SMILE治疗近视患者效果及对角膜生物力学的影响

目的:探讨飞秒激光小切口角膜基质透镜取出术(SMILE)治疗近视患者的效果及对角膜生物力学的影响。方法:回顾性研究。选择2020-01/2021-12在安阳市眼科医院拟行角膜屈光手术的近视患者120例240眼。根据手术治疗方式分为SMILE组64例128眼,经上皮准分子激光角膜切削术(TransPRK)组56例112眼。比较两组患者术后1、7 d,1、3、6 mo,1 a的裸眼视力、角膜生物力学、角膜内皮细胞数目、角膜后表面高度、角膜表面规则指数、手术并发症。结果:SMILE组患者术后1、7 d,1 mo裸眼视力均优于TransPRK组(均P<0.001),但两组术后3、6 mo,1 a均无差异(均P>0.05)。与术前相比,两组患者术后的角膜补偿眼压、模拟Goldmann眼压、角膜阻力因子、角膜滞后量呈先下降后升高趋势。SMILE组术后1、7 d,1 mo角膜补偿眼压、模拟Goldmann眼压、角膜阻力因子、角膜滞后量均高于TransPRK组(均P<0.05),但术后3、6 mo,1 a均无差异(均P>0.05)。手术前后两组患者角膜内皮细胞数目、角膜后表面高度均无差异(均P>0.05)。与术前相比,两组患者术后角膜表面规则指数呈先升高后降低趋势,但组间比较无差异(P>0.05)。两组患者术后并发症发生率比较无差异(P>0.05)。结论:相比TransPRK,SMILE对角膜生物力学的影响较小,早期视力恢复效果更好,两种手术的远期视力无差异,均有良好的安全性和有效性。

SMILE,FS-LASIK治疗术对高度近视患者角膜稳定性及视觉质量的影响

评估SMILE和FS-LASIK两种手术方式对高度近视患者角膜稳定性及视觉质量的影响。方法 采用回顾性分析选取我院于2020年6月-2021年6月期间收诊的96例高度近视患者,根据治疗方式分为SMILE组与FS-LASIK组,各48例。比较这两种方法对患者角膜稳定性和视觉质量的影响。结果 术后1、3mo的跟踪观察中,与术前相比,两组患者的角膜最薄点显著降低(p<0.05);而角膜后表面高度降低幅度无显著差异(p>0.05)。在术后1mo,SMILE组的角膜最薄点高度高于FS-LASIK组(p<0.05);术后3mo,SMILE组的该高度低于FS-LASIK组,差异不显著(p>0.05)。在术后1、3mo,SMILE组的角膜后表面高度普遍低于FS-LASIK组,无统计学意义(p>0.05)。术后1mo,两组患者客观散射指数(OSI)与术前比较升高,且SMILE组低于FS-LASIK组(p<0.05);术后3mo,两组患者OSI与术前比较升高,且SMILE组低于FS-LASIK组,无统计学差异(p>0.05)。术后1mo,两组患者的调制传递函数截止频率(MTF cut-off)较术前降低,且SMILE组高于FS-LASIK组(p<0.05);术后3mo,两组患者的MTF cut-off值较术前降低,SMILE组高于FS-LASIK组,无统计学差异(p>0.05)。SMILE组的斯特列比(SR)在术后1、3mo均高于FS-LASIK组,但无统计学差异(p>0.05)。结论 SMILE手术在术后早期对高度近视患者的视觉质量改善方面显示出一定的优势,特别是在OSI和MTF cut-off值方面。但就角膜稳定性而言,SMILE和FS-LASIK手术之间无显著差异。这表明SMILE手术是高度近视患者的一个更佳选择,尤其是在考虑早期视觉质量改善方面。

