Three-year results of small incision lenticule extraction and wavefront-guided femtosecond laser-assisted laser in situ keratomileusis for correction of high myopia and myopic astigmatism

AIM： To compare and calculate the 3-year refractive results, higher-order aberrations （HOAs）, contrast sensitivity （CS） and dry eye parameters after small incision lenticule extraction （SMILE） and wavefront-guided femtosecond laser-assisted laser in situ keratomileusis （FS-LASIK） for correction of high myopia and myopic astigmatism. METHODS： In this prospective, non-randomized comparative study, 78 eyes with spherical equivalent （SE） of -8.11±1.09 diopters （D） received a SMILE surgery, and 65 eyes with SE of -8.05±1.12 D received a wavefront-guided FS-LASIK surgery with the VisuMax femtosecond laser （Carl Zeiss Meditec, Jena, Germany） for flap cutting. Visual acuity, manifest refraction, CS, HOAs, ocular surface disease index （OSDI） and tear break-up time （TBUT） were evaluated during a 3-year follow-up. RESULTS： The difference of uncorrected distance visual acuity （UDVA） postoperatively was achieved at lmo and at 3mo, whereas the difference of the mean UDVA between two groups at 3y were not statistically significant （t=-1.59, P=-0.13）. The postoperative change of SE was 0.89 D in the FS-LASIK group （t=5.76, P=0.00）, and 0.14 D in the SMILE group （t=-0.54, P=0.59） from lmo to 3y after surgery. At 3-year postoperatively, both HOAs and spherical aberrations in the SMILE group were obviously less than those in the FS-LASIK group （P=0.00）, but the coma root mean square （RMS） was higher in the SMILE group （0.59±0.26） than in the FS-LASIK group （0.29±0.14, P=0.00）. The mesopic CS values between two groups were not statistically significant at 3y postoperatively. Compared with the FS-LASIK group, lower OSDI scores and longer TBUT values were found in the SMILE group at Imo and 3mo postoperatively. With regard to safety, no eye lost any line of CDVA in both groups at 3y after surgery. CONCLUSION： Both SMILE and wavefront-guided FS- LASIK procedures provide good visual outcomes. Both procedures are effective and safe, but SMILE surgery achieve more stable long-term refractive outcome and better control of early postoperative dry eye as compared to FS-LASIK.

Dry eye and corneal sensitivity after small incision lenticule extraction and femtosecond laser-assisted in situ keratomileusis:a Meta-analysis

AIM：To assess the corneal sensitivity and the incidences of dry eye after small incision lenticule extraction（SMILE） and femtosecond laser-assisted in situ keratomileusis（FSLASIK）.METHODS：The Meta-analysis was performed using Rev Man 5.3.We searched on Pub Med from inception to March 2016.Summary weighted mean difference（WMD） and 95% confidence intervals（CIs） were used to analyze the datum.Random-effects or fixed-effects models were chosen up to between-study heterogeneity.The main outcomes were composed of the Ocular Surface Disease Index（OSDI） scores,tear film break-up time（TBUT）,Schirmer Test and corneal sensitivity.RESULTS：Eight eligible studies including 772 eyes（386 in SMILE group and 386 in FS-LASIK group） were identified.The parameters have no significiant difference heterogeneity between SMILE and FS-LASIK group preoperatively.There were significant differences between the two groups in OSDI scores at one and three months postoperatively,in TBUT at one and three months postoperatively,in corneal sensitivity at one week,about one month and three months postoperatively.However,there was no significant difference observed in Schirmer Test at the follow-up periods.CONCLUSION：Compare to FS-LASIK,dry eye and the corneal sensitivity recover better in the SMILE group,in first three months after the surgery.

