对比分析阿玛仕1050RS自旋补偿FS-LASIK与SMILE矫正近视散光的临床疗效

Comparison of clinical efficacy between AMARIS 1050RS cyclotorsion-compensation femtosecond laser-assisted in situ keratomileusis and small incision lenticule extraction for myopic astigmatism

目的对比分析阿玛仕1050RS自旋补偿飞秒激光制瓣准分子激光原位角膜磨镶术(FS-LASIK)与飞秒激光小切口角膜基质透镜取出术(SMILE)矫正近视散光的临床疗效。方法选取2021年1月至9月在我院行近视屈光手术的患者113例(203眼)作为研究对象。按手术方式不同将患者分为FS-LASIK组56例(103眼,行自旋补偿FS-LASIK)和SMILE组57例(100眼,行SMILE)。根据术前散光度将两组患者进一步分为低度散光组(散光度<-2.0 D)和高度散光组(散光度≥-2.0 D)。低度散光组:FS-LASIK组患者38例(70眼),SMILE组患者40例(70眼);高度散光组:FS-LASIK组患者18例(33眼),SMILE组患者17例(30眼)。分别于术前和术后6个月常规检查患者裸眼视力(UCVA)、最佳矫正视力(BCVA)、球镜度、柱镜度并记录与分析。结果两组患者术前基线资料,年龄、性别构成、球镜度、柱镜度、BCVA、角膜厚度及角膜曲率比较差异均无统计学意义(均为P>0.05)。低度散光组:术后SMILE组和FS-LASIK组患者UCVA达到或超过0.8的患眼比例均为100.0%;UCVA达到或超过1.0的患眼比例,SMILE组为90.0%,FS-LASIK组为93.2%,差异均无统计学意义(均为P>0.05)。高度散光组:术后患者UCVA达到或超过0.8的患眼比例,SMILE组为83.3%,FS-LASIK组为87.9%,差异无统计学意义(P>0.05);UCVA达到或超过1.0的患眼比例,SMILE组为80.0%,FS-LASIK组为84.9%,差异无统计学意义(P>0.05)。低度散光组:术后SMILE组患眼柱镜度为(-0.39±0.22)D,FS-LASIK组为(-0.32±0.21)D,差异无统计学意义(t=1.249,P=0.147);高度散光组:术后SMILE组患眼柱镜度为(-0.65±0.33)D,FS-LASIK组为(-0.42±0.28)D,SMILE组高于FS-LASIK组,差异有统计学意义(t=2.583,P=0.014)。进一步比较柱镜度矫正的可预测性:低度散光组中FS-LASIK组患眼实际矫正柱镜度与预期矫正柱镜度差值为(-0.14±0.12)D,SMILE组为(-0.18±0.16)D,两组差异无统计学意义(t=0.700,P=0.472);高度散光组中FS-LASIK组患眼实际矫正柱镜度与预期矫正柱镜度差值[(-0.31±0.17)D]低于SMILE组[(-0.46±0.24)D],两组差异有统计学意义(t=2.117,P=0.020)。结论阿玛仕1050RS自旋补偿FS-LASIK对于近视散光的矫正效果优于SMILE。≥-2.0 D的高度散光患者选择自旋补偿的FS-LASIK矫治效果较好。

Objective To compare the clinical effect of AMARIS 1050RS cyclotorsion-compensation femtosecond laser-assisted in situ keratomileusis(FS-LASIK)and small incision lenticule extraction(SMILE)for myopic astigmatism.Methods A total of 113 patients(203 eyes)who underwent refractive surgery in our hospital from January to September 2021 were enrolled in this study.According to the surgical method,these patients were divided into the FS-LASIK group(56 patients,103 eyes,with cyclotorsion-compensation FS-LASIK)and the SMILE group(57 patients,100 eyes,with SMILE).According to the preoperative astigmatism,these patients were further divided into the low astigmatism group(astigmatism<-2.0 D)and the high astigmatism group(astigmatism≥-2.0 D).The low astigmatism group included 38 patients(70 eyes)from the FS-LASIK group and 40 patients(70 eyes)from the SMILE group.The high astigmatism group included 18 patients(33 eyes)from the FS-LASIK group and 17 patients(30 eyes)from the SMILE group.The uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),sphere,and cylinder were checked and analyzed before and 6 months after operation.Results There were no significant differences in preoperative baseline data such as age,gender composition,sphere,cylinder,BCVA,corneal thickness,and corneal curvature between the FS-LASIK group and the SMILE group(all P>0.05).In the low astigmatism group,100.0%of eyes had the UCVA better than or equal to 0.8 after operation,and the percentage of eyes with postoperative UCVA≥1.0 was 90.0%in the SMILE group and 93.2%in the FS-LASIK group(P>0.05).In the high astigmatism group,the percentage of eyes with postoperative UCVA≥0.8 was 83.3%in the SMILE group and 87.9%in the FS-LASIK group,and there was no significant difference between the two groups(P>0.05);the percentage of eyes with postoperative UCVA≥1.0 was 80.0%in the SMILE group and 84.9%in the FS-LASIK group,and there was no significant difference between the two groups(P>0.05).Among the patients with preoperative astigmatism<-2.0 D,the postoperative cylinder was(-0.39±0.22)D in the SMILE group and(-0.32±0.21)D in the FS-LASIK group,and there was no significant difference between the two groups(t=1.249,P=0.147).Among the patients with preoperative astigmatism≥-2.0 D,the postoperative cylinder was(-0.65±0.33)D in the SMILE group and(-0.42±0.28)D in the FS-LASIK group,and the difference between the two groups was statistically significant(t=2.583,P=0.014).Among the patients with preoperative astigmatism<-2.0 D,the mean deviation of the actual and expected cylinder correction was(-0.14±0.12)D in the FS-LASIK group and(-0.18±0.16)D in the SMILE group,and there was no significant difference between the two groups(t=0.700,P=0.472).Among the patients with preoperative astigmatism≥-2.0 D,the mean deviation of the actual and expected cylinder correction was significantly higher in the SMILE group[(-0.46±0.24)D]than that in the FS-LASIK group[(-0.31±0.17)D](t=2.117,P=0.020).Conclusion AMARIS 1050RS cyclotorsion-compensation FS-LASIK is better than SMILE in astigmatism correction.The patients with astigmatism≥-2.0 D improve better after the cyclotorsion-compensation FS-LASIK.