Corneal densitometry after femtosecond assisted laser in situ keratomileusis combined with accelerated collagen cross-linking

doi:10.3877/cma.j.issn.2095-2007.2024.06.002

Abstract

Abstract:

Objective

The aim of this study is to investigate the changes and influencing factors of corneal densitometry（CD）characteristics after femtosecond assisted laser in situ keratomileusis combined with accelerated collagen cross-linking（FS-LASIK Xtra）procedures.

Methods

From June 2020 to March 2021，a total of 56 patients（112 eyes）with thin cornea and myopic astigmatism were enrolled in the Refractive Surgery of Beijing Tongren Hospital Affiliated to Capital Medical University.There were 10 males（20 eyes）and 46 females（92 eyes）with the average age of 26.50（23.00，30.00）years（raging from 18 to 39 years）.Patients were divided into FS-LASIK Xtra group and femtosecond assisted laser in situ keratomileusis（FS-LASIK）group according to the surgical method.The changes in visual acuity and CD at different positions between two groups before and after surgery at 1 month，3 months，6 months，and 12 months were compared.The spherical equivalent（SE）and CD conformed to the normal distribution，and were expressed as±s.Paired t-test was used for comparison at different time points before and after surgery，and independent sample t-test was used for comparison between groups.Age，visual acuity，corneal curvature，and corneal thickness did not follow a normal distribution according to Kolmogorov-Smirnov test，and were represented by median and interquartile range M（Q1，Q3）.Rank test was used for inter group comparison.The comparison of CD at different time points was analyzed using a two factor repeated measurement analysis of variance，and the correlation between corneal position and CD was analyzed using Spearman's method.

Results

There were included 56 patients（112 eyes），with 25 patients（50 eyes）in the FS-LASIK Xtra group and 31 patients（62 eyes）in the FS-LASIK group.The preoperative SE of FSLASIK Xtra group and FS-LASIK group were（-7.63±1.80）D and（-7.93±2.24）D，and which were（-0.17±0.66）D and（-0.02±0.52）D at 12 months postoperatively.There was no statistically significant difference between the groups（t=-1.31，P＞0.05），while the difference within the group comparison were statistically significant（t=-27.64，-26.50；P＜0.05）.The logarithms of the minimum angle of resolution（logMAR）for two groups of preoperative uncorrected visual acuity（UDVA）were 1.30（1.30，1.52）logMAR and 1.30（1.30，1.40）logMAR，and which were were-0.08（-0.18，-0.08）logMAR and-0.08（-0.18，-0.08）logMAR at 12 months postoperatively.There was no statistically significant difference between the groups（Z=-0.20，P＞0.05），while the difference within the group comparison were statistically significant（Z=-6.17，-6.88；P＜0.05）.The average preoperative corneal curvature of the two groups were 43.58（43.19，44.79）D and 43.52（43.10，44.30）D，and which were 37.30（35.68，38.67）D and 36.86（36.13，38.53）D at 12 months postoperatively.There was no statistically significant difference between the groups（Z=-0.47，P＞0.05），while the difference within the group comparison were statistically significant（Z=-6.15，-6.85；P＜0.05）.The CD values of the the anterior 120μm and the central layer at 0 to2 mm and 2 to6 mm in the FS-LASIK Xtra group were 24.93±1.56，30.55±4.28，29.37±6.31，24.98±2.99，22.92±22.08，22.32±1.30，26.59±3.10，26.06±3.52，23.10±1.76，21.15±1.53 and 15.49±0.92，17.69±2.53，16.33±1.64，14.96±1.32，14.31±1.24，13.81±0.70，14.79±1.25，14.18±0.94，13.64±0.80，13.18±0.83 at preoperative and postoperative 1，3，6，and 12 months，respectively.The CD values of the FS-LASIK group were 24.86±1.62，25.41±1.69，24.32±1.40，23.12±1.30，22.08±1.19，22.30±1.44，22.72±1.53，22.31±1.29，21.76±1.20，21.15±1.53 and 15.15±0.94，15.46±0.96，14.86±0.91，14.26±0.98，13.59±0.76，13.57±0.81，13.72±0.76，13.60±0.69，13.48±0.69，12.90±0.54，respectively.There were a statistically significant difference in the changes of CD at different times within the groups（F=140.49，126.18，125.74，78.10；P＜0.05）and between groups（F=40.86，43.39，31.86，13.66；P＜0.05）.At one month after surgery，the CD values of the anterior 120μm and central layer at 0-2mm and 2-6mm in the FS-LASIK Xtra group were significantly increased compared to preoperative values（t=10.56，10.90，6.63，5.67；P＜0.05），with slight increases in the FS-LASIK group（t=4.34，3.12，3.40，2.22；P＜0.05）.The CD values of FSLASIK Xtra group were higher than that of the FS-LASIK group，and the difference were statistically significant（t=8.01，8.07，5.90，5.32；P＜0.05）.At 12 months after surgery，the CD values of FSLASIK Xtra group and FS-LASIK group were lower than those before surgery（t=-7.48，-6.64，-7.70，-5.98，-15.73，-11.73，-13.49，-7.92，respectively；P＜0.05）.The CD values of the FSLASIK Xtra group was still slightly higher than the FS-LASIK group，and the difference was statistically significant（t=2.35，2.00，3.60，2.09；P＜0.05）.

