飞秒激光小切口角膜透镜取出术前后主导眼变化及其影响因素

Ocular dominance switches after small incision lenticule extraction and its influencing factors

目的研究飞秒激光小切口角膜透镜取出术(SMILE)术后主导眼变化和分布特点,并分析主导眼转变的影响因素。方法采用回顾性病例观察研究,纳入2017年11月至2018年2月于天津市眼科医院行SMILE手术的患者112例224眼,其中男42例,女70例,年龄(25.1±5.4)岁。术前及术后3个月采用卡洞法检查患者主导眼;术前,术后1 d、1周、1个月及3个月行主、客观验光和裸眼视力检查。根据术后3个月主导眼是否发生转变将患者分为转变组和未转变组。采用二元Logistic回归分析主导眼转变的主要影响因素。结果术后3个月时,转变组18例(16.1%),未转变组94例(83.9%);转变组中男7例(38.9%),女11例(61.1%),未转变组中男35例(37.2%),女59例(62.8%),2个组性别构成比比较差异无统计学意义(χ^(2)=0.02,P=0.89)。术后1个月和3个月,主导眼与非主导眼的柱镜度差异均有统计学意义(t=2.31、1.95,均P<0.05)。二元Logistic回归方程显示,术前等效球镜度[比值比(OR)=0.47,95%置信区间(CI):0.35~0.66]和双眼屈光参差(OR=3.04,95%CI:2.12~4.36)与主导眼转变有显著关系。结论SMILE术后16.1%患者发生主导眼转变,主导眼转变与术前较高的等效球镜度和较大屈光参差有关。

Objective To investigate the changes,distribution and influencing factors of ocular dominance after small incision lenticule extraction(SMILE).Methods A retrospective observational case series study was conducted.One hundred and twelve patients(224 eyes)with an average age of 25.1±5.4 years who underwent SMILE surgery at Tianjin Eye Hospital from November 2017 to February 2018 were enrolled.There were 42 male and 70 female patients.The dominant eye was determined using the hole-in-the-card test before and after the surgery.Subjective and objective refraction and uncorrected visual acuity examination were performed before operation,and 1 day,1 week,1 month and 3 months after operation.The subjects were divided into switch group and non-switch group based on whether the dominant eye changed after surgery.Binary logistic regression was used to analyze the main influencing factors of dominant eye switches.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Tianjin Eye Hospital(No.201905).Written informed consent was obtained from each patient before any medical examination.Results There were 18 patients(16.1%)in the switch group including 7 males(38.9%)and 11 females(61.1%),and 94 patients(83.9%)in the non-switch group including 35 males(37.2%)and 59 females(62.8%).No statistically significant difference was found in sex between the two groups(χ^(2)=0.02,P=0.89).At 1 month and 3 months after the surgery,there was a statistically significant difference in the cylindrical power between the dominant and non-dominant eye(t=2.31,1.95;both at P<0.05).Binary logistic regression equation showed that spherical equivalent[odds ratio(OR)=0.47,95%confidence interval(CI):0.35-0.66]and refractive error difference(OR=3.04,95%CI:2.12-4.36)were significantly related to the eye dominance switches.Conclusions There were 16.1%of patients having eye dominance switches after SMILE.The dominant eye transfomation is associated with higher spherical equivalent and anisometropia difference before surgery.