近视眼SMILE与SPT-TransPRK术后早期视觉质量比较

Comparison of early postoperative visual quality between SMILE and SPT-Trans

目的探讨飞秒激光小切口角膜基质透镜取出术(SMILE)与智能脉冲技术辅助经上皮准分子激光角膜切削术(SPT-TransPRK)术后早期视觉质量的差异和变化情况。方法采用队列研究方法,选取2021年2—5月于大连医科大学附属大连市第三人民医院行角膜屈光手术者92例92眼,均为右眼入组,其中SMILE组40例40眼,SPT-TransPRK组52例52眼。分别于术前及术后1个月、3个月检查受检者视力,计算有效性,有效性=术后裸眼视力(UCVA)/术前最佳矫正视力;采用AR-1自动电脑验光仪测量屈光度;采用Sirius角膜地形图测量角膜高阶像差(HOA),包括总HOA、球差和彗差;采用OQASⅡ视觉质量分析系统测量客观散射指数(OSI),调制传递函数截止频率(MTF cut-off),斯特列尔比(SR),模拟对比度视力VA100、VA20和VA9(白天、黄昏、夜晚)。结果术后3个月,SMILE组与SPT-TransPRK组UCVA、有效性比较差异均无统计学意义(Z=0.880,P=0.380;t=0.920,P=0.058),SPT-TransPRK组术后表现为低度远视。术前、术后1个月和术后3个月SMILE组总HOA分别为(0.47±0.18)、(0.70±0.22)和(0.74±0.19)μm,SPT-TransPRK组分别为(0.40±0.14)、(0.98±0.35)和(0.94±0.22)μm;术前、术后1个月和术后3个月SMILE组球差分别为(-0.20±0.09)、(-0.44±0.14)和(-0.44±0.15)μm,SPT-TransPRK组分别为(-0.20±0.10)、(-0.71±0.23)和(-0.75±0.20)μm。2个组术眼手术前后不同时间点总HOA和球差比较,差异均有统计学意义(总HOA:F_(分组)=13.851,P=0.001;F_(时间)=29.960,P<0.001.球差:F_(分组)=31.037,P<0.001;F_(时间)=48.005,P<0.001),其中2个组术后角膜总HOA、球差均较术前增加,差异均有统计学意义(均P<0.05);术后1个月和3个月,SMILE组术眼总HOA和球差均小于SPT-TransPRK组,差异均有统计学意义(均P<0.05)。2个组术后1个月、3个月角膜彗差较术前增加,差异均有统计学意义(均P<0.05)。SMILE组术后1个月OSI高于术前,MTF cut-off、SR和VA9低于术前,差异均有统计学意义(均P<0.05);术后3个月OSI高于术前,SR和VA9低于术前,差异均有统计学意义(均P<0.05)。SPT-TransPRK组术后1个月OSI高于术前,MTF cut-off、SR、VA100、VA20和VA9低于术前,差异均有统计学意义(均P<0.05),术后3个月OSI、MTF cut-off、SR、VA100、VA20和VA9与术前比较差异均无统计学意义(均P>0.05)。2个组间术眼彗差、OSI、MTF cut-off、SR、VA100、VA20和VA9总体比较差异均无统计学意义(均P>0.05)。结论SMILE和SPT-TransPRK均是矫正近视的有效方法,术后早期视觉质量相似,但相较SPT-TransPRK,SMILE引起更小的角膜总HOA与球差改变。

Objective To investigate the differences and changes in early postoperative visual quality after small incision lenticule extraction(SMILE)and smart pulse technology-assisted transepithelial photorefractive keratectomy(SPT-TransPRK).Methods A cohort study was performed.A total of 92 patients(92 eyes)who underwent corneal laser refractive surgery were enrolled in Dalian Third People's Hospital Affiliated to Dalian Medical University from February 2021 to May 2021.The data from the right eye were collected for analysis.The patients were divided into SMILE group(40 patients,40 eyes)and SPT-TransPRK group(52 patients,52 eyes).Preoperative,1-and 3-month postoperative visual acuity were measured to calculate the effectiveness,which was defined as the ratio of postoperative uncorrected visual acuity(UCVA)to preoperative best corrected visual acuity.Refraction was measured by an AR-1 autorefractor.Corneal higher-order aberration(HOA)including total HOA,spherical aberration and coma was measured by Sirius corneal topographer.Objective scatter index(OSI),modulation transfer function cut-off frequency(MTF cut-off),Strehl ratio(SR),simulated contrast visual acuity VA100(day),VA20(dusk)and VA9(night)were measured via OQAS II visual quality analysis system.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the Dalian Third People's Hospital Affiliated to Dalian Medical University(No.2019-KT-010).Written informed consent was obtained from each subject.Results There was no significant difference in 3-month postoperative UCVA and effectiveness between the two groups(Z=0.880,P=0.380;t=0.920,P=0.058).Patients in SPT-TransPRK group showed mild hyperopia 3 months after surgery.Preoperative,1-and 3-month postoperative total corneal HOA was(0.47±0.18),(0.70±0.22)and(0.74±0.19)μm in SMILE group,and(0.40±0.14),(0.98±0.35)and(0.94±0.22)μm in SPT-TransPRK group respectively,showing statistically significant differences(F_(group)=13.851,P=0.001;F_(time)=29.960,P<0.001).Preoperative,1-and 3-month postoperative spherical aberration was(-0.20±0.09),(-0.44±0.14)and(-0.44±0.15)μm in SMILE group,and(-0.20±0.10),(-0.71±0.23)and(-0.75±0.20)μm in SPT-TransPRK group respectively,showing statistically significant differences(F_(group)=31.037,P<0.001;F_(time)=48.005,P<0.001).The postoperative total corneal HOA and spherical aberration were increased in both groups compared with before surgery,with statistically significant differences(all at P<0.05).The 1-and 3-month postoperative total corneal HOA and spherical aberrations were smaller in SMILE group than in SPT-TransPRK group,and the differences were statistically significant(all at P<0.05).The 1-and 3-month postoperative coma were increased in both groups compared with before surgery,showing statistically significant differences(all at P<0.05).In SMILE group,1-month postoperative OSI was higher and 1-month postoperative MTF cut-off,SR,and VA9 were lower than those before surgery,and 3-month postoperative OSI was higher and 3-month postoperative SR and VA9 were lower than those before surgery,showing statistically significant differences(all at P<0.05).In SPT-TransPRK group,1-month postoperative OSI was higher and 1-month postoperative MTF cut-off,SR,VA100,VA20,and VA9 were lower than those before surgery,showing statistically significant differences(all at P<0.05).There was no significant difference in OSI,MTF cut-off,SR,VA100,VA20,and VA9 between 3 months postoperatively and before surgery in the SPT-TransPRK group(all at P>0.05).There was no significant difference in coma,OSI,MTF cut-off,SR,VA100,VA20,and VA9 between two groups(all at P>0.05).Conclusions Both SMILE and SPT-TransPRK are effective methods for correcting myopia and they have comparable visual quality.Compared with SPT-TransPRK,corneal total HOA and spherical aberration are smaller after SMILE.