Optical and visual quality comparison of implantable collamer lens and femtosecond laser assisted laser in situ keratomileusis for high myopia correction

AIM:To compare clinical outcomes and refractive stability of implantable collamer lens(ICL)implantation and femtosecond laser assisted laser in situ keratomileusis(FSLASIK)for high myopia correction.METHODS:The Optical Quality Analysis System(OQAS)was used to evaluate clinical outcomes objectively after operation for high myopia correction.We compared the two procedures in terms of 1-year changes in uncorrected distance visual acuity(UDVA),corrected distance visual acuity(CDVA),safety index,efficacy index,spherical equivalent,modulation transfer function(MTF)cutoff frequency,strehl ratio(SR)and objective scatter index(OSI).RESULTS:At 1 y postoperatively,the safety indices were 1.33±0.27 in ICL group,and 1.17±0.24 in FS-LASIK group.39.58%in the ICL group and 27.59%in the FS-LASIK group gained CDVA in 2 lines or better than that in preoperative CDVA.The efficacy indices were 1.28±0.22 in ICL group,and 1.13±0.26 in FS-LASIK group.The changes of spherical equivalent from 1 wk to 1 y postoperatively was-0.12±0.37 D in ICL group,and-0.79±0.58 D in FS-LASIK group(P<0.05).Spherical equivalent within±0.50 D was achieved in 97.92%in ICL group and 68.97%in FS-LASIK group.MTF cutoff frequency were higher with ICL as compared to FSLASIK(P<0.05)at each postoperative follow-up stage;for postoperative 1 mo later,SR was statistically significant difference between two groups(P<0.05);with no statistically significant difference in OSI between two groups(P>0.05)in postoperative 3 mo later.CONCLUSION:ICL implantation and FS-LASIK procedures both provide good safety and predictability in high myopia correction.ICL implantation provides better clinical outcomes and refractive stability than FS-LASIK.

Clinical outcomes of transepithelial photorefractive keratectomy versus femtosecond laser assisted keratomileusis for correction of high myopia in South Egyptian population

AIM: To evaluate the safety and efficacy of transepithelial photorefractive keratectomy(t-PRK) with adjuvant mitomycin C(MMC) versus femtosecond laser assisted keratomileusis(Femto-LASIK) in correction of high myopia.METHODS: Prospective randomized comparative study including 156 eyes of 156 patients with high myopia and a spherical equivalent refraction(SER) <-6.00 D. They were divided randomly into two groups: Group A included 72 eyes treated with t-PRK with adjuvant MMC and Group B included 84 eyes treated with Femto-LASIK. Visual acuity, SER, corneal topography, pachymetry and keratometry were assessed for 12 mo postoperatively.RESULTS: The preoperative mean SER was-8.86±1.81 and-9.25±1.70 D in t-PRK MMC group and Femto-LASIK respectively(P=0.99) which improved to-0.65±0.43 D and-0.69±0.50 D at 12 mo follow up. Mean SER remained stable during the 12 mo of follow-up, with no statistically significant difference between the two groups(P=0.64). In t-PRK MMC group, only six eyes needed retreatment after six months of follow up. And two eyes showed haze(one reversible haze grade 2, while the other had dense irreversible haze grade 4).CONCLUSION: t-PRK MMC provides safe and satisfactory visual outcomes and acceptable risk as Femto-LASIK in patients with high myopia.

Dislocation,fold and striae of comeal flap with laser assisted in situ keratomileusis after ocular trauma:a case report

Objective： To report the occurrence, management and outcome ot late-onset traumauc aemscence ana dislocation of laser assisted in situ keratomileusis （LASIK） flaps. Treatment and Results： One patient occurred late-onset LASIK corneal flap dislocation after ocular trauma 7days after surgery. The flap was lifted, stretched, and repositioned after irrigation and scraping of the stromal bed and the underside of the flap. A bandage contact lens was placed, and topical antibiotic and corticosteroids were given postoperatively. The dislocated corneal flap was successfully repositioned in the case. The dislocated flap was repositioned 7 days after the trauma, and the patient recovered his uncorrected visual acuity （UCVA） of 10/20, 20/20 day 1 and day 20 after the procedure, of 20/20 20 days later and had a well-positioned flap with a clear interface. Diffuse lamellar keratitis developed in the patients that resolved with the use of topical corticosteroids. Conclusion： Laser in situ keratomileusis corneal flaps are vulnerable to traumatic dehiscence and dislocation, which should be pay more attention to it for us.

Above-average defocus curves in photopic and mesopic vision with multifocal intraocular lenses after laser assisted in situ keratomileusis

I am Dr. David P Pifiero from the Department of Optics, Pharmacology and Anatomy of the University of Alicante and from the Department of Ophthalmology of Vithas Medimar （Oftalmar） and Vithas Virgen del Carmen （Qvision） hospitals in Spain.

