飞秒激光小切口基质透镜摘除术矫治中高度近视的疗效和对角膜形态的影响

Efficacy of Small Incision Lenticule Extraction Based on Total Femtosecond Laser and Influence on Corneal Surface

目的 研究飞秒激光小切口基质透镜摘除术矫治近视的疗效和对角膜形态的影响。方法 前瞻性实验研究2020年6月至2020年12月,行近视矫正手术的中高度近视患者200例,根据手术方式分为飞秒激光小切口微透镜取出术(femtosecond laser small incision lenticule extraction,SMILE)组102例200只眼和飞秒激光制瓣准分子激光原位角膜磨镶术(femtosecond assisted laser in situ keratomileusis,FS-LASIK)组98例190只眼。分别于术后1d、术后1周、术后1个月、术后3个月和术后6个月检查两组裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)、等效屈光度(equivalent spherical,SE),角膜非球面Q值、角膜曲率(keratometry,K)、角膜厚度和角膜表面规则指数(surface reguiarity index,SRI),并进行统计学分析。结果 (1)UCVA、BCVA改变。术后1 d、1周SMILE组UCVA、BSCVA略低于FS-LASIK组,但两组的差异无统计学意义(P>0.05);术后1个月、3个月、6个月两组UCVA、BSCVA相当。(2)SE改变。术后1 d、1周、1个月,FS-LASIK组SE与SMILE组比较,差异具有统计学意义(P<0.01);术后3个月、6个月,FS-LASIK组SE与SMILE组比较差异无统计学意义(P>0.05)。(3)K改变。两组术后比较,差异具有显著意义(P<0.01)。SMILE组术后K水平基本维持不变,FS-LASIK组术后K呈增加趋势。(4)角膜Q值改变。术后1 d、术后1周、术后1个月,两组的角膜Q值改变组间比较,差异无统计学意义(P>0.05);术后3个月、6个月两组间比较,差异具有显著意义(P<0.01)。(5)角膜SRI值,SMILE组术后不同时间点角膜SRI值均高于FS-LASIK组,两组间比较差异具有显著意义(P<0.01)。结论 SMILE和FS-LASIK手术矫治中高度近视均有效,与FS-LASIK相比,SMILE术后角膜曲率的变化更稳定,非球面Q值的影响更小,而SRI值更大。

Objective To analyze the efficacy of small incision lenticule extraction(SMILE)based on total femtosecond laser and its influence on corneal surface.Methods Totally 200 patients with moderate and high myopia treated over the period from Jun.to Dec.2020 were selected as the research subjects.They were divided into two groups by surgical methods:the SMILE group wirh 102 cases(200 eyes)and FS-LASIK group with 98 cases(190 eyes).The uncorrected visual acuity(UCVA),best corrected visual acuity(BSCVA),anterior corneal surface asphericity index(Q-value),surface reguiarity index(SRI),equivalent spherical(SE),keratometry(K)and corneal depth were compared between the two groups respectively before operation and 1 d,1 week and 1,3 and 6 months after the operation.Results (1)The changes of UCVA and BCVA.The UCVA and BSCVA were higher in the SMILE group than in the FS-LASIK group 1 d and 1 week after the operation.There was no obvious difference between the two groups in UCVA or BSCVA(P>0.05).(2)The change of SE.The SE of the SMILE group did not change over the period from 1 d to 6 months after the operation.There was statistical difference in SE between two groups 1 d,1 week and 1 month after the operation(P<0.01),but the difference was not statistically significant 3 months or 6 months after the operation(P>0.05).(3)The change of corneal curvature.After the operation,the corneal curvature maintained a stable level in the SMILE group,but showed an increasing trend in the FS-LASIK group.The difference between the two groups in corneal curvature was statistically significant(P>0.01).(4)The change of Q values.There was no dramatic difference in Q values between two groups 1 d,1 w or 1 m(P>0.05)after the operation,but the difference was statistically significant 3 m and 6 m after the operation(P<0.01).(5)The change of SRI.The SRI was higher in the SMILE group than in the FS-LASIK group at any point after the operation,and the difference was statistically significant(P<0.01).Conclusions Both SMILE and FS-LASIK are effective in correcting middle and high myopia.Compared with FS-LASIK,SMILE features more stable change of corneal curvature,less impact on asphericity index Q-value and larger SRI.