FS-LASIK与SMILE术后角膜高阶像差变化比较

Comparison of corneal higher order aberration after femtosecond laser-assisted laser in situ keratomileusis and small incision lenticule extraction

目的分析并比较飞秒激光辅助准分子激光角膜原位磨镶术(FS-LASIK)和飞秒激光小切口角膜基质透镜取出术(SMILE)术后角膜高阶像差(HOA)变化。方法采用非随机对照研究方法,纳入2018年4月至2020年1月于山东省眼科医院接受FS-LASIK或SMILE矫正的近视患者60例60眼,均收集右眼数据纳入分析。FS-LASIK组30例30眼,术前等效球镜度为(-5.36±1.11)D;SMILE组30例30眼,术前等效球镜度为(-4.93±1.03)D。分别于术前和术后1、3、6、12个月采用Pentacam三维眼前节分析系统测定直径6 mm范围的角膜前表面、后表面和全角膜HOA,获取患者角膜总HOA、球差、彗差和三叶草像差,以均方根值(μm)表示,比较2个组不同时间点各指标差异。结果术前及术后1、3、6、12个月FS-LASIK组角膜前表面HOA分别为(0.428±0.126)、(0.775±0.169)、(0.811±0.194)、(0.759±0.214)、(0.704±0.199)μm,SMILE组分别为(0.409±0.094)、(0.656±0.148)、(0.681±0.161)、(0.668±0.175)、(0.648±0.160)μm,总体比较差异均有统计学意义(F_(分组)=5.652,P=0.024;F_(时间)=107.169,P<0.01)。与SMILE组相比,FS-LASIK组术后各时间点角膜前表面总HOA、球差明显增大,差异均有统计学意义(均P<0.05);2个组术眼术后各时间点角膜前表面总HOA、球差明显大于术前,术后6个月和12个月角膜前表面总HOA小于术后3个月,术后12个月角膜前表面球差明显小于术后1个月和3个月,差异均有统计学意义(均P<0.05)。手术前后不同时间点角膜前表面彗差、三叶草像差总体比较差异均有统计学意义(彗差:F_(时间)=47.848,P<0.01;三叶草像差:F_(时间)=2.497,P=0.046),其中与术前比较,2个组术眼术后各时间点角膜前表面彗差明显增大,差异均有统计学意义(均P<0.05)。2个组间手术前后不同时间点全角膜总HOA、球差总体比较差异均有统计学意义(总HOA:F_(分组)=8.093,P=0.008;F_(时间)=125.019,P<0.01.球差:F_(分组)=4.771,P=0.037;F_(时间)=34.033,P<0.01),其中与SMILE组相比,FS-LASIK组术后各时间点全角膜总HOA、球差明显增大,差异均有统计学意义(均P<0.05);2个组术眼术后各时间点全角膜总HOA、球差明显大于术前,术后12个月全角膜球差明显小于术后1个月和3个月,差异均有统计学意义(均P<0.05)。手术前后不同时间点全角膜彗差总体比较差异有统计学意义(F_(时间)=30.829,P<0.01),其中与术前比较,2个组术眼术后各时间点全角膜彗差明显增大,差异均有统计学意义(均P<0.05)。结论FS-LASIK和SMILE术后均导致角膜前表面和全角膜总HOA、球差和彗差增加;相较FS-LASIK,SMILE术后引入了更少的角膜前表面、全角膜总HOA和球差。

Objective To analyze and compare the corneal higher order aberration(HOA)after femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK)and small incision lenticule extraction(SMILE).Methods A non-randomized controlled study was conducted.Sixty myopic patients(60 eyes)who underwent FS-LASIK or SMILE correction at Shandong Eye Hospital from April 2018 to January 2020 were enrolled and the data from the right eye were collected for analysis.Thirty cases(30 eyes)who received FS-LASIK in FS-LASIK group and 30 cases(30 eyes)who received SMILE in SMILE group had a preoperative equivalent spherical diopter of(-5.36±1.11)D and(-4.93±1.03)D,respectively.The HOA of the 6-mm anterior surface,posterior surface,and whole cornea were measured before surgery and at 1,3,6,and 12 months after surgery using Pentacam.The root mean square values(μm)of total corneal HOA,spherical aberration,coma and trefoil were obtained.Differences in the above root mean square values at different time points were compared between the two groups.The study protocol adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Shandong Eye Hospital(No.SDSYKYY20180306).Written informed consent was obtained from each subject.Results The preoperative and 1-,3-,6-,12-month postoperative total HOA of the anterior corneal surface were(0.428±0.126),(0.775±0.169),(0.811±0.194),(0.759±0.214),(0.704±0.199)μm in the FS-LASIK group and(0.409±0.094),(0.656±0.148),(0.681±0.161),(0.668±0.175),(0.648±0.160)μm in the SMILE group,with a significant overall difference(F_(group)=5.652,P=0.024;F_(time)=107.169,P<0.01).Compared with SMILE group,the postoperative total HOA of anterior corneal surface and spherical aberration at different time points were increased in FS-LASIK group,showing statistically significant differences(all at P<0.05).Compared with before surgery,the postoperative total HOA of the anterior corneal surface and spherical aberration at different time points were increased in both groups,showing statistically significant differences(all at P<0.05).In the two groups,the 6-and 12-month postoperative total HOA of the anterior corneal surface were reduced in comparison with the 3-month postoperative ones of the anterior corneal surface,and the 12-month postoperative spherical aberrations of the anterior corneal surface were significantly reduced in comparison with the 1-and 3-month postoperative ones of the anterior corneal surface,showing statistically significant differences(all at P<0.05).There were significant differences in the coma and trefoil of the anterior corneal surface between before and after the operation(coma:F_(time)=47.848,P<0.01;trefoil:F_(time)=2.497,P=0.046).Compared with before surgery,the postoperative coma was significantly increased in the two groups(all at P<0.05).There were significant differences in total corneal HOA and spherical aberration at different postoperative time points between the two groups(total HOA:F_(group)=8.093,P=0.008;F_(time)=125.019,P<0.01.spherical aberration:F_(group)=4.771,P=0.037;F_(time)=34.033,P<0.01).Compared with SMILE group,the total corneal HOA and spherical aberration were significantly increased in FS-LASIK group at different postoperative time points(all at P<0.05).Compared with before surgery,postoperative total HOA of the anterior corneal surface and spherical aberration at different postoperative time points were significantly increased in both groups(all at P<0.05).In both groups,the 12-month postoperative corneal spherical aberration was significantly reduced in comparison with the 1-and 3-month postoperative ones(all at P<0.05).There was a significant difference in coma between before and after surgery(F time=30.829,P<0.01).Compared with before surgery,the postoperative coma was significantly increased at different time points in both groups(all at P<0.05).Conclusions Both FS-LASIK and SMILE increase the HOA of the anterior corneal surface and the whole cornea.Compared with FS-LASIK,SMILE introduces less HOA of the anterior corneal surface and the whole cornea as well as spherical aberrations.