Conclusions

The transparency of FS-LASIK Xtra group and FS-LASIK group decrease one month after surgery compared to preoperative levels，which increase and even exceeded preoperative levels by 12 months.The recovery of FS-LASIK Xtra group is slower compared to FS-LASIK group，but it has no significant effect on vision.The change in corneal measurement position may have a certain impact on results of CD values.

Key words: Corneal densitometry, Femtosecond assisted laser in situ keratomileusis, Femtosecond assisted laser in situ keratomileusis combined with corneal collagen cross-linking, Refraction surgery, Myopia

Yan Zheng, Changbin Zhai, Caiyun Fu, Li Zhang, Yue Wang, Yabin Hu, Jing Liu. Corneal densitometry after femtosecond assisted laser in situ keratomileusis combined with accelerated collagen cross-linking[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2024, 14(06): 327-334.

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Figures/Tables 2

References 23

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组别	眼数（只眼）	前层厚度120μm，范围0～2mm					前层厚度120μm，范围2～6mm
组别	眼数（只眼）	术前	1个月后	3个月后	6个月后	12个月后	术前	1个月后
FS-LASIK Xtra	50	24.93±1.56	30.55±4.28	29.37±6.31	24.98±2.99	22.92±2.28	22.32±1.30	26.59±3.10
FS-LASIK	62	24.86±1.62	25.41±1.69	24.32±1.40	23.12±1.30	22.08±1.19	22.30±1.44	22.72±1.53
t值		0.26	8.01	5.55	4.11	2.35	0.10	8.07
P值		＞0.05	＜0.05	＜0.05	＜0.05	＜0.05	＞0.05	＜0.05
组别	眼数（只眼）	前层厚度120μm，范围2～6mm			前层厚度120μm，范围6～10mm
组别	眼数（只眼）	3个月后	6个月后	12个月后	6个月后	术前	1个月后	3个月后
FS-LASIK Xtra	50	26.06±3.52	23.10±1.76	21.15±1.53	21.90±3.29	22.19±2.93	21.27±3.18	20.05±2.85
FS-LASIK	62	22.31±1.29	21.76±1.20	20.64±1.04	21.42±3.11	20.35±2.67	20.26±2.70	19.73±2.79
t值		7.15	4.61	2.00	0.79	3.46	1.81	0.59
P值		＜0.05	＜0.05	＜0.05	＞0.05	＜0.05	＞0.05	＞0.05
组别	眼数（只眼）	前层厚度120μm范围6～10mm	中央层厚度200～250μm，范围0～2mm
组别	眼数（只眼）	12个月后	术前	1个月后	3个月后	6个月后	12个月后
FS-LASIK Xtra	50	19.28±2.66	15.49±0.92	17.69±2.53	16.33±1.64	14.96±1.32	14.31±1.24
FS-LASIK	62	19.03±2.59	15.15±0.94	15.46±0.96	14.86±0.91	14.26±0.98	13.59±0.76
t值		0.50	1.91	5.90	5.67	3.19	3.60
P值		＞0.05	＞0.05	＜0.05	＜0.05	＜0.05	＜0.05
组别	眼数（只眼）	中央层厚度200～250μm，范围2～6mm					中央层厚度200～250μm范围6～10mm
