SMILE与FS-LASIK术后角膜生物力学变化的Meta分析

Meta-Analysis of Corneal Biomechanics after SMILE and FS-LASIK

目的:探讨飞秒激光小切口透镜取出术(small incision lenticule extraction, SMILE)和飞秒激光制瓣的准分子激光角膜原位磨镶术(femtosecond laser-assisted laser in situ keratomileusis, FS-LASIK)治疗近视术后角膜生物力学的差异。方法:进行荟萃分析,使用MEDLINE、EMABASE、中国知网、Cochrane图书馆检索有SMILE和FS-LASIK术后角膜生物力学的报告。分析内容包括术前和术后3个月角膜滞后量CH和角膜阻力因子CRF。使用Newcastle-Ottawa Scale (NOS)文献质量评价量表评价报告的质量。采用RevMan5进行统计学分析。结果:在这项荟萃分析中,最终只包括6项研究,771只眼,并使用随机效应模型。术前SMILE组和FS-LASIK组相比较CH和CRF差异均无统计学意义(WMD, ?0.12;95% CI, ?0.31~0.06;P, 0.19;WMD, ?0.05;95% CI, ?0.29~0.19;P, 0.69)。术后3个月CH,国外组,两种手术方式差异无统计学意义(WMD, 0.19;95% CI, ?1.02~1.41;P, 0.75)。中国组,两种手术方式CH差异无统计学意义(WMD, 0.13;95% CI, ?0.16~0.41;P, 0.75)。术后3个月CRF,国外组,两种手术方式差异无统计学意义(WMD, ?0.11;95% CI, ?2.53~?2.31;P, 0.93)。中国组,两种手术方式差异有统计学意义(WMD, 0.26;95% CI, 0.06~0.47;P, 0.01)。结论:这一荟萃分析表明,SMILE和FS-LASIK术后CH差异无统计学意义;CRF国外组差异无统计学意义,国内组SMILE优于FS-LASIK。

Objective:To evaluate and compare corneal biomechanics after small-incision lenticule extraction and femtosecond laser-assisted laser in situ keratomileusis.Methods:We conducted a me-ta-analysis and searched for reports concerning corneal biomechanical effects after small-incision lenticule extraction and femtosecond laser-assisted laser in situ keratomileusis using Medline,EMbase,CNKI,and the Cochrane Library.The quality of the reports was evaluated using the New-castle-Ottawa Scale(NOS).Results:Only six studies with a total of 771 eyes were ultimately in-cluded in this meta-analysis and the random-effects model was used.CH and CRF after SMILE and FS-LASIK were compared by meta-analysis,including pre-operation and 3 months post-operation.There was no difference in CH and CRF between SMILE and FS-LASIK before surgery(WMD,?0.12;95%CI,?0.31~0.06;P,0.19;WMD,?0.05;95%CI,?0.29~0.19;P,0.69).There was no significant difference between the two surgical methods in CH at 3 months after operation and in the foreign group(WMD,0.19;95%CI,?1.02~1.41;P,0.75).In the Chinese group,there was no significant difference in CH between the two surgical methods(WMD,0.13;95%CI,?0.16~0.41;P,0.75).There was no significant difference between the two surgical methods in CRF at 3 months after operation and in the foreign group(WMD,?0.11;95%CI,?2.53~?2.31;P,0.93).In the Chinese group,the difference between the two surgical methods was statistically significant(WMD,0.26;95%CI,0.06~0.47;P,0.01).Conclusion:This meta-analysis showed that there was no significant difference in CH between SMILE and FS-LASIK;there was no significant difference in CRF in the foreign group,but in the domestic group,SMILE was better than FS-LASIK.