SMILE和WG-FS-LASIK治疗低度无散光近视患者术后早期视觉质量比较

目的比较飞秒激光小切口角膜基质内透镜取出术(SMILE)和波前像差引导的准分子激光原位角膜磨镶术(WG-FS-LASIK)治疗低度无散光近视患者术后的早期视觉质量。方法选择2022年3月至6月在广西壮族自治区人民医院视光中心行SMILE治疗的患者15例(30眼,SMILE组),行WG-FS-LASIK治疗的患者15例(30眼,WG-FS-LASIK组)。所有患者术前无散光且最佳矫正视力所需最低球镜度数均≤-3.00 D。于术前和术后1 d、1周、1个月测量视力、全眼像差(慧差、三叶草像差和球差)、客观散射指数(OSI)、调制传递函数截止频率(MTF_(cut-off))、斯特列尔比(SR)、可预测对比度视力(PVA)(包括PVA 100%、PVA 20%、PVA 9%)。比较两组观察指标测量结果。结果两组术后等效球镜、视力情况均较术前显著改善(P<0.05),但两组各时间点比较差异无统计学意义(P>0.05)。两组术后OSI、SR、PVA 9%均较术前显著改善(P<0.05)。WG-FS-LASIK组在术后1 d、1周、1个月的OSI水平均显著低于SMILE组(P<0.05)。在术后1个月,WG-FS-LASIK组PVA 9%显著高于SMILE组(P<0.05)。SMILE组和WG-FS-LASIK组术后慧差均呈先上升后下降的趋势,但WG-FS-LASIK组变化幅度更小,在术后1 d、1周、1个月,WG-FS-LASIK组慧差小于SMILE组,差异有统计学意义(P<0.05)。结论SMILE和WG-FS-LASIK均能提高低度无散光近视患者术后早期视觉质量,但WG-FS-LASIK早期视力恢复更好,且夜间视觉质量改善更优。

SMILE术后主导眼转变及对视觉质量的影响

目的:分析SMILE术后主导眼的转变情况及对视觉质量的影响。方法:前瞻性临床研究。选取2022-06/12在新疆医科大学第一附属医院行SMILE术矫正近视的患者140例280眼,根据术后3 mo内随访时卡洞法检查主导眼别转变情况分为转变组(46例92眼)和非转变组(94例188眼)。术前、术后1、3 mo,评估两组患者的裸眼视力(UCVA),采用屈光矫正者生活质量(QIRC)量表评估主观视觉质量,并检测全眼高阶像差评价客观视觉质量。结果:纳入患者SMILE术前主导眼为右眼105例,左眼35例,术后1 mo 46例患者主导眼发生转变,术后3 mo较术后1 mo无新发主导眼转变。术前、术后1、3 mo,转变组和非转变组患者UCVA、QIRC量表评分均无差异(P>0.05)。两组患者主导眼比较,术后3 mo转变组患者总高阶像差、球差显著高于非转变组(P=0.030、0.046);两组患者非主导眼比较,术后1 mo转变组患者三叶草像差显著高于非转变组(P=0.008)。术后1 mo,转变组患者双眼三叶草像差差值明显高于非转变组(P=0.022),余均无差异。结论:SMILE术后部分患者会发生主导眼的转变,但对主观视觉质量无显著影响,术后早期客观视觉质量下降可能是主导眼转变的相关因素。

SMILE不同角膜帽厚度对近视散光患者术后散光及早期视觉质量的影响

目的:比较飞秒激光小切口角膜基质透镜取出术(SMILE)中不同眼角膜帽厚度对近视散光患者术后散光及早期视觉质量的影响。方法:采用前瞻性对照研究,选取我院2020-06/2022-06接受SMILE手术的近视散光患者54例108眼,根据随机数字表法分为A组、B组(各27例54眼),A组、B组角膜帽厚度设计分别为110、120μm,其余手术参数一致。比较两组患者术前及术后1 d,1 wk,1 mo的裸眼视力(UCVA)、等效球镜度(SE)、角膜硬度参数(SP-A1)、视觉质量和散光矢量分析结果等。结果:两组患者手术前后各时间点的UCVA、SE、SP-A1有时间差异(均P<0.05),术后1 d A组UCVA优于B组(P<0.05)。两组患者的散光矢量分析结果比较无差异(均P>0.05)。术后1 d A组的客观散射指数(OSI)低于B组,斯特列尔比(SR)高于B组(均P<0.05)。两组间术后调制传递函数截止频率(MTF cut off)、对比度视力、视觉症状及总体满意度、并发症发生率比较无差异(均P>0.05)。结论:110μm或120μm的角膜帽厚度在SMILE矫正近视散光方面均是安全有效的,且不影响术后的SE、散光、SP-A1以及对比度视力。110μm角膜帽厚度术后早期视力恢复更快且早期视觉质量优于120μm。

