SMILE术中大Kappa角的调整对术后全眼高阶像差的影响

Effects of adjustment of large angle Kappa during small incision lenticule extraction on postoperative total higher-order aberrations

目的探讨大Kappa角患者于飞秒激光小切口角膜基质透镜取出术(SMILE)中进行Kappa角调整对术后全眼高阶像差(HOA)的影响。方法收集2021年1月至6月于中国中医科学院眼科医院屈光手术科行SMILE的近视患者162例(162眼),均纳入右眼进行研究。Sirius眼前节分析系统测量患者术前Kappa角,将Kappa角≥0.2 mm者作为大Kappa角组,术中对Kappa角进行调整;将Kappa角<0.2 mm者作为小Kappa角组,术中不进行Kappa角调整。大Kappa角组患者75例(75眼),等效球镜度数(SE)为(-6.07±2.46)D,小Kappa角组患者87例(87眼),SE为(-5.85±2.12)D。分别于术前及术后3个月、6个月、1年检测两组患者裸眼视力(UCVA)、最佳矫正视力(BCVA)、SE、球镜度数、柱镜度数、总HOA、球差、彗差及三叶草差的变化并进行比较,分析小Kappa角及调整后的大Kappa角与术后各时间点HOA的相关性。结果小Kappa角组与大Kappa角组患者间术前及术后各时间点UCVA、BCVA、SE、球镜度数、柱镜度数比较,差异均无统计学意义(均为P>0.05)。两组患者间术后有效性指数和安全性指数比较,差异均无统计学意义(均为P>0.05);两组患者间术后各时间点残余SE在±0.5 D和±1.0 D的眼数百分比差异均无统计学意义(均为P>0.05)。两组患者术后各时间点总HOA、球差、彗差均较术前升高,差异均有统计学意义(均为P<0.05)。两组患者间术前及术后各时间点总HOA、球差、彗差、三叶草差比较,差异均无统计学意义(均为P>0.05)。小Kappa角及调整后的大Kappa角与术后各时间点总HOA、球差、彗差、三叶草差均无明显相关性(均为P>0.05)。结论大Kappa角患者SMILE术中调整Kappa角,可获得与小Kappa角患者一样的术后视觉质量,且具有良好的手术有效性、安全性、可预测性。

Objective To investigate the effects of angle Kappa adjustment during small incision lenticule extraction(SMILE)on postoperative total higher-order aberrations(HOAs)in patients with large angle Kappa.Methods A total of 162 myopic patients(162 right eyes)who underwent SMILE surgery in the Refractive Surgery Department of Eye Hospital,China Academy of Chinese Medical Sciences from January to June 2021 were included in this study.The preoperative angle Kappa was measured by the Sirius anterior segment analysis system.The angle Kappa with the displacement distance larger than or equal to 0.2 mm was distributed into the large angle Kappa group and received adjustment during the operation.The angle Kappa with the displacement distance less than 0.2 mm was distributed into the small angle Kappa group and received no adjustment during the operation.Seventy-five patients(75 eyes)were in the large angle Kappa group and the average spherical equivalent(SE)was(-6.07±2.46)D.The rest 87 patients(87 eyes)were in the small angle Kappa group and the average SE was(-5.85±2.12)D.The uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),spherical power,cylindrical power,total HOAs,spherical aberration,comatic aberration and trefoil aberration were measured and compared between the two groups before operation,3 months,6 months and 1 year after operation.The correlations between the small angle Kappa,the adjusted large angle Kappa and HOAs at different time points after surgery were analyzed.Results There were no significant differences in UCVA,BCVA,SE,spherical and cylindrical powers between the large angle Kappa group and the small angle Kappa group before and at each time point after operation(all P>0.05).There were no significant differences in postoperative efficacy and safety indexes between the two groups(all P>0.05).No significant difference was found in the percentage of eyes with residual SE at±0.5 D and±1.0 D between the two groups at each time point after operation(all P>0.05).The total HOAs,spherical aberrations and comatic aberrations in the two groups at each time point after operation were higher than those before operation,and the differences were statistically significant(all P<0.05).There were no significant differences in the total HOAs,spherical aberrations,comatic aberrations and trefoil aberrations between the two groups before and at each time point after operation(all P>0.05).The small angle Kappa and the adjusted large angle Kappa had no significant correlation with the total HOAs,spherical aberrations,comatic aberrations and trefoil aberrations at each time point after operation(all P>0.05).Conclusion Patients with large angle Kappa,after receiving the angle Kappa adjustment during the SMILE surgery,can obtain the same postoperative visual quality as the patients with small angle Kappa.The angle Kappa adjustment has good surgical effectiveness,safety and predictability.