活质量在中老年青光眼患者疼痛与焦虑之间中介效应[J].中国公共卫生，2017,33:509- 512.
• [12] Pereira V,Garcia R,Torricelli A,et al.Codeine Plus Acetaminophen for Pain After Photorefractive Keratectomy:A Randomized,Double-Blind,Placebo-Controlled Add-On Trial[J].Cornea,2017,36:1206- 1212.
• [13] Lievens CW,Norgett Y,Briggs N,et al.Natural course of lid wiper epitheliopathy (LWE) in symptomatic contact lens wearers[J].Cont Lens Anterior Eye,2022,45:101529.
• [14] Sandvik GF,Rand-Hendriksen S,Drolsum L,et al.Photophobia and disability glare in adult patients with Marfan syndrome:a case-control study[J].Acta Ophthalmol,2022,100:337- 343.
• [15] Asakawa K,Kanno S,Ando T,et al.The Effects of Chewing Gum in Preventing Eyestrain[J].Biomed Res Int,2020,2020:2470473.
• [16] 许正华，张小玲，刘毅，等.绷带镜在翼状胬肉切除联合结膜瓣移植术后的应用[J].国际眼科杂志，2017,17:1786- 1789.
• [17] Wen D,Tu R,Flitcroft I,et al.Corneal Surface Ablation Laser Refractive Surgery for the Correction of Myopia:A Network Meta-analysis[J].J Refract Surg,2018,34:726- 735.
• [18] Luft N,Schumann RG,Dirisamer M,et al.Wound Heal-ing,Inflammation,and Corneal Ultrastructure After SMILE and Femtosecond Laser-Assisted LASIK:A Human Ex Vivo Study[J].J Refract Surg,2018,34:393- 399.
• [19] Liu L,Cheng W,Wu D,et al.The Differential Expression of Cytokines and Growth Factors After SMILE Compared With FS-LASIK in Rabbits[J].Invest Ophthalmol Vis Sci,2020,61:55.
• [20] Wen D,McAlinden C,Flitcroft I,et al.Postoperative Efficacy,Predictability,Safety,and Visual Quality of Laser Corneal Refractive Surgery:A Network Meta-analysis[J].Am J Ophthalmol,2017,178:65- 78.
• [21] Mastropasqua L,Calienno R,Curcio C,et al.In Vivo and Ex Vivo Evaluation of Inflammation and Apoptosis Induced after SMILE Procedures for Different Refractive Error Range[J].Curr Eye Res,2017,42:701- 707.
• [22] Szaflik JP,Ambroziak AM,Szaflik J.Therapeutic use of a lotrafilcon A silicone hydrogel soft contact lens as a bandage after LASEK surgery[J].Eye Contact Lens,2004,30:59- 62.
• [23] Ortega-Usobiaga J,Baviera-Sabater J,Llovet-Osuna F,et al.Outcomes of Flap Lift Laser In Situ Keratomileusis Enhancements in a Large Patient Population:Does Application of a Bandage Contact Lens Affect Incidence of Epithelial Ingrowth?[J].Cornea,2019,38:1531- 1535.
• [24] Sekundo W,Dick HB,Meyer CH.Benefits and side effects of bandage soft contact lens application after LASIK:a prospective randomized study[J].Ophthalmology,2005,112:2180- 2183.
• [25] 中国健康管理协会接触镜安全监控与视觉健康专业委员会.中国治疗用绷带镜临床应用专家共识(2019年)[J].中华眼科杂志，2019,55:405- 412.
• [26] Vidal-Rohr M,Wolffsohn JS,Davies LN,et al.Effect of contact lens surface properties on comfort,tear stability and ocular physiology[J].Cont Lens Anterior Eye,2018,41:117- 121.
• [27] AlDahash F,AlAmeer A,Hussain OB,et al.Effect of Bandage Contact Lens Exchange on Pain and Healing After Photorefractive Keratectomy-A Randomized Control Trial[J].Eye Contact Lens,2021,47:113- 117.
• [28] Seguí-Crespo M,Parra Picó J,Ruíz Fortes P,et al.Usefulness of bandage contact lenses in the immediate postoperative period after uneventful myopic LASIK[J].Cont Lens Anterior Eye,2018,41:187- 192.
• [29] Zhu B,Liu Y,Lin L,et al.Characteristics of Infectious Keratitis in Bandage Contact Lens Wear Patients[J].Eye Contact Lens,2019,45:356- 359.
• [30] Orucov F,Frucht-Pery J,Raiskup FD,et al.Quantitative assessment of bandage soft contact lens wear immediately after LASIK[J].J Refract Surg,2010,26:744- 748.