SMILE与ICL植入术治疗伴低度散光的高度近视患者的疗效比较

Comparison of the efficacy of small incision lenticule extraction and implantable collamer lens implantation in the treatment of high myopia with low astigmatism

目的:比较全飞秒激光小切口角膜基质透镜取出术(SMILE)与有晶状体眼后房型人工晶状体(ICL)植入术治疗伴低度散光的高度近视患者的疗效、安全性及视觉质量的临床效果。方法:回顾性研究。纳入2021-01/2022-01我院收治伴低度散光的高度近视患者80例159眼,根据手术方式不同分为SMILE组46例91眼和ICL植入组34例68眼。比较两组患者术前,术后3、6 mo等效球镜、裸眼视力(UCVA)、最佳矫正视力(BCVA)以及角膜高阶像差、光学质量指标(SR)及有效性、安全性指数,统计手术并发症。结果:两组术后6 mo等效球镜、UCVA及BCVA均较术前提高(均P<0.05)。术后6 mo,两组患者UCVA、BCVA、等效球镜、有效性指数、安全性指数比较均无差异(均P>0.05),SMILE组患者总高阶像差、球差、彗差、垂直彗差和水平彗差的均方根值均高于ICL植入组,术后3、6 mo ICL植入组SR高于SMILE组(均P<0.05)。结论:SMILE和ICL植入术治疗伴低度散光的高度近视患者的手术效果良好,术后患者均能获得较好的术后视力和客观视觉质量,相比于SMILE,ICL植入术术后视觉质量更好。

AIM:To compare the clinical effect of small incision lenticule extraction(SMILE)and implantable collamer lens(ICL)implantation on efficacy,safety and visual quality in patients with high myopia complicated with low astigmatism.METHODS:Retrospective study.A total of 80 cases(159 eyes)of high myopia and low astigmatism treated in the hospital from January 2021 to January 2022 were included,and they were divided into 46 cases(91 eyes)in SMILE group and 34 cases(68 eyes)in ICL implantation group by means of different surgical methods.The spherical equivalent,uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),higher order aberrations of cornea and optical quality index,effectiveness and safety index were compared between the two groups before surgery and at 3 and 6 mo after surgery,and the surgical complications were counted.RESULTS:The spherical equivalent,UCVA and BCVA of both groups were all improved at 6 mo postoperatively(all P<0.05).At 6 mo after surgery,there were no differences in UCVA,BCVA,spherical equivalent,effectiveness and safety index between both groups(all P>0.05).The root mean square values of total higher order aberration,spherical aberration,coma,vertical coma and horizontal coma in the SMILE group were higher than those in the ICL implantation group,and Strehl ratio(SR)in the ICL implantation group was higher than that in the SMILE group at 3 and 6 mo after surgery(all P<0.05).CONCLUSION:SMILE and ICL implantation have good surgical efficacy in the treatment of patients with high myopia and low astigmatism,and both methods can achieve good postoperative visual acuity and objective visual quality.Furthermore,the ICL implantation has better postoperative visual quality than SMILE.