Ground-based and additional science support for SMILE

The joint European Space Agency and Chinese Academy of Sciences Solar wind Magnetosphere Ionosphere Link Explorer(SMILE)mission will explore global dynamics of the magnetosphere under varying solar wind and interplanetary magnetic field conditions,and simultaneously monitor the auroral response of the Northern Hemisphere ionosphere.Combining these large-scale responses with medium and fine-scale measurements at a variety of cadences by additional ground-based and space-based instruments will enable a much greater scientific impact beyond the original goals of the SMILE mission.Here,we describe current community efforts to prepare for SMILE,and the benefits and context various experiments that have explicitly expressed support for SMILE can offer.A dedicated group of international scientists representing many different experiment types and geographical locations,the Ground-based and Additional Science Working Group,is facilitating these efforts.Preparations include constructing an online SMILE Data Fusion Facility,the discussion of particular or special modes for experiments such as coherent and incoherent scatter radar,and the consideration of particular observing strategies and spacecraft conjunctions.We anticipate growing interest and community engagement with the SMILE mission,and we welcome novel ideas and insights from the solar-terrestrial community.

不同程度近视患者行SMILE术后的有效光学区及角膜高阶像差比较

目的:比较低、中、高度近视患者行飞秒激光小切口基质透镜取出术(SMILE)后的有效光学区和角膜高阶像差。方法:收集2019-02/2021-02在我院行SMILE手术的患者134例,均取右眼入组,按等效球镜度(SE)分为低度近视组SE>-3.00 D,中度近视组-6.00 D<SE≤-3.00 D,高度近视组SE≤-6.00 D三组,分别于术前和术后1 mo行Pentacam检查,分析各组内手术前后角膜总高阶像差(tHOA)、球差、彗差有无差异,及术后三组间角膜总高阶像差、球差、彗差及有效光学区大小(EOZ)有无差异。结果:SMILE术后1 mo,三组术后有效光学区均小于预设光学区,随着屈光度数增加,有效光学区越小(P<0.05);术后1 mo角膜总高阶像差、球差、彗差均高于术前,除低近视度组球差术前与术后1 mo无差异(P>0.05),其余组别均有差异(P<0.05);角膜总高阶像差、球差和彗差随着屈光度数增加而增加,三组角膜总高阶像差和球差有差异(均P<0.05),高度近视组与中度近视组、低度近视组彗差结果均有差异(P<0.05),中度近视组与低度近视组彗差结果无差异(P>0.05)。结论:随着手术矫正的屈光度数增加,术后有效光学区减少越多,角膜高阶像差增加越明显;SMILE术后1 mo角膜高阶像差较术前增加。

Preface to the Special Issue on Modeling and Data Analysis Methods for the SMILE mission

The SMILE(Solar wind Magnetosphere Ionosphere Link Explorer)project(http://www.nssc.cas.cn/smile/,https://www.cosmos.esa.int/web/smile/mission)is a joint spacecraft mission of the European Space Agency(ESA)and the Chinese Academy of Sciences(CAS)with an expected launch in 2025.SMILE aims to study the global interactions of solar wind–magnetosphere–ionosphere innovatively by imaging the Earth’s magnetosheath and cusps in soft X-rays and the northern auroral region in ultraviolet(UV)while simultaneously measuring plasma and magnetic field parameters in the solar wind and magnetosheath along a highly-elliptical and highly-inclined orbit.This special issue is composed of 22 articles,presenting recent progress in modeling and data analysis techniques developed for the SMILE mission.In this preface,we categorize the articles into the following seven topics and provide brief summaries:(1)instrument descriptions of the Soft X-ray Imager(SXI),(2)numerical modeling of the X-ray signals,(3)data processing of the X-ray images,(4)boundary tracing methods from the simulated images,(5)physical phenomena and a mission concept related to the scientific goals of SMILE-SXI,(6)studies of the aurora,and(7)ground-based support for SMILE.

SMILE soft X-ray Imager flight model CCD370 pre-flight device characterisation

Throughout the SMILE mission the satellite will be bombarded by radiation which gradually damages the focal plane devices and degrades their performance.In order to understand the changes of the CCD370s within the soft X-ray Imager,an initial characterisation of the devices has been carried out to give a baseline performance level.Three CCDs have been characterised,the two flight devices and the flight spa re.This has been carried out at the Open University in a bespo ke cleanroom measure ment facility.The results show that there is a cluster of bright pixels in the flight spa re which increases in size with tempe rature.However at the nominal ope rating tempe rature(-120℃) it is within the procure ment specifications.Overall,the devices meet the specifications when ope rating at -120℃ in 6 × 6 binned frame transfer science mode.The se rial charge transfer inefficiency degrades with temperature in full frame mode.However any charge losses are recovered when binning/frame transfer is implemented.

