SMILE和超薄瓣FS-LASIK矫正中度近视疗效比较

Comparison of the efficacy of small-incision lenticule extraction and ultra-thin flap femtosecond laser assistedlaser in situ keratomileusis for correction of moderate myopia

目的比较飞秒激光小切口角膜基质透镜取出术(SMILE)和超薄瓣飞秒激光辅助准分子激光原位角膜磨镶术(FS‐LASIK)矫正中度近视的临床疗效。方法回顾性病例对照研究。本研究纳入了年龄、性别和角膜厚度匹配合适的中度近视(等效球镜度-3.00~-6.00 D)患者,36例接受SMILE治疗患者的72只眼和36例接受超薄瓣FS‐LASIK治疗患者的72只眼。分别于术前及术后3个月记录所有患者的视力、屈光度及角膜高阶像差等变量,最后进行统计学分析以评估手术疗效。结果在术后随访3个月时,SMILE组和超薄瓣FS‐LASIK组疗效指数和安全指数比较,差异无统计学意义(t=1.179和-0.255,P=0.242和0.800)。SMILE组和超薄瓣FS‐LASIK组术后屈光度呈正视并相对稳定,术后等效球镜度比较差异无统计学意义(t=0.206,P=0.837)。SMILE组和超薄瓣FS‐LASIK组患者的角膜后表面曲率和非球面因子Q值比较,差异无统计学意义(t=-1.852和0.576,P=0.066和0.566)。SMILE组和超薄瓣FS‐LASIK组患者术前的总高阶像差、球差及彗差与术后比较,差异均具有统计学意义(均P<0.05)。在术后3个月时,SMILE组患者的总高阶像差及球差明显低于超薄瓣FS‐LASIK组(均P<0.05)。结论SMILE和超薄瓣FS‐LASIK两种术式矫治中度近视均安全有效,但SMILE组患者的术后总高阶像差及球差增加量低于超薄瓣FS‐LASIK组。

Objective To compare the efficacy of small incision lenticule extraction(SMILE)and ultra-thin flap femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK)in the treatment of moderate myopia.Methods A retrospective case-control study was used.72 eyes of 36 patients receiving SMILE,and 72 eyes of 36 patients receiving ultrathin flap FS-LASIK were selected.The study included age,sex,and corneal thickness matched patients with moderate myopia(spherical equivalent degree-3.00 to-6.00 D).Variables such as visual acuity,diopter and corneal aberration of all patients were recorded before and at 3 months after the surgery,respectively.Results At 3 months of follow-up,there was no significant difference in efficacy index and safety index between the SMILE group and ultra-thin flap FS-LASIK group(t=1.179and-0.255,P=0.242 and 0.800).The postoperative diopter of the SMILE group and ultra-thin flap FS-LASIK group was straight and relatively stable,and there was no significant difference in the postoperative spherical equivalent degree(t=0.206,P=0.837).There was no significant difference in posterior corneal surface curvature and aspherical factor Q values between the SMILE group and ultra-thin flap FS-LASIK group(t=-1.852 and 0.576,P=0.066 and 0.566).The total highorder aberration,spherical aberration and coma in the SMILE group and ultra-thin flap FS-LASIK group were significantly increased as compared with those before the surgery(all P<0.05),and the increase of total high-order aberration and spherical aberration in the SMILE group was significantly lower than that in the ultra-thin flap FS-LASIK group(all P<0.05).Conclusions Both SMILE and ultra-thin flap FS-LASIK are safe and effective in the treatment of moderate myopia.However,the increase of total high-order aberration and spherical aberration after the surgery in the SMILE group is lower than that in the ultra-thin flap FS-LASIK group.