三种不同手术对屈光不正患者术后视觉质量及高阶像差的比较

Comparative analysis on the effects of three surgical methods on postoperative visual quality and higher-order aberrations in patients with refractive errors

目的:探讨飞秒激光制瓣的准分子激光原位角膜磨镶术(FS-LASIK)、角膜地形图引导LASIK(TG-LASIK)和飞秒激光小切口角膜基质透镜取出术(SMILE)对屈光不正患者术后视觉质量及高阶像差的效果。方法:纳入2019-12/2020-02本院屈光中心收治的296例586眼单纯近视或近视散光患者。在明确手术适应证的前提下,患者自行选择接受FS-LASIK、TG-LASIK、SMILE手术,其中FS-LASIK组95例189眼,TG-LASIK组104例205眼,SMILE组97例192眼。收集患者术前及术后6、12mo时视力、屈光度、角膜地形图、高阶像差及对比敏感度。结果:术后6、12mo各组患者裸眼视力、最佳矫正视力及球镜度数、柱镜度数、等效球镜度数均优于术前(P<0.05),组间比较均无差异(P>0.05)。术后6、12mo TG-LASIK组角膜表面规则指数、表面非对称指数均显著低于SMILE组、FS-LASIK组(P<0.05);SMILE组、FS-LASIK组组间比较无差异(P>0.05)。术后6、12mo时FS-LASIK组总高阶像差、彗差、球差及术后6mo时三叶草像差高于TG-LASIK组、SMILE组(P<0.05);术后6、12mo时SMILE组球差显著低于其他两组(P<0.05)。术后6、12mo时TG-LASIK组在无眩光及有眩光时12.0、18.0c/d频率下对比敏感度显著高于SMILE组、FS-LASIK组(P<0.05)。结论:FS-LASIK、TG-LASIK、SMILE三种手术均可获得较为满意的治疗效果,但TG-LASIK术后像差增加较小,角膜形态更规则,视觉质量更高。

AIM:To explore the effects of femtosecond laser-assisted in situ keratomileusis(FS-LASIK),topography guided LASIK(TG-LASIK)and small incision lenticule extraction(SMILE)on postoperative visual quality and higher-order aberrations(HOA)in patients with refractive errors.METHODS:A total of 296 patients(586 eyes)with simple myopia or myopic astigmatism who were admitted to refractive center of the hospital between December 2019 and February 2020 were enrolled.Under the premise of determining surgical indications,the patients chose to undergo FS-LASIK,TG-LASIK and SMILE voluntarily.Among them,there were 95 cases(189 eyes)in FS-LASIK group,104 cases(205 eyes)in TG-LASIK group and 97 cases(192 eyes)in SMILE group.The data such as visual acuity,diopter,corneal topography,HOA and contrast sensitivity were collected before and at 6,12mo after surgery.RESULTS:The uncorrected visual acuity,best corrected visual acuity,spherical equivalent and spherical equivalent refraction at 6mo after surgery were better than those before surgery(P<0.05),and there was no significant difference among different groups(P>0.05).At 6,12mo after surgery,regularity index of corneal surface and surface asymmetry index in TG-LASIK group were significantly lower than those in SMILE group and FS-LASIK group(P<0.05),and there was no significant difference between SMILE group and FS-LASIK group(P>0.05).At 6,12mo after surgery,total HOA,clover aberration and coma at 6mo spherical aberration in FS-LASIK group were significantly higher than those in TG-LASIK group and SMILE group(P<0.05),while the spherical aberration in the SMILE group was significantly lower than that of the other two groups(P<0.05).At 6,12mo after surgery,contrast sensitivities with or without glare in TG-LASIK group were significantly higher than those in SMILE group and FS-LASIK group at frequencies of 12.0c/d and 18.0c/d(P<0.05).CONCLUSION:The curative effect of FS-LASIK,TG-LASIK and SMILE are satisfactory.However,the aberration increase is less after TG-LASIK,the corneal topography is more regular,and the visual quality is higher.