质谱中气相Smiles重排反应的研究进展

人名反应基于反应机理对复杂的有机化学反应进行了梳理和总结,极大地促进了有机化学研究,并方便了化学家们的交流。在质谱领域,气相人名反应的类型并不多,常见的包括麦氏重排(McL)和逆狄尔斯-阿尔德(RDA)反应等。这些广为人知的气相人名反应由于具有显著的结构特异性,成为了质谱结构解析的有力工具。随着软离子化结合多级质谱技术的发展,越来越多新型的气相反应被发现和研究,其中气相Smiles重排反应因其复杂而有趣的骨架重排而备受质谱学家和化学家关注。气相Smiles重排能够引起化合物骨架的变化,导致一些意想不到的中性丢失。与凝聚相Smiles重排反应相比,气相Smiles重排反应不受五元环过渡态形式的限制,也无需碱性条件的引发。这正是气相离子反应的特点,但同时,更多可能的裂解途径也给解谱带来了挑战。系统总结了近年来报道的质谱中气相Smiles重排反应,分析了化合物结构、离子化方法以及电荷状态对气相Smiles重排反应的影响,为基于质谱中气相Smiles重排反应进行化合物结构解析,以及发现化合物在凝聚相条件下的类似反应提供了线索和信息。

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

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。

On the apparent line-of-sight alignment of the peak X-ray intensity of the magnetosheath and the tangent to the magnetopause,as viewed by SMILE-SXI

The Soft X-ray Imager(SXI)on board the Solar wind Magnetosphere Ionosphere Link Explorer(SMILE)spacecraft will be able to view the Earth’s magnetosheath in soft X-rays.Simulated images of the X-ray emission visible from the position of SMILE are created for a range of solar wind densities by using 3 years of the SMILE mission orbit,together with models of the expected X-ray emissivity from the Earth’s magnetosheath.Results from global magnetohydrodynamic simulations and a simple model for exospheric neutral densities are used to compare the locations of the lines of sight along which integrated soft X-ray intensities peak with the lines of sight lying tangent to surfaces(defined here to be the magnetopause)along which local soft X-ray intensities peak or exhibit their strongest gradients,or both,for strongly southward interplanetary magnetic field conditions when no depletion or low-latitude boundary layers are expected.Where,in the parameter space of the various times and seasons,orbital phases,solar wind conditions,and magnetopause models,the alignment of the X-ray emission peak with the magnetopause tangent is good,or is not,is presented.The main results are as follows.The spacecraft needs to be positioned well outside the magnetopause;low-altitude times near perigee are not good.In addition,there are seasonal aspects:dayside-apogee orbits are generally very good because the spacecraft travels out sunward at high altitude,but nightside-apogee orbits,behind the Earth,are bad because the spacecraft only rarely leaves the magnetopause.Dusk-apogee and dawnapogee orbits are intermediate.Dayside-apogee orbits worsen slightly over the first three mission years,whereas nightside-apogee orbits improve slightly.Additionally,many more times of good agreement with the peak-to-tangent hypothesis occur when the solar wind is in a high-density state,as opposed to a low-density state.In a high-density state,the magnetopause is compressed,and the spacecraft is more often a good distance outside the magnetopause.

Analysis of the joint detection capability of the SMILE satellite and EISCAT-3D radar

The Solar wind Magnetosphere Ionosphere Link Explorer(SMILE)satellite is a small magnetosphere–ionosphere link explorer developed cooperatively between China and Europe.It pioneers the use of X-ray imaging technology to perform large-scale imaging of the Earth’s magnetosheath and polar cusp regions.It uses a high-precision ultraviolet imager to image the overall configuration of the aurora and monitor changes in the source of solar wind in real time,using in situ detection instruments to improve human understanding of the relationship between solar activity and changes in the Earth’s magnetic field.The SMILE satellite is scheduled to launch in 2025.The European Incoherent Scatter Sciences Association(EISCAT)-3D radar is a new generation of European incoherent scatter radar constructed by EISCAT and is the most advanced ground-based ionospheric experimental device in the high-latitude polar region.It has multibeam and multidirectional quasi-real-time three-dimensional(3D)imaging capabilities,continuous monitoring and operation capabilities,and multiple-baseline interferometry capabilities.Joint detection by the SMILE satellite and the EISCAT-3D radar is of great significance for revealing the coupling process of the solar wind–magnetosphere–ionosphere.Therefore,we performed an analysis of the joint detection capability of the SMILE satellite and EISCAT-3D,analyzed the period during which the two can perform joint detection,and defined the key scientific problems that can be solved by joint detection.In addition,we developed Web-based software to search for and visualize the joint detection period of the SMILE satellite and EISCAT-3D radar,which lays the foundation for subsequent joint detection experiments and scientific research.

