近视患者SMILE术后人工晶状体度数计算公式精确性比较

Predictability of intraocular lens power calculation after small-incision lenticule extraction for myopia

目的研究和比较近视小切口基质透镜取出术(SMILE)后人工晶状体度数计算公式的准确性,为患者提供更加理想的视觉质量。方法前瞻性病例对照研究。选取在我院行近视SMILE手术的患者60例(60只眼),选取患者右眼为研究对象。使用IOL Master 500测量患者SMILE术前的人工晶状体度数,Pentacam HR分别测量SMILE术后3个月的角膜曲率、眼轴长度、前房深度、角膜厚度,显然验光分别测量SMILE术前、术后的等效球镜的变化(SMILE-dif)。根据以上资料建立理论模型,假设该眼行白内障手术,植入与SMILE术前相同度数的人工晶状体。SMILE术后人工晶状体度数计算使用美国白内障与视光手术协会(ASCRS)网站上的屈光术后人工晶状体在线计算公式,包括Shammas、Haigis-L,Barrett True K公式。SMILE术后人工晶状体目标屈光度与SMILE术前目标屈光度的差值(IOL-dif)与SMILE-dif的差值为预测误差(PE)。按照术前等效球镜度数将研究对象分为A组(≤-3 D),B组(>-3 D),分别比较A、B两组PE结果。结果Shammas、Haigis-L和Barrett True K公式计算的PE分别为(0.43±0.11)D、(0.51±0.28)D和(0.99±0.10)D。A组内Shammas、Haigis-L和Barrett True K公式计算的PE分别为(1.38±0.24)D、(1.55±0.02)D和(0.37±0.05)D,3组数据差异具有统计学意义(P≤0.05)。B组内Shammas、Haigis-L和Barrett True K公式计算的PE分别为(0.27±0.15)D、(0.33±0.20)D和(1.09±0.26)D,3组数据具有统计学意义(P≤0.05)。在PE≤0.5 D区间内Shammas、Haigis-L,Barrett True K公式分别占81%、79%、68%。结论在SMILE术前等效球镜小于3 D的患者Barrett True K公式优于Shammas、Haigis-L公式,等效球镜大于3 D的患者Shammas、Haigis-L公式优于Barrett True K公式。

Objective To evaluate and compare the predictability of intraocular lens(IOL)power calculation after small-incision lenticule extraction(SMILE)for myopia.Methods A retrospective case series study.60 patients with myopia and myopic astigmatism underwent SMILE in our hospital were collected,and the right eye of the patient was selected as the research object.Preoperative evaluation included optical biometry using IOLMaster 500.Postoperative evaluation included corneal radius,anterior chamber depth,axial length and corneal thickness using Pentacam HR at 3 months postoperatively.The change of spherical equivalent due to SMILE was calculated by the manifest refraction at corneal plane(SMILE-dif).A theoretical model,involving the virtual implantation of the same IOL power before and after SMILE was used.The Shammas,Haigis-L,Barrett True K formulas of American Society of Cataract and Refractive Surgeons(ASCRS)on-line IOL power calculated were used for postoperative of SMILE IOL calculated.The difference between the IOL-induced refractive error before and after SMILE(IOL-dif)was compared with SMILE-dif.The prediction error(PE)was calculated as the difference between SMILE-dif–IOL-dif.The study divided into two groups:27 eyes with spherical equivalent≤-3 D in A group,and 33 eyes with spherical equivalent>-3 D in B group.The difference of PE between two groups was compared.Results The PE with Shammas was(0.43±0.11)diopter(D);Haigis-L,(0.51±0.28)D and Barrett True K,(0.99±0.10)D.Statistically significant differences were observed between Shammas(1.38±0.24)D、Haigis-L(1.55±0.02)D and Barrett True K(0.37±0.05)D in A group(P≤0.05);and Shammas(0.27±0.15)D、Haigis-L(0.33±0.20)and Barrett True K(1.09±0.26)D in B group(P≤0.05).Shammas,Haigis-L,Barrett True K formulas resulted in an absolute PE of 0.5 D or lesser in 81%、79%、68%of the cases.Conclusions Barrett True K was more accurate approach than Shammas,Haigis-L for IOL power calculation after myopic SMILE with spherical equivalent≤-3 D;and Shammas、Haigis-L were more accurate approach than Barrett True K with spherical equivalent>-3 D.