飞秒激光微小切口角膜基质透镜切除术治疗近视对角膜波前像差的影响

Effects of femtosecond laser small incision lenticule extraction on corneal wavefront aberration in the treatment of myopia

目的对比和评价飞秒激光微小切口角膜基质透镜切除术和飞秒激光制瓣的LASIK手术治疗近视和近视散光的效果。方法选取42例(82)眼近视和近视散光患者为全飞秒组(SMILE组),同期41例(82眼)飞秒激光制瓣LASIK的近视和近视散光患者为飞秒激光制瓣的LASIK组(FEMTO LASIK组)。SMILE组、FEMTO LASIK组等效球镜度数分别为(-4.91±1.29)D、(-6.29±2.37)D。术后1d、1周、2周、3周、1个月、2个月、3个月复查,包括裸眼视力、最佳矫正视力、SE、IOP、裂隙灯显微镜、Pentacam眼前节分析仪检查等。用Pentacam眼前节分析系统记录术前和术后3个月的角膜RMS TOTAL、RMS LOA、RMS HOA、Z40、C8、C9、C11并进行分析。结果术后1d FEMTO LASIK组裸眼视力(0.97±0.11)优于SMILE组(0.81±0.24),两组差异有统计学意义(P<0.05)。SMILE组术后的RMS TOTAL、RMS LOA、RMS HOA、C8分别为0.778±0.337、0.749±0.338、0.186±0.054、0.082±0.196,均优于FEMTO LASIK组0.995±0.423、0.962±0.432、0.226±0.078、-0.049±0.302,各指标差值差异均有统计学意义(均为P<0.05),两组Z40、C9、C11差值差异无统计学意义(均为P>0.05)。SMILE组术后RMS TOTAL、RMS LOA、RMS HOA、Z40均比术前增加,差异均有统计学意义(均为P<0.05);C8术后比术前增加,差异无统计学意义(P>0.05);C9术后比术前减少,差异有统计学意义(P<0.05)。FEMTO LASIK组术后RMS TOTAL、RMS LOA、RMS HOA、Z40均比术前增加,C9较术前减小,手术前后差异均有统计学意义(均为P<0.05)。结论 Visumax飞秒激光的SMILE和FEMTO LASIK手术治疗近视安全、有效,SMILE引入的角膜RMS TOTAL、RMS LOA、RMS HOA和C8更小。

Objective To compare and evaluate the postoperative outcomes of femtosecond laser small incision lenticule extraction（SMILE） and laser in-situ keratomileusis with Visumax femtosecond laser（ FEMTO LASIK） for myopia and myopic astigmatism. Methods 42 patients （82 eyes） with myopia and myopic astigmatism were selected as small incision lenticule extraction（ SMILE group） and another 41 patients（82 eyes） with myopia and myopic astigmatism at the same period were selected as laser insitu keratomileusis with femtosecond laser（ FEMTO LASIK group）. The spherical equivalent degree was （ - 4.91 ± 1.29 ） D （ SMILE group） and （ - 6.29 ± 2.37 ） D （ FEMTO LASIK group）. At postoperative l day, 1 week,2 weeks,3 weeks, 1 month,2 months and 3 months, the naked vision, best corrected vision, SE, IOP, slit lamp microscope and Pentacam eye protomerite analysator were detected. RMS TOTAL, RMS LOA, RMS HOA, Z40,C8 ,C9 and Cll of cornea at preoperative and postoperative 3 months were recorded by Pentacam-HR system. Results The naked vision in FEMTO LASIK group （ 0. 97 ± 0.11 ） was significantly better than the SMILE group （0.81 ± 0.24） at postoper- ative 1 day （P 〈 0.05 ）. The postoperative RMS TOTAL, RMS LOA, RMS HOA and C8 in SMILE group（0. 778 ± 0. 337,0. 749 ± 0.338,0. 186 ± 0. 054,0. 082 ± 0. 196, respectively） were better than those in FEMTO LASIK group（0. 995 ±0. 423,0.962 ±0.432,0.226 ±0. 078, -0. 049 ±0. 302 ,respectively） ,there was significant difference（all P 〈 0. 05 ） and disparities of Z40, C9 and C11 were not significantly different（ all P 〉 0.05 ）. The postoperative RMS TOTAL, RMS LOA, RMS HOA and Z40 in SMILE group were higher than those of preoperation and differences were statistically significant （ all P 〈 0.05 ） ; C8 was not significantly higher than that of preoperation （P 〉 0.05 ） ; C9 was significantly lower than that of preoperation （P 〈 0.05 ）. The preoperative RMS TOTAL, RMS LOA, RMS HOA and Z40 in FEMTO LASIK group were significantly higher than those in preoperation （ all P 〈 0.05 ）, while C9 was significantly lower （ P 〈 0.05 ）. Conclusion SMILE and FEMTO LASIK are safe and effective in the treatment of myopia, and the corneal RMS TOTAL, RMS LOA, RMS HOA and C8 are fewer on small incision lenticule extractionmvonic.