手动旋转补偿法在SMILE手术矫正近视散光中的应用

Application of manual cyclotorsion compensation in myopic astigmatism correction during small incision lenticule extraction

目的研究手动旋转补偿法在飞秒激光小切口角膜基质透镜取出术(SMILE)中矫正近视散光的疗效。方法采用回顾性队列研究。纳入2019年1月至2020年7月在广州医科大学附属第五医院眼科行SMILE矫正近视散光且术中行手动旋转补偿的患者67例104眼,根据柱镜度数分为低度散光组(-0.75~-1.25 D)64眼和中度散光组(-1.50~-3.00 D)40眼。观察患者术后3个月的显然验光结果,评估SMILE的有效性、安全性和可预测性,并运用Alpins散光矢量分析法对两组患者散光矢量指标进行比较。结果所有患者术眼术前球镜度数为(-4.87±1.73)D,柱镜度数为(-1.34±0.43)D,等效球镜度数为(-5.50±1.69)D。术后3个月时,所有术眼裸眼远视力均达到20/32及以上,96眼(92.31%)达到20/20及以上。术后3个月时,74眼(71.15%)最佳矫正视力与术前相同,24眼(23.08%)较术前提高1行,3眼(2.88%)提高2行,3眼(2.88%)下降1行,无下降2行及以上者。术后3个月,所有术眼等效球镜度数均在±1.00 D之间,97眼(93.27%)等效球镜度数在±0.50 D之间。Alpins矢量分析结果显示,低度散光组和中度散光组患者平均差异矢量分别为(0.22±0.20)D、(0.26±0.20)D(P=0.353),误差角度分别为(-0.80±12.62)°、(0.49±3.66)°(P=0.855),矫正指数分别为0.89±0.19、0.93±0.13(P=0.165),两组患者间差异矢量、误差角度、矫正指数差异均无统计学意义(均为P>0.05);两组患者成功指数分别为0.25±0.25、0.16±0.11(P=0.011),中度散光组术眼成功指数小于低度散光组。结论SMILE术中应用手动旋转补偿方法简单易行,可以安全、有效矫正近视散光,特别是对较高度数的散光尤为必要。

Objective To study the effect of manual cyclotorsion compensation in correcting myopic astigmatism during small incision lenticule extraction(SMILE).Methods In this retrospective cohort study,67 patients(104 eyes)who underwent manual cyclotorsion compensated SMILE surgery to correct myopic astigmatism in the Fifth Affiliated Hospital of Guangzhou Medical University from January 2019 to July 2020 were included.According to the cylindrical degree,64 eyes were categorized into the low astigmatism group(-0.75--1.25 D)and 40 eyes in the moderate astigmatism group(-1.50--3.00 D).The manifest refraction at 3 months after surgery was analyzed to evaluate the efficacy,safety and predictability of SMILE,and the Alpins method was used to compare the astigmatism vector parameters between the two groups.Results Preoperatively,the mean spherical degree of all included eyes was(-4.87±1.73)D,the mean cylindrical degree was(-1.34±0.43)D,and the mean spherical equivalent degree was(-5.50±1.69)D.Three months after surgery,all eyes had uncorrected distance visual acuity(UDVA)improved to 20/32 or better,including 96 eyes(92.31%)with UDVA of 20/20 or better.At the end of the 3-month follow-up,74 eyes(71.15%)had best corrected visual acuity(BCVA)unchanged,24 eyes(23.08%)had BCVA increased by 1 Snellen line,3 eyes(2.88%)had BCVA increased by 2 Snellen lines,3 eyes(2.88%)had BCVA decreased by 1 Snellen line,and no eyes had BCVA decreased by 2 and more Snellen lines.The spherical equivalent degree of all treated eyes was within±1.00 D,in which 97 eyes(93.27%)were within±0.50 D.Alpins vector analysis results showed the mean difference vector(DV)was(0.22±0.20)D and(0.26±0.20)D(P=0.353),the mean angle of error(AE)was(-0.80±12.62)°and(0.49±3.66)°(P=0.855),and the mean correction index(CI)was 0.89±0.19 and 0.93±0.13(P=0.165),respectively in the low and moderate astigmatism groups.There were no significant differences between the two groups regarding the DV,AE,and CI(all P>0.05).The mean index of success(IOS)in the low and moderate astigmatism groups was 0.25±0.25 and 0.16±0.11,respectively(P=0.011).Conclusion The manual cyclotorsion compensation is a simple and feasible approach to safely and effectively correct myopic astigmatism,especially high-degree astigmatism,during the SMILE surgery.