高度近视患者SMILE与ICL V4c植入术后视觉质量差异

Comparison of visual quality after small incision lenticule extraction and implantable collamer lens V4c implantation in patients with high myopia

目的比较飞秒激光小切口角膜基质透镜取出术(SMILE)和中央孔型有晶状体眼后房型人工晶状体V4c(ICL V4c)植入术矫正高度近视患者术后视觉质量的差异。方法回顾性研究。选取中国中医科学院眼科医院屈光手术科2019年9月至2022年7月,术前等效球镜度(SE)-6.00~-10.00 D,同时满足SMILE和ICL V4c植入两种手术要求,且按时完成术后3、6、12个月随访的高度近视患者90例(179眼)进行观察。SMILE组患者51例(102眼),ICL组患者39例(77眼)。术后3、6、12个月,观察并比较两组患者裸眼视力(UCVA)、最佳矫正视力(BCVA)、SE、安全性指数、有效性指数、调制传递函数截止频率(MTF cut off)、客观散射指数(OSI)、白天对比度视力(VA100%)、黄昏对比度视力(VA20%)、夜晚对比度视力(VA9%)、总高阶像差(HOAs)、球差、彗差、三叶草像差。结果术后3、6、12个月,SMILE组与ICL组患者UCVA、BCVA、SE、有效性指数、VA100%差异均无统计学意义(均为P>0.05)。术后3个月,ICL组患者安全性指数、MTF cut off、VA20%、VA9%均高于SMILE组,SMILE组患者HOAs、OSI均高于ICL组(均为P<0.05);术后6、12个月,两组患者安全性指数、HOAs、OSI、MTF cut off、VA20%、VA9%差异均无统计学意义(均为P>0.05)。术后3、6、12个月,SMILE组患者球差、彗差均高于ICL组,ICL组患者三叶草像差均高于SMILE组(均为P<0.05)。结论SMILE与ICL V4c植入术两种手术方式矫正高度近视均有良好的有效性、安全性,并能使患者获得良好的视觉质量。

Objective To compare the visual quality in patients with high myopia after small incision lenticule extraction(SMILE)and implantable collamer lens V4c(ICL V4c)implantation.Methods This was a retrospective study.A total of 90 high myopic patients(179 eyes)with preoperative spherical equivalent(SE)between-6.00 D and-10.00 D,who received treatment at the Department of Refractive Surgery,Eye Hospital of China Academy of Chinese Medical Sciences from September 2019 to July 2022,met the surgical requirements of SMILE and ICL V4c implantation at the same time,and completed the follow-ups on time at 3,6 and 12 months after surgery were enrolled.Finally,51 patients(102 eyes)were in the SMILE group and 39 patients(77 eyes)were in the ICL group.The uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),SE,safety index,efficacy index,modulation transfer function(MTF)cut off,objective scatter index(OSI),daytime contrast visual acuity(VA100%),dusk contrast visual acuity(VA20%),night contrast visual acuity(VA9%),total higher-order aberrations(HOAs),spherical aberration,comatic aberration and trefoil aberration were measured and compared between the two groups at 3,6 and 12 months after surgery.Results At 3,6 and 12 months after surgery,there were no significant differences in UCVA,BCVA,SE,efficacy index and VA100%between the two groups(all P>0.05).At 3 months after surgery,the safety index,MTF cut off,VA20%and VA9%in the ICL group were higher than those in the SMILE group,and HOAs and OSI in the SMILE group were higher than those in the ICL group(all P<0.05),but there were no significant differences in the safety index,HOAs,OSI,MTF cut off,VA20%and VA9%between the two groups at 6 and 12 months after surgery(all P>0.05).At 3,6 and 12 months after surgery,the spherical and comatic aberrations in the SMILE group were higher than those in the ICL group,and the trefoil aberration in the ICL group was higher than that in the SMILE group(all P<0.05).Conclusion Both SMILE and ICL V4c are effective and safe for the correction of high myopia and can help patients achieve good visual quality.