组别	眼数（只眼）	术前	1个月后	3个月后	6个月后	12个月后	术前	1个月后
FS-LASIK Xtra	50	13.81±0.70	14.79±1.25	14.18±0.94	13.64±0.80	13.18±0.83	14.10±1.99	13.85±1.65
FS-LASIK	62	13.57±0.81	13.72±0.76	13.60±0.69	13.48±0.69	12.90±0.54	13.84±1.72	13.70±1.43
t值		1.73	5.32	3.78	1.14	2.09	0.75	0.53
P值		＞0.05	＜0.05	＜0.05	＞0.05	＜0.05	＞0.05	＞0.05
组别	眼数（只眼）	中央层厚度200～250μm6～10mm			后层厚度60μm0～2mm
组别	眼数（只眼）	3个月后	6个月后	12个月后	6个月后	术前	1个月后	3个月后
FS-LASIK Xtra	50	13.41±1.84	13.17±1.76	13.05±1.50	13.13±1.12	13.04±1.33	12.48±1.05	12.05±1.17
FS-LASIK	62	13.61±1.43	13.43±1.45	13.02±1.36	13.02±1.09	12.84±0.86	12.37±0.89	11.89±0.82
t值		-0.61	-0.86	0.09	0.49	0.94	0.61	0.80
P值		＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05
组别	眼数（只眼）	后层厚度60μm范围0～2mm	后层厚度60μm，范围2～6mm
组别	眼数（只眼）	12个月后	术前	1个月后	3个月后	6个月后	12个月后
FS-LASIK Xtra	50	11.99±0.89	11.88±0.89	11.91±0.87	11.63±0.69	11.53±0.73	11.46±0.58
FS-LASIK	62	11.71±0.77	11.73±0.96	11.94±0.71	11.83±0.66	11.71±0.56	11.44±0.53
t值		1.74	0.80	-0.23	-1.60	-1.52	0.20
P值		＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05
组别	眼数（只眼）	后层厚度60μm，范围6～10mm					全层厚度200～400μm范围0～2mm
组别	眼数（只眼）	术前	1个月后	3个月后	6个月后	12个月后	术前	1个月后
FS-LASIK Xtra	50	12.77±1.35	12.83±1.54	12.43±1.70	12.22±1.57	12.19±1.33	17.85±1.05	20.43±2.29
FS-LASIK	62	12.54±1.31	12.91±1.08	12.74±1.14	12.61±1.17	12.10±0.97	17.67±1.05	17.90±1.02
t值		0.9	-0.36	-1.09	-1.46	0.44	0.89	7.28
P值		＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＜0.05
组别	眼数（只眼）	全层厚度200～400μm，范围0～2mm			全层厚度200～400μm，范围2～6mm
组别	眼数（只眼）	3个月后	6个月后	12个月后	6个月后	术前	1个月后	3个月后
FS-LASIK Xtra	50	19.39±2.61	17.32±1.52	16.39±1.31	16.01±0.84	17.77±1.51	17.30±1.48	16.09±0.92
FS-LASIK	62	17.18±0.96	16.42±0.94	15.79±0.76	15.86±0.92	16.13±0.88	15.91±0.79	15.65±0.73
t值		5.69	3.66	2.89	0.89	6.81	5.97	2.84
P值		＜0.05	＜0.05	＜0.05	＞0.05	＜0.05	＜0.05	＜0.05
组别	眼数（只眼）	全层厚度200～400μm范围2～6mm	全层厚度200～400μm，范围6～10mm
组别	眼数（只眼）	12个月后	术前	1个月后	3个月后	6个月后	12个月后
FS-LASIK Xtra	50	15.27±0.89	16.26±2.10	16.29±1.93	15.70±2.14	15.15±1.99	14.84±1.76
FS-LASIK	62	14.99±0.62	15.93±1.94	15.65±1.64	15.53±1.67	15.25±1.73	14.72±1.57
t值		1.9	0.86	1.89	0.47	-0.27	0.37
P值		＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.0

