SMILE术中不透明气泡层对术后患者视觉质量的影响

Effect of opaque bubble layer on the visual quality of patients after small incision lenticule extraction

目的:研究不透明气泡层(opaque bubble layer,OBL)对飞秒激光小切口角膜基质透镜取出术(femtosecond small incision lenticule extraction,SMILE)患者视觉质量的影响。方法:采用前瞻性队列研究方法,依次纳入2015-06/09在解放军四七四眼科医院屈光手术中心行SMILE患者116例116眼,按照术中是否产生OBL分为OBL组(51眼)和对照组(65眼)。随访OBL组与对照组的研究对象在术前、术后1、3、6mo患者最佳矫正视力(BCVA)、调制传递函数截止空间频率(modulation transfer function cut off frequency,MTF_(cut off))、斯特列尔比(strehl ratio,SR)、眼内客观散射指数(objective scattering index,OSI)、全眼高阶像差(RMSH)、垂直彗差(C7)、水平彗差(C8)和球差(C12)等视觉质量指标的差异。结果:在术前及术后各个时间点上比较OBL组与对照组间BCVA的差异均无统计学意义(P>0.05),OBL组和对照组的BCVA组内各个时间点间比较发现术后3、6mo分别与术前相比差异有统计学意义(P<0.05),两组的BCVA在术后3、6mo均显著优于术前;OBL组和对照组内的SR,MTF_(cut off),OSI,C7,C12,RMSH 6个指标在各个时间点间比较差异有统计学意义(P<0.05),而C8指标在各个时间点间差异无统计学意义(P>0.05);RMSH指标在术后1mo时在OBL组与对照组间差异有统计学意义(P<0.05)。结论:SMILE手术过程中OBL的产生对术后患者视觉质量的恢复在术后6mo时无明显影响,因此SMILE手术过程中OBL的产生对患者视觉质量的影响较小。

AIM： To study the femtosecond small incision lenticule extraction（SMILE）intraoperative appear opaque bubble layer（OBL）group and the control group visual quality whether there are differences. METHODS： A prospective cohort study were enrolled from Jun. to Sep.2015 in 116 cases of refractive surgery center of PLA included 116 eye hospital for SMILE patients. Intraoperative OBL were divided into OBL group（51 eyes）and control group（65 eyes）. The best corrected visual acuity on the follow-up of OBL group and control group before and after operation on 1,3 and 6mo after the operation best corrected visual acuity（BCVA）, modulation transfer function cut off frequency（MTFcutoff）, Strehl ratio（SR）, objective scattering index（OSI）and total higher-order aberrations（RMSH）, vertical coma（C7）, horizontal coma（C8）and spherical aberration（C12）differences in visual quality index. RESULTS：Fixed in the preoperative and postoperative each time point to compare the differences of BCVA between OBL group and control group were not statistically significant（P〉0.05）, OBL group and control group of BCVA in each time point comparison between 3mo and 6mo respectively compared with the preoperative difference was statistically significant（P〈0.05）, the two groups BCVA after 3mo and 6mo were significantly better than preoperative. OBL group and control group in SR, MTFcutoff, OSI, C7, C12, RMSH were statistically significant different at each time point 6 index（P〈0.05）, and C8 had no statistical difference at each time（P〉0.05）. There was statistical significance of RMSH index in 1mo after operation in OBL group and control group（P〈0.05）.CONCLUSION： There is no significant effect on the quality of recovery after surgery, and the effect of OBL on the visual quality of patients during the SMILE operation is small.