DIAGNOSIS AND TREATMENT FOR DEGENERATIVE RETINOSCHISIS OF MEDIUM TO HIGH MYOPIA IN YOUNG ADULTS PRIOR TO LASER-ASSISTED IN SITU KERATOMILEUSIS SURGERY

Objective To discuss the characteristics of degenerative retinoschisis in young adults with medium to high myopia prior to laser-assisted in situ keratomileusis(LASIX) surgery and the significance of preventive photocoagulation.Methods A total of 32 eyes in 19 patients suffering from myopia combined with degenerative retinoschisis were included.The mean best-corrected visual acuity was 0.82±0.13 and the mean spherical equivalent of the subjective refraction was -(6.50±3.98) Diopter. The patients underwent preventive photocoagulation 1 month before the laser surgery for myopia.Results All the eyes that received preventive photocoagulation for retinoschisis had no further progression or retinal detachment during 4-year period of follow-up.Conclusion The degenerative retinoschisis in young adults should be recognized and treated with preventive photocoagulation.This may prevent further damage of visual field and other complications of slowly progressive retinoschisis after LASIK surgery.

Femtosecond laser corneal refractive surgery for the correction of high myopic anisometropic amblyopia in juveniles

AIM： To evaluate the effects of femtosecond laser-assisted in situ keratomileusis（FS-LASIK） and small-incision lenticule extraction（SMILE） to correct high myopic anisometropic amblyopia in juvenile patients. METHODS： From November 2013 to January 2015, 33 amblyopic patients with high myopic anisometropic amblyopia were studied. FS-LASIK（30 eyes） or SMILE（3 eyes） was performed in the amblyopic eyes. Visual acuity, refraction, contrast sensitivity, stereoacuity and complications were evaluated. Patients completed followup examinations at 3 d, 1 mo, 3 mo and the last follow-up time（mean 8.17±3.23 mo） after surgery. RESULTS： The mean age at surgery was 9.04±3.04 y（range 6-16 y）. The mean spherical equivalent in the amblyopic eyes was significantly decreased from-10.00±2.39 D preoperatively to-0.06±1.06 D at 1 mo,-0.19±1.33 D at 3 mo and-0.60±1.43 D at approximately 8 mo postoperatively（P〈0.05 for all）. The mean myopic anisometropia was significantly decreased from-9.45±2.33 D preoperatively to ＋0.37±1.48 D at 1 mo,-0.46±1.47 D at 3 mo and-0.09±1.83 D at approximately 8 mo（P〈0.05 for all）. The logarithm of the minimum angle of resolution（log MAR） for uncorrected and corrected distance visual acuity（UDVA and CDVA, respectively） of the amblyopic eye improved from 1.74±0.35 and 0.98±0.63 preoperatively to 0.45±0.31 and 0.41±0.33 at approximately 8 mo after surgery, respectively. The logM AR CDVA at 3 d, 1, 3 and 8 mo postoperatively improved by means of 1.42, 2.22, 2.96, and 4.39 lines, and a gain of more than two lines accounted for 45%, 50%, 74% and 86% of all patients, respectively. The contrast sensitivity of both amblyopic eyes and dominant eyes at 0.5, 2, 8 cycles perdegree was significantly improved postoperatively（P〈0.05 for all）. Of the 33 pediatric patients, no patients had near stereopsis preoperatively and seven patients（21.2%） recovered near stereopsis（400″ to 60″） at approximately 8 mo after surgery. No intraoperative or postoperative complications occurred in any patient.CONCLUSION： FS-LASIK or SMILE can be promising alternative methods to correct high myopic anisometropic amblyopia in juvenile patients who have failed with traditional approaches.

