散光精准定位标记工具用于飞秒激光小切口角膜基质透镜取出术矫正近视散光的效果

Effect of astigmatism precise positioning marker used in small incision lenticule extraction to correct myopic astigmatism

目的探讨散光精准定位标记工具用于飞秒激光小切口角膜基质透镜取出术(SMILE)矫正近视散光的效果。方法选取2022年1月至12月在我院行SMILE且散光在-5.00~-1.25 D的患者120例120眼(均选右眼)作为研究对象,按随机数表将患者分为标记组(60例)和不标记组(60例)。标记组患者由手术医生使用我科自主研发的散光精准定位标记工具进行标记。所有患者分别于术前及术后1 d、术后1周、术后3个月进行检查,收集术前及术后3个月的检查数据(裸眼视力、最佳矫正视力、电脑验光结果)。利用矢量分析工具计算相关散光评价指标:|平均差异矢量|(|DV|)、矫正指数(CI)、误差角度绝对值(|AofE|)。采用尼德克屈光分析仪测量患者高阶像差,包括球差、彗差、三叶草差。应用SPSS 26.0软件对两组患者相关数据进行统计学分析。结果术前两组患者最佳矫正视力、球镜度和柱镜度差异均无统计学意义(均为P>0.05)。标记组患者术后3个月裸眼视力(logMAR)优于不标记组,差异有统计学意义(P<0.05);术后3个月两组患者球镜度、柱镜度差异均无统计学意义(均为P>0.05)。术后3个月两组患者|DV|、CI差异均无统计学意义(均为P>0.05);术后3个月标记组患者|AofE|小于不标记组,差异有统计学意义(P<0.05)。术前两组患者彗差、三叶草差、球差差异均无统计学意义(均为P>0.05);术后3个月两组患者彗差、三叶草差、球差均较术前明显增加(均为P<0.05)。术后3个月标记组患者彗差小于不标记组,差异有统计学意义(P<0.05)。结论散光精准定位标记工具标记后行SMILE较不标记具有更佳的散光矫正效果,能明显优化SMILE所带来的彗差,提高患者视觉质量。

Objective To explore the effect of the astigmatism precise positioning marker used in small incision lenticule extraction(SMILE)to correct myopic astigmatism.Methods A total of 120 patients(120 right eyes)with myopic astigmatism between-5.00 D and-1.25 D,who underwent SMILE in our hospital from January to December 2022,were selected in this study.According to the random number table,the patients were divided into the marking group(60 eyes)and the non-marking group(60 eyes).The patients in the marking group were marked by surgeons using the astigmatism precise positioning marker developed by our department.All patients were examined before operation and at 1 day,1 week and 3 months after operation,and the data such as uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),and computer optometry results were collected before and 3 months after operation.The vector analysis tools were used to calculate the relevant astigmatism evaluation indicators:absolute value of the difference vector(|DV|),correction index(CI),and absolute value of the angle of error(|AofE|).Higher-order aberrations,including spherical aberration,coma aberration and clover aberration,were measured by Nidek refractive analyzer.Relevant data of patients in the two groups were statistically analyzed using the SPSS 26.0 software.Results There was no significant difference in the BCVA,spherical and cylindrical power between the two groups before operation(all P>0.05).At 3 months after operation,the UCVA(logMAR)in the marking group was better than that in the non-marking group(P<0.05),while the spherical and cylindrical power showed no significant difference between the two groups(both P>0.05).There was no significant difference in|DV|and CI between the two groups at 3 months after operation(both P>0.05).The|AofE|in the marking group was significantly lower than that in the non-marking group at 3 months after operation(P<0.05).There was no significant difference in coma,trefoil and spherical aberrations between the two groups before operation(all P>0.05).The coma,trefoil and spherical aberrations in the two groups significantly increased at 3 months after operation(all P<0.05).The coma aberration in the marking group was smaller than that in the non-marking group at 3 months after operation(P<0.05).Conclusion SMILE with the marking by the astigmatism precise positioning marker can better correct astigmatism,optimize the coma aberration caused by SMILE,and improve the visual quality of patients.