Simulation of the SMILE Soft X-ray Imager response to a southward interplanetary magnetic field turning

The Solar wind Magnetosphere Ionosphere Link Explorer(SMILE)Soft X-ray Imager(SXI)will shine a spotlight on magnetopause dynamics during magnetic reconnection.We simulate an event with a southward interplanetary magnetic field turning and produce SXI count maps with a 5-minute integration time.By making assumptions about the magnetopause shape,we find the magnetopause standoff distance from the count maps and compare it with the one obtained directly from the magnetohydrodynamic(MHD)simulation.The root mean square deviations between the reconstructed and MHD standoff distances do not exceed 0.2 RE(Earth radius)and the maximal difference equals 0.24 RE during the 25-minute interval around the southward turning.

0.05 D间隔球镜片验光引导下SMILE矫正不同程度近视术后早期视觉质量

目的:探讨0.05 D(屈光度)间隔球镜片验光引导下飞秒激光小切口角膜基质透镜取出术(SMILE)矫正不同程度近视术后的早期视觉质量。方法:回顾性研究。选取2023-05/09于联勤保障部队第九八九医院接受SMILE的患者200例200眼,均为右眼。采用0.05 D验光方法进行屈光度测定。根据术前等效球镜度数分为低中度近视组(>-6.0 D)和高度近视组(≤-6.0 D),每组各100眼。比较两组术前及术后6 mo角膜总高阶像差(HOA)、球差、彗差、三叶草差,并填写视觉质量调查问卷。结果:术后6 mo两组患者角膜总HOA、球差、垂直彗差均较术前显著增大(均P<0.05);术后6 mo低中度近视组HOA、球差、垂直彗差均低于高度近视组(均P<0.05)。低中度近视组视觉质量调查问卷综合评分、近视力、夜视力、夜间眩光及视疲劳评分均高于高度近视组(均P<0.05)。结论:0.05 D间隔球镜片验光引导下SMILE在矫正低中度近视和高度近视虽然均有视觉症状发生,但术后早期能获得良好的视觉质量。

SMILE来源的角膜基质透镜临床再利用的研究进展

随着飞秒激光小切口角膜基质透镜取出术(SMILE)的普及,术中大量一片式角膜基质透镜被取出。角膜基质透镜作为手术的额外产物,对其进行基础研究及临床再利用已成为近年来的研究热点。角膜基质透镜薄而透明,来源丰富,成本低廉,具有低免疫源性及良好的组织相容性等优点,是研究细胞和角膜基质的重要来源,也可作为临床上角膜加固、补片移植、屈光矫正及泪道栓塞的良好生物材料。文章就SMILE手术来源的角膜基质透镜在治疗角膜相关疾病,矫治远视及老视,覆盖青光眼引流阀防止其暴露及用于泪道栓等方面的应用进行综述,旨在充分认识其在临床上的再利用,扩大其手术应用范围,为其他眼病的治疗及组织器官中的应用提供新方向。

