智能脉冲技术辅助的激光角膜屈光手术早期效果

Comparison of short term visual outcomes of TPRK and FS-LASIK with or without the assistance of SmartPulse Technology

目的分别比较智能脉冲技术（SPT）辅助的经上皮准分子激光角膜切削术（TPRK）与普通TPRK，SPT辅助的飞秒激光制瓣准分子激光原位角膜磨镶术（FS-LASIK）与普通FS-LASIK治疗近视的早期视力结果。方法回顾性非随机对照研究。表层手术组：纳入行SPT辅助的TPRK手术患者19例（36眼）为SVF-TPRK组，行普通TPRK手术患者21例（40眼）为普通TPRK组，分别记录患者术后3d、10d、1个月及3个月时的裸眼视力（UCVA）；板层手术组：纳入接受S胛辅助的FS-LASIK患者25例（49眼）为SPT-FS-LASIK组，接受普通FS-LASIK手术患者24例（48眼）为普通FS-LASIK组，分别记录患者术后1d、10d、1个月及3个月时的UCVA；记录各组患者术前、术后1个月、术后3个月的角膜地形图表面规则指数（SRI）和表面非对称性指数（SAI）。数据采用重复测量资料的方差分析、卡方检验及独立样本t检验进行比较。结果普通TPRK组和SPT-TPRK组相比，术后视力恢复情况整体差异无统计学意义．术前、术后1个月及3个月时角膜地形图SRI和SAI指数差异均无统计学意义。普通FS-LASIK组与SPT-FS-LASIK组相比，术后视力恢复情况整体差异有统计学意义（F=12．067，P〈0．01），2组之间术后1、10d的UCVA差异有统计学意义（P〈0．05），SPT-FS-LASIK组UCVA更好；术后1d2组UCVA≥1．0的术眼比例分别为25％、39％，术后10d分别为61％、73％，组间差异均无统计学意义。2组术后1个月的角膜地形图SRI值差异具有统计学意义（t=2．95，P〈0．01），SPT-FS-LASIK组较低。结论与普通FS-LASIK相比，SPT-FS-LASIK术后患者早期视力更优，接受SPT辅助的TPRK或FS-LASIK手术的患者中有更大比例在术后早期获得好的UCVA。

Objective To compare early visual outcomes of SmartPulse Technology （SPT）-assisted transepithelial photorefraetive keratectomy （TPRK） or femtosecond laser-assisted laser in situ keratomileusis （FS-LASIK） with that of traditional TPRK/FS-LASIK. Methods This was a retrospective comparative study of two main groups, a surface surgery group and a stromal surgery group. The surface surgery group included two subgroups： an SPT-TPRK group consisting of 36 eyes of 19 patients and a TPRK group consisting of 40 eyes of 21 patients. All patients were followed up on the 3rd day, 10th day, 1st month and 3rd month after surgery and uncorrected visual acuity （UCVA） was measured and recorded. The stromal surgery group included two subgroups： an SPT-FS-LASIK group consisting of 49 eyes of 25 patients and a FS-LASIK group consisting of 48 eyes of 24 patients. All patients were followed up on the 1st day, 10th day, 1st month, and 3rd month after surgery, and UCVA was measured and recorded. Topography was performed before surgery and on the 1st month and 3rd month after surgery in all patients. Statistical analysis included repeated measures ANOVA, χ2 test and independent t-test. Results There were no significant differences between the SPT-TPRK group and TPRK group in age, spherical equivalent, best corrected visual acuity or central corneal thickness before surgery, nor were there any significant differences between the SPT-FS-LASIK group and FS-LASIK group in the pre-operative examinations. There were no significant differences in post-operative UCVA between the TPRK and SPT-TPRK groups at any time point after surgery. However, there was a significant difference in UCVA between the SPT-FS--LASIK group and FS-LASIK group （F=12.067, P〈0.01） on the 1st day and 10th day （P〈0.05） after surgery with better acuity results in the SPT-FS-LASIK group. But there was no significant difference in post-operative visual outcomes between these two groups on the 1st and 3rd months. The surface regularity index （SRI） of the SPT-FS-LASIK group on the 1st month was significantly lower than that of the FS-LASIK group （t=2.95, P〈0.01）. Conclusion SPT-FS-LASIK tends to provide better UCVA than traditional FS-LASIK during the early days after surgery.