FS-LASIK与SMILE手术矫正低度近视散光的疗效比较

Comparison of Correction of Myopic Astigmatism with FS-LASIK and SMILE

目的比较飞秒激光辅助的原位角膜磨镶术(femtosencond laser-assisted laser assisted in situ keratomileusis,FS-LASIK)与飞秒激光小切口基质透镜切除术(small incision lenticule extraction,SMILE)矫正低度近视散光的疗效。方法选取2021年6月至2021年12月,低度近视伴散光患者106例200只眼。按手术方式不同分成FS-LASIK组和SMILE组,FS-LASIK手术组54例102只眼、SMILE手术组52例98只眼。于术前和术后1、3、6个月常规检查裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)、等效屈光度(equivalent spherical,SE)、球镜屈光度、柱镜屈光度以及角膜球差、彗差、角膜表面规则指数(surface reguiarity index,SRI)并做比较。结果术后6个月,两组患者术后UCVA≥0.8(100%);SMILE组UCVA≥1.0的患眼比例为89.1%,而FS-LASIK组为92.8%,两组差异无统计学意义(P>0.05)。术后不同时间点FS-LASIK组柱镜屈光度均小于SMILE组,但只有在术后1个月时差异具有统计学意义(P>0.05),术后3、6个月时,两组柱镜屈光度比较差异无统计学意义(P>0.05);进一步绘制柱镜矫正的可预测性曲线,两组预期矫正散光度数和实际矫正散光度数显著相关(P均<0.01)。术后1、3、6个月FS-LASIK组彗差小于SMILE组,(P均<0.01)。术后1、3、6个月,FS-LASIK组SRI值均显著小于SMILE组(P均<0.01)。结论FS-LASIK和SMILE均可有效矫正低度近视散光,但SMILE术后对彗差和角膜形态指数SRI值的变化大于FS-LASIK,证实SMILE出现了散光残留的发生率高。

Objective To compare the effect to treat myopia astigmatism with FS-LASIK and SMILE.Methods Totally 106 patients with myopia astigmatism treated between Jun.2021 and Dec.2021 were selected and divided into two groups by treating methods:the SMILE group(52 cases and 98 eyes)and FS-LASIK group(54 cases and 102 eyes).The uncorrected visual acuity(UCVA),best corrected visual acuity(BSCVA),column diopter,coma and surface reguiarity index(SRI)were compared between the two groups before and 1,3 and 6 months after the operation respectively.Results Six months after the surgery,the proportion of eyes with UCVA of 0.8 or above was 100%in both groups.The proportion of patients with UCVA of 1.0 or higher was 89.1%in SMILE group and 92.8%in FS-LASIK group,and the difference was not significant(P>0.05).The post-operative column degree in the FS-LASIK group was smaller than that in the SMILE group.The difference was statistically significant 1 month after the operation(P<0.05)but not remarkable 3 months or 6 months after the operation(P>0.05).The coma in FS-LASIK group was smaller than that in SMILE group 1,3 and 6 months after the surgery,and the difference was statistically remarkable(P<0.01).Conclusions Both FS-LASIK surgery and SMILE surgery are safe and effective for myopic astigmatism.High order aberrations were introduced after the surgery for both groups.The postoperative coma was smaller in SMILE group than in FS-LASIK group,and the SRI greater in SMILE group than in FS-LASIK group.