SMILE术中眼球移位对角膜切削精准度和屈光状态的影响

Influence of eye movement on precision of corneal ablation and refraction status in SMILE

目的:评估飞秒激光小切口角膜基质透镜取出术(SMILE)激光扫描时眼球轻微移位对角膜切削精准度及术后屈光状态的影响。方法:纳入2019-01/2021-03于本院行SMILE手术的患者32例62眼,依据术中眼球有无轻微移位分为移位组和固视组,并选取单眼眼球轻微移位的患者进行双眼配对,比较移位组和固视组组间和单眼眼球轻微移位患者双眼间术后1mo实际与术前预估角膜切削厚度偏差绝对值(ACE)、散光偏差(AE)、屈光偏差绝对值(ARE)及视力偏差绝对值(AVE)的差异,并将手术图像量化,分析眼球移位幅度与AE的相关性,观察眼球轻微移位所处区域、层面及移位方向对ACE的影响。结果:移位组和固视组各观察指标均无差异(P>0.05)。术中单眼眼球轻微移位的患者双眼AE具有差异(0.57±0.31D vs 0.33±0.27D,P<0.05),且眼球移位幅度与术后1mo AE具有正相关性(r=0.564,P<0.05)。眼球轻微移位所处不同区域(中心区/周边区)、层面(透镜上层/透镜下层)及方向(鼻侧/颞侧)的患者术后1mo ACE比较均无差异(均P>0.05)。结论:SMILE手术中激光扫描时眼球轻微移位对角膜切削精准度无明显影响,主要引起偏中心切削,导致角膜散光改变,但对等效球镜度及视力影响甚微。

AIM:To evaluate the influence of slight eye movement during laser scanning on femtosecond laser precision of corneal ablation and postoperative refractive status in small incision lenticule extraction(SMILE).METHODS:Totally 32 patients(62 eyes)who underwent SMILE surgery in our hospital from January 2019 to March 2021 were included and divided into the movement group and the fixation group according to whether the eyeballs were slightly moved during the operation,and select patients with slightly moved monocular eyeballs for binocular pairing.The actual difference of absolute value of corneal absolute cutting error(ACE),astigmatism error(AE),absolute refractive error(ARE)and absolute visual error(AVE)was compared between the movement group and the fixation group and the two eyes of the patients with slight ocular movement in one eye at 1mo after surgery,and the surgical images were quantified to analyze the correlation between the amplitude of ocular movement and AE,and to compare the effects of the area,layer and direction of slight eye movement on ACE.RESULTS:There were no differences in all observed results between movement group and fixation group(P>0.05).Patients with slight movement of one eye had a difference in binocular AE(0.57±0.31D vs 0.33±0.27D,P<0.05),and the amplitude of movement was positively correlated with AE at 1mo after surgery(r=0.564,P<0.05).There was no statistical differences in ACE at 1mo after surgery in patients with slight ocular movement in different regions(central/peripheral),layers(upper/lower lens)and direction(nasal/temporal)(all P>0.05).CONCLUSION:The slight eye movement during laser scanning in SMILE has no significant influence on precision of corneal ablation.It mainly causes decentered ablation and the changes of corneal astigmatism,which has little effect on the spherical equivalent and visual acuity.