绷带型角膜接触镜改善SMILE术后临床症状和生活质量: 回顾性队列研究

Bandage Contact Lenses Improve Clinical Symptoms and Quality of Life After Small Incision Lenticule Extraction: A Retrospective Cohort Study

  • 摘要:
      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。

     

    Abstract:
      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 group10.0(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.

     

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