LASEK和TransPRK及FS-LASIK术后角膜屈光力及视觉质量比较

目的:比较准分子激光上皮下角膜磨镶术(LASEK)、经上皮准分子激光角膜切削术(TransPRK)、飞秒激光制瓣的准分子激光原位角膜磨镶术(FS-LASIK)三种角膜屈光手术术后角膜屈光力及视觉质量。方法:回顾性研究。选取2021-01/2022-12在我院择期行角膜屈光手术的232例464眼患者作为研究对象,根据患者选择手术方式不同分为LASEK组70例140眼、TransPRK组76例152眼、FS-LASIK组86例172眼。比较三组患者术前,术后1、3 mo时裸眼视力(UCVA)、视觉质量、生物力学稳定性、泪膜破裂时间(BUT)、泪液分泌试验(SⅠt)及生活质量变化情况。结果:术后1、3 mo三组患者裸眼视力较术前均改善,全角膜总高阶像差、球差、水平彗差、垂直彗差均升高,生物学稳定性均降低(均P<0.05)。术后3 mo, TransPRK组、LASEK组生物学稳定性均高于FS-LASIK组(均P<0.05),TransPRK组生活质量评分较LASEK组及FS-LASIK组高(P<0.05)。手术前后三组患者BUT、SⅠt比较均无差异(均P>0.05)。结论:LASEK、TransPRK、FS-LASIK三种角膜屈光手术治疗屈光不正疗效确切,在改善裸眼视力和提高视觉质量方面结果相似,但TransPRK、LASEK较FS-LASIK具有更稳定的生物力学性能,且TransPRK组在改善患者生活质量方面具有更好的效果。

FS-LASIK Xtra治疗中高度近视患者术后2a的矫正效果

目的:评估FS-LASIK Xtra治疗中高度近视患者术后2 a的矫正效果及角膜形态的稳定性。方法:回顾性病例对照研究。纳入2019-08/2020-08在我院拟行屈光手术的中高度近视合并散光患者30例58眼,根据术前角膜地形图中圆锥角膜筛查相关指数行不同手术方式,分为FS-LASIK Xtra组15例29眼,FS-LASIK组15例29眼。术前,术后3 mo,1、2 a观察裸眼视力(UCVA)、最佳矫正视力(BCVA)、等效球镜度(SE)及Sirius三维角膜地形图仪测量的不同直径区域(3、5、7 mm)前后表面角膜曲率。结果:两组患者术后不同时间点UCVA均较术前明显提高(均P<0.01),两组间UCVA和SE比较均无差异(P>0.05)。术后2 a,FS-LASIK Xtra组25眼(86%),FS-LASIK组24眼(83%)残余散光为-0.25-0 D。两组实际矫正SE与预矫正SE均呈正相关(均P<0.05)。两组患者术后3 mo,1、2 a不同直径区域(3、5、7 mm)前后表面角膜曲率均较术前有差异(均P<0.05),术后1、2 a FS-LASIK Xtra组角膜直径3、5 mm后表面曲率均高于FS-LASIK组(P<0.05)。结论:FS-LASIK Xtra治疗中高度近视患者有良好的安全性、有效性及可预测性。

基于Corvis ST分析飞秒LASIK联合快速交联矫正高度近视术后角膜生物力学变化

目的应用Corvis ST评估飞秒激光辅助准分子激光原位角膜磨镶术(LASIK)联合快速角膜交联术(FS-LASIK Xtra)矫正高度近视术后角膜生物力学的变化。方法前瞻性病例对照研究。选取2020年7月至2022年7月在山东中医药大学附属眼科医院行手术矫正高度近视的患者185例(185眼)为研究对象,所有患者均将右眼纳入研究,其中行FS-LASIK Xtra者93例为FS-LASIK Xtra组,行FS-LASIK者92例为FS-LASIK组,术后随访6个月,记录患者的裸眼视力、等效球镜度、平均角膜曲率(Km)、最薄点角膜厚度(TCT)、角膜生物力学参数[2 mm处变形幅度比(DAR 2 mm)、综合半径(IR)、第一次压平刚度系数(SP-A1)、应力应变指数(SSI)]和手术前后角膜生物力学参数变化量(术后6个月与术前的差值,即ΔDAR 2 mm、ΔIR、ΔSP-A1、ΔSSI)。采用独立样本t检验和Mann-Whitney U检验对组间数据进行比较。结果术后3个月等效球镜度FS-LASIK组和FS-LASIK Xtra组患者分别为(-0.21±0.31)D和(-0.04±0.36)D,差异有统计学意义(t=3.49,P=0.001);术后6个月两组分别为(-0.33±0.31)D、(-0.14±0.37)D,差异均有统计学意义(t=4.00,P<0.001)。术后6个月时FS-LASIK组与FS-LASIK Xtra组患者手术的有效性指数和安全性指数差异均无统计学意义(均为P>0.05)。术前两组患者DAR 2 mm、IR、SP-A1、SSI等角膜生物力学参数比较差异均无统计学意义(均为P>0.05);术后6个月,FS-LASIK组与FS-LASIK Xtra组患者角膜生物力学参数变化量ΔIR分别为3.03±0.78、2.67±0.80,ΔSP-A1为-35.93±12.04、-30.43±12.44,ΔSSI为-0.09±0.10、-0.03±0.06,两组相比差异均有统计学意义(均为P<0.05)。结论FS-LASIK Xtra矫正高度近视术后患者视力、等效球镜度稳定,具有良好的安全性和有效性,角膜生物力学稳定性较术前降低,但优于常规FS-LASIK,长期效果需要进一步观察。