组别	眼数（只眼）	前层厚度120μm，范围0～2mm					前层厚度120μm，范围2～6mm
组别	眼数（只眼）	术前	1个月后	3个月后	6个月后	12个月后	术前	1个月后
FS-LASIK Xtra	50	24.93±1.56	30.55±4.28	29.37±6.31	24.98±2.99	22.92±2.28	22.32±1.30	26.59±3.10
FS-LASIK	62	24.86±1.62	25.41±1.69	24.32±1.40	23.12±1.30	22.08±1.19	22.30±1.44	22.72±1.53
t值		0.26	8.01	5.55	4.11	2.35	0.10	8.07
P值		＞0.05	＜0.05	＜0.05	＜0.05	＜0.05	＞0.05	＜0.05
组别	眼数（只眼）	前层厚度120μm，范围2～6mm			前层厚度120μm，范围6～10mm
组别	眼数（只眼）	3个月后	6个月后	12个月后	6个月后	术前	1个月后	3个月后
FS-LASIK Xtra	50	26.06±3.52	23.10±1.76	21.15±1.53	21.90±3.29	22.19±2.93	21.27±3.18	20.05±2.85
FS-LASIK	62	22.31±1.29	21.76±1.20	20.64±1.04	21.42±3.11	20.35±2.67	20.26±2.70	19.73±2.79
t值		7.15	4.61	2.00	0.79	3.46	1.81	0.59
P值		＜0.05	＜0.05	＜0.05	＞0.05	＜0.05	＞0.05	＞0.05
组别	眼数（只眼）	前层厚度120μm范围6～10mm	中央层厚度200～250μm，范围0～2mm
组别	眼数（只眼）	12个月后	术前	1个月后	3个月后	6个月后	12个月后
FS-LASIK Xtra	50	19.28±2.66	15.49±0.92	17.69±2.53	16.33±1.64	14.96±1.32	14.31±1.24
FS-LASIK	62	19.03±2.59	15.15±0.94	15.46±0.96	14.86±0.91	14.26±0.98	13.59±0.76
t值		0.50	1.91	5.90	5.67	3.19	3.60
P值		＞0.05	＞0.05	＜0.05	＜0.05	＜0.05	＜0.05
组别	眼数（只眼）	中央层厚度200～250μm，范围2～6mm					中央层厚度200～250μm范围6～10mm
组别	眼数（只眼）	术前	1个月后	3个月后	6个月后	12个月后	术前	1个月后
FS-LASIK Xtra	50	13.81±0.70	14.79±1.25	14.18±0.94	13.64±0.80	13.18±0.83	14.10±1.99	13.85±1.65
FS-LASIK	62	13.57±0.81	13.72±0.76	13.60±0.69	13.48±0.69	12.90±0.54	13.84±1.72	13.70±1.43
t值		1.73	5.32	3.78	1.14	2.09	0.75	0.53
P值		＞0.05	＜0.05	＜0.05	＞0.05	＜0.05	＞0.05	＞0.05
组别	眼数（只眼）	中央层厚度200～250μm6～10mm			后层厚度60μm0～2mm
组别	眼数（只眼）	3个月后	6个月后	12个月后	6个月后	术前	1个月后	3个月后
FS-LASIK Xtra	50	13.41±1.84	13.17±1.76	13.05±1.50	13.13±1.12	13.04±1.33	12.48±1.05	12.05±1.17
FS-LASIK	62	13.61±1.43	13.43±1.45	13.02±1.36	13.02±1.09	12.84±0.86	12.37±0.89	11.89±0.82
t值		-0.61	-0.86	0.09	0.49	0.94	0.61	0.80
P值		＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05
组别	眼数（只眼）	后层厚度60μm范围0～2mm	后层厚度60μm，范围2～6mm
组别	眼数（只眼）	12个月后	术前	1个月后	3个月后	6个月后	12个月后
FS-LASIK Xtra	50	11.99±0.89	11.88±0.89	11.91±0.87	11.63±0.69	11.53±0.73	11.46±0.58
FS-LASIK	62	11.71±0.77	11.73±0.96	11.94±0.71	11.83±0.66	11.71±0.56	11.44±0.53
t值		1.74	0.80	-0.23	-1.60	-1.52	0.20
P值		＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05
组别	眼数（只眼）	后层厚度60μm，范围6～10mm					全层厚度200～400μm范围0～2mm
组别	眼数（只眼）	术前	1个月后	3个月后	6个月后	12个月后	术前	1个月后
FS-LASIK Xtra	50	12.77±1.35	12.83±1.54	12.43±1.70	12.22±1.57	12.19±1.33	17.85±1.05	20.43±2.29
FS-LASIK	62	12.54±1.31	12.91±1.08	12.74±1.14	12.61±1.17	12.10±0.97	17.67±1.05	17.90±1.02
t值		0.9	-0.36	-1.09	-1.46	0.44	0.89	7.28
P值		＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＜0.05
组别	眼数（只眼）	全层厚度200～400μm，范围0～2mm			全层厚度200～400μm，范围2～6mm
组别	眼数（只眼）	3个月后	6个月后	12个月后	6个月后	术前	1个月后	3个月后
FS-LASIK Xtra	50	19.39±2.61	17.32±1.52	16.39±1.31	16.01±0.84	17.77±1.51	17.30±1.48	16.09±0.92
FS-LASIK	62	17.18±0.96	16.42±0.94	15.79±0.76	15.86±0.92	16.13±0.88	15.91±0.79	15.65±0.73
t值		5.69	3.66	2.89	0.89	6.81	5.97	2.84
P值		＜0.05	＜0.05	＜0.05	＞0.05	＜0.05	＜0.05	＜0.05
组别	眼数（只眼）	全层厚度200～400μm范围2～6mm	全层厚度200～400μm，范围6～10mm
组别	眼数（只眼）	12个月后	术前	1个月后	3个月后	6个月后	12个月后
FS-LASIK Xtra	50	15.27±0.89	16.26±2.10	16.29±1.93	15.70±2.14	15.15±1.99	14.84±1.76
FS-LASIK	62	14.99±0.62	15.93±1.94	15.65±1.64	15.53±1.67	15.25±1.73	14.72±1.57
t值		1.9	0.86	1.89	0.47	-0.27	0.37
P值		＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.0

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