SMART与PRK临床效果的比较

Clinical Effects:SMART vs PRK

目的观察比较智能脉冲技术辅助的经上皮准分子激光角膜切削术(smart pulse technology-assisted transepithelial photorefracrive keratectomy,SMART)与准分子激光角膜表面切削术(photorefractive keratectomy,PRK)的临床疗效。方法回顾性分析2019年8月至2020年5月,近视合并散光患者74例74只眼,按照手术方法不同,分为两组:(1)试验组患者42例42只眼,采用SMART治疗;(2)对照组患者32例32只眼,采用PRK治疗,SMART和PRK均采用同一台准分子机治疗,频率1050 Hz。术后5 d、1、3和6个月,比较两组患者裸眼视力(uncorrected visual acuity,UCVA)、屈光度、主观疼痛评分、角膜上皮愈合情况、高阶像差及角膜上皮下混浊(haze)发生率。结果术后5 d,SMART组UCVA、等效球镜、主观疼痛评分、角膜上皮愈合情况、高阶像差与PRK组比较,差异均具有统计学意义(均P<0.05);术后1、3和6个月,两组间UCVA、等效球镜、角膜上皮愈合情况、高阶像差、角膜上皮下haze发生率比较,差异无统计学意义(均P>0.05);两组术后5 d等效球镜均偏负,1个月后等效球镜均偏正。结论SMART与PRK比较,术后角膜上皮修复更快,早期视力恢复更佳,更接近于目标屈光度;术后疼痛更轻,引入的高阶像差更小。

Objective To observe the clinical efficacy of SMART(smart pulse technology assisted transient photorefractive keratectomy and PRK(photo refractive keratectomy).Methods A retrospective analysis was conducted.Altogether 74 patients(74 eyes)with myopia and astigmatism were divided into two groups by surgical methods.42 patients(42 eyes)in the experimental group were treated with SMART,and 32 patients(32 eyes)in the control group with PRK.The uncorrected visual acuity(UCVA),diopter,subjective pain score,corneal epithelial healing,high-order aberration and incidence of haze in corneal epithelium(haze)were compared between the two groups 5 days and 1,3 and 6 months after the operation respectively.Results The difference was statistically significant(P<0.05)between SMART group and PRK group in UCVA,equivalent spherical lens,subjective pain score,corneal epithelial healing and higher-order aberration 5 days after the operation.Nevertheless,1,3 and6 months after the operation,there was no significant difference in UCVA,equivalent spherical lens,corneal epithelial healing,highorder aberration and incidence of supracorneal subcutaneous haze between the two groups(P>0.05).For both groups,the equivalent spherical lens was negative 5 days after the operation and positive 1 month after the operation.Conclusions Compared with PRK,SMART brings in faster repair of corneal epithelial,better early visual acuity recovery,closer realization of target diopter,lighter postoperative pain and smaller introduction of higher-order aberration.