SMILE术后调节功能变化

Changes in Accommodative Function after Small Incision Lenticular Extraction

目的:研究飞秒激光小切口角膜基质透镜取出术(SMILE)后双眼视及调节功能的变化特点。方法:回顾性研究。选取2015年3-12月在天津市眼科医院屈光手术中心接受SMILE的近视散光患者25例。分别在术前,术后1周、1个月、3个月测量调节功能参数,包括单眼调节幅度(MAA)、单眼调节灵敏度(MAF)、双眼交叉柱镜法(BCC)测量的调节反应、正相对调节(PRA)及负相对调节(NRA)。不同时间段之间参数的差异比较采用重复测量方差分析,两两比较采用LSD-t检验。结果:MAA在SMILE手术后1周下降,术后3个月时恢复到术前水平,差异有统计学意义(F=5.418,P=0.002);MAF及PRA在SMILE术后1周轻微下降,术后3个月较术前显著增加(F=8.090,P<0.001;F=5.466,P=0.002)。BCC测量的调节反应及NRA在术后各个时期差异无统计学意义(F=2.445,P=0.071;F=0.536,P=0.659)。结论:SMILE可暂时性降低调节功能,但随着时间推移逐渐好转。

Objective:To analyze the changes in accommodative function after small incision lenticular extraction.Methods:This was a retrospective study.Twenty-five myopic patients who underwent small incision lenticular extraction(SMILE)surgery from March 2015 to December 2015 at Tianjin Eye Hospital were included in this study.The values of the accommodative parameters including monocular accommodative amplitude(MAA),monocular accommodative facility(MAF),positive relative accommodation(PRA),negative relative accommodation(NRA)and accommodative responses by binocular cross-cylinder(BCC)were measured preoperatively and at 1 week,1 month and 3 months postoperatively.Comparisons among the different follow-up periods were performed by repeated measures analysis of variance and comparisons between every two periods by the LSD-t test.Results:The MAA had decreased at 1 week but returned to the preoperative level 3 months after the SMILE procedure and the difference was significant(F=5.418,P=0.002).The MAF and PRA had slightly decreased at 1 week but had significantly increased 3 months after surgery(F=8.090,P<0.001;F=5.466,P=0.002).There were no significant differences in BCC or NAR at each observation period preoperatively and postoperatively(F=2.445,P=0.071;F=0.536,P=0.659).Conclusions:SMILE may temporarily reduce accommodative function.However,function reverts back to the preoperative level or even better.