SMILE术中应用十字定位法矫正低中度散光的临床效果

目的:采用Alpins矢量分析法评估飞秒激光小切口角膜基质透镜取出术(SMILE)术中应用十字定位法矫正低中度散光的临床效果。方法:前瞻性随机对照研究。纳入2022-05/11在西安市第一医院激光近视治疗中心进行SMILE手术且散光度数≤1.50 D的低中度顺规散光患者50例81眼,依据随机表分为十字组患者25例41眼术中在进行标准SMILE程序之前术者根据十字交叉线调整患者头位,使患者双眼外眦与水平线对齐,眉心及鼻梁与垂直线对齐;未用十字定位法的对照组25例40眼。观察两组患者术后3 mo视力及屈光情况,采用Alpins矢量分析法对散光变化进行分析评估。结果:随访期间十字组失访6例11眼,对照组失访8例14眼。最终十字组纳入19例30眼,对照组纳入17例26眼。术后3 mo,两组患者术眼裸眼视力(UCVA)均≥1.0,均未出现严重并发症,两组间UCVA、最佳矫正视力(BCVA)、球镜度及等效球镜度比较均无差异(均P>0.05)。十字组柱镜度数0.00(0.00,0.00)D小于对照组-0.13(-0.50,0.00)D(P=0.01)。矢量分析结果显示,十字组的矢量误差(DV)低于对照组[0.00(0.00,0.00)vs 0.13(0.00,0.50),P=0.01],成功指数(IOS)优于对照组[0.00(0.00,0.00)vs 0.18(0.00,0.77),P<0.01]。术后3 mo,十字组和对照组角度误差(AE)在±5°内的眼数分别为26眼(87%)、15眼(58%)。结论:SMILE术中应用十字定位法校准患者头位,减小了SMILE矫正低中度散光的轴位误差,提高SMILE矫正低中度散光的精确性。

Recent Progress of the Solar Wind Magnetosphere Ionosphere Link Explorer (SMILE) Mission

The SMILE(Solar wind Magnetosphere Ionosphere Link Explorer)mission is a joint space science mission between the Chinese Academy of Sciences(CAS)and the European Space Agency(ESA),aiming to understand the interaction of the solar wind with the Earth’s magnetosphere in a global manner.As of May 2024,the SMILE mission is in phase-D with an expected launch date of September 2025.This report summarizes developments in the mission during the past two years.

不同程度近视患者SMILE术后不同时间干眼情况对比研究

[目的]探讨不同程度近视患者行飞秒激光小切口角膜基质内透镜取出术(SMILE)术后不同时间干眼情况。[方法]收集行SMILE的近视患者150例,按照近视程度分为三组:高度近视组、中度近视组、低度近视组,每组50例,取右眼数据进行研究。比较三组患者术前及术后1周、1个月、6个月、1年的干眼指标[泪膜破裂时间(BUT)、泪液分泌试验(ST)读数、眼表疾病指数量表(OSDI)评分]。[结果]三组患者术前干眼指标无统计学差异(P>0.05),术后1周、1个月高度近视组BUT短于低度、中度近视组,ST读数低于低度、中度近视组,OSDI评分明显高于低度、中度近视组(均P<0.05),中度近视组与低度近视组的各干眼指标比较无统计学差异(均P>0.05);术后6个月、术后1年三组的各干眼指标比较无统计学差异(均P>0.05)。[结论]不同近视程度患者进行SMILE,高度近视者术后6个月内干眼情况比低度、中度近视者严重,6个月后不同近视程度患者的干眼情况相似,SMILE术后远期干眼情况与近视程度不存在明显关联。

SMILE术后角膜后表面高度变化及其影响因素

目的研究飞秒激光小切口角膜基质透镜取出术(SMILE)后角膜后表面高度的变化及其影响因素。方法回顾分析SMILE近视矫正患者285例(559眼)。比较术前、术后1天、术后1周、术后1月顶点及以顶点为圆心2mm、4mm、6mm直径范围上0°、90°、180°、270°角膜后表面高度的变化。计算术后与术前的差值,分析变化量与年龄、术前等效球镜度数、角膜厚度、透镜厚度、角膜帽厚度、透镜直径、残余角膜厚度、角膜帽厚度/角膜厚度、透镜厚度/角膜厚度及后表面曲率的相关性。结果术后1天、术后1周、术后1月时角膜顶点、2mm环、4mm环、6mm环处的后表面高度较术前差异均有统计学意义(F=52.01,P<0.0001;F=44.63,P<0.0001;F=32.15,P<0.0001;F=30.27,P<0.0001),术后1天与术后1周、术后1月角膜后表面高度变化无统计学意义(P>0.05)。术后1天、术后1周、术后1月在顶点和2mm环处表面高度变化为后移,与术前角膜后表面K1、K2、Km值呈正相关(r>0,P<0.05);在4mm环和6mm环处,后表面高度变化为前移,与术前角膜后表面K1、K2、Km值呈负相关(r<0,P<0.05);余研究因素与角膜后表面高度改变相关性无统计学意义。结论角膜后表面高度在术后第一天显著变化,后趋于稳定。在切削深度安全范围内,SMILE术后发生后表面扩张的可能性小。对于角膜后表面曲率过大或过小的患者选择手术时应慎重。