SMILE与FS-LASIK术后光学区特性比较

Comparison of the Actual Optical Zones after SMILE and FS-LASIK for Myopia

目的:比较飞秒激光小切口角膜基质透镜取出术(SMILE)、SCHWIND Amaris1050平台和Wavelight EX500平台的飞秒激光制瓣的准分子激光原位角膜磨镶术(FS-LASIK)单纯近视矫正术后的实际光学区大小、非球面性和高阶像差。方法:回顾性病例对照研究。选取于2018年1月至2019年1月期间在广州爱尔眼科医院行近视手术矫正患者,根据手术方式和平台分为SMILE组、Amaris1050组和EX500组;收集患者术后1、3个月光学区直径、Q值、高阶像差等数据,利用Topolyzer术后切线曲率图(切线法)和Pentacam术前、术后切线曲率差异图(切线差异法)测量光学区直径。3组间光学区大小、Q值、高阶像差比较采用ANOVA单因素方差分析,多重比较采用Bonferroni法。2种方法间比较采用配对样本t检验。结果:共纳入91例(113眼),其中SMILE组42眼,Amaris1050组25眼,EX500组46眼。术后3个月,切线法和切线差异法所测光学区直径SMILE组大于Amaris1050组和EX500组(均P<0.001),分别为(6.90±0.12)mm和(5.17±0.15)mm,(6.58±0.19)mm和(5.00±0.10)mm,(6.56±0.16)mm和(4.86±0.15)mm;Amaris1050组切线差异法所测光学区大于EX500组(P=0.003)。3组切线法光学区测量值大于切线差异法(t=64.836、34.146、63.927,均P<0.001);角膜中央5、6 mm范围Q值,SMILE组小于Amaris1050组和EX500组(5 mm:P=0.017、0.013;6 mm:P=0.004、0.005),Amaris1050组和EX500组差异无统计学意义(P=1.000);6 mm瞳孔直径下,SMILE组球差小于Amaris1050组和EX500组(P=0.004、0.017),Amaris1050组和EX500组差异无统计学意义(P=0.793)。结论:SMILE术后实际光学区大于FS-LASIK,非球面形态优于FS-LASIK,引入球差更少;再者,SMILE和Amaris1050平台切削深度接近,大于EX500,消耗更多角膜组织。

Objective:To compare the actual diameter,asphericity and higher order aberrations(HOAs)of the optical zone after small incision lenticule extraction(SMILE)and femtosecond-assisted laser in situ keratomileusis(FS-LASIK)using the SCHWIND Amaris1050 and WaveLight EX500 excimer laser platforms for myopia.Methods:This was a retrospective study that included 91 patients(113 eyes)from January 2018 to January 2019 in the Refractive Surgery Center,Guangzhou Aier Eye Hospital.The patients were divided into a SMILE group(42 eyes),an Amaris1050(25 eyes)and and an EX500 group(46 eyes).The postoperative optical zone was measured using two different maps.A tangential curvature map was generated with a placido corneal topographer(Topolyzer)and a tangential curvature difference map was generated with a Scheimplfag tomographer(Pentacam)for each eye 1 month and 3 months after surgery.The Q value and HOAs were also obtained with the Topolyzer.The postoperative optical zone,Q-value and HOAs among the three groups were analyzed with a one-way analysis of variance with Bonferroni-adjusted post hoc comparisons.The optical zones measured with the two maps were analyzed with a paired-samples t test.Results:The mean optical zones measured on the two maps were 6.90±0.12 mm and 5.17±0.15 mm with SMILE,6.58±0.19 mm and 5.00±0.10 mm with Amaris1050,6.56±0.16 mm and 4.86±0.15 mm with EX500 at 3 months postoperatively.The postoperative optical zones of SMILE were larger than Amaris1050 and EX500 in both maps(P<0.001),the optical zone of Amaris1050 was larger than EX500 in the tangential curvature difference map(P=0.003);the optical zone measured in the tangential curvature map was significantly larger than in the tangential curvature difference map(t=64.836,34.146,63.927,P<0.001).The postoperative Q-values of the cornea in the 5 mm and 6 mm areas of SMILE were both smaller than Amaris1050 and EX500(5 mm:P=0.017,0.013;6 mm:P=0.004,0.005).No significant difference was found between Amaris1050 and EX500(P=1.000).As for the postoperative HOAs of the cornea in a 6 mm pupil diameter,the spherical aberrations of SMILE were larger than for both Amaris1050 and EX500(P=0.004,0.017).There was no significant difference between Amaris1050 and EX500(P=0.793).Conclusions:When there is a same programmed optical zone,SMILE achieves a larger and a better aspheric shape of the optical zone than FS-LASIK,and induces fewer spherical aberrations after surgery.Whereas there was also a deeper ablation depth with SMILE and Amaris1050 than with EX500,thus consuming more corneal tissue.