2种不同飞秒激光术治疗薄角膜近视散光的效果分析

目的探讨飞秒激光制瓣的准分子激光原位角膜磨镶术(FS-LASIK)与飞秒激光小切口角膜基质透镜取出术(SMILE)治疗薄角膜近视散光的效果。方法选取2022年9月—2023年9月本院收治的薄角膜近视散光患者128例为研究对象,随机分为FS-LASIK组(64例,128眼,接受FS-LASIK治疗)和SMILE组(64例,124眼,接受SMILE治疗)。比较2组患者术前及术后1年视力水平[未矫正视力(UCVA)、最佳矫正视力(BCVA)],术后3、6、12个月的屈光参数等效球镜(SE)水平,术前及术后1年角膜表面形态[角膜平均曲率值(K_(Ave))、角膜表面规则指数(SRI)、角膜表面不对称指数(SAI)],以及角膜生物力学参数[角膜扩张综合偏差分析指数(BAD-D)、角膜生物力学指数(CBI)、综合分析指数(TBI)]、角膜损伤程度[角膜内皮细胞计数、角膜内皮细胞大小变异系数(CV)]、术后散光矫正矢量指标[误差幅度(ME)、误差角度(AE)、矫正指数(CI)和成功指数(IOS)]的差异,并记录术后残余基质床厚度及并发症发生情况。结果术后1年,2组UCVA和BCVA均较术前升高,差异有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05)。术后3、6、12个月,2组SE水平均高于术前,差异有统计学意义(P<0.05),但组间以上时点的SE水平比较,差异无统计学意义(P>0.05)。术后1年,2组角膜表面形态KAve、SRI、SAI水平均较术前降低,且SMILE组低于FS-LASIK组,差异有统计学意义(P<0.05)。术后1年,2组BAD-D和TBI均较术前升高,CBI均较术前降低,但SMILE组BAD-D和TBI低于FS-LASIK组,CBI高于FS-LASIK组,差异有统计学意义(P<0.05)。术后1年,2组角膜内皮细胞计数均较术前降低,角膜内皮细胞大小CV较术前升高,但SMILE组角膜内皮细胞计数高于FS-LASIK组,角膜内皮细胞大小CV低于FS-LASIK组,差异有统计学意义(P<0.05)。2组术后ME、AE、CI和IOS比较,差异无统计学意义(P>0.05)。术后FS-LASIK组残余基质床厚度为(302.01±55.03)μm,SMILE组为(310.23±46.03)μm,差异无统计学意义(t=1.284,P=0.200);术后1年,FS-LASIK组发生干眼症5例,SMILE组2例,2组干眼症发生率比较,差异无统计学意义(χ^(2)=1.227,P=0.268)。结论对于薄角膜的近视散光患者,应用FS-LASIK和SMILE治疗均能取得满意的视力提升和屈光改善效果,但后者对角膜结构完整性、生物力学稳定性以及手术损伤程度的影响相对更小。

近视患者准分子激光原位角膜磨镶术围术期综合干预的效果分析

目的探究近视患者准分子激光原位角膜磨镶术(LASIK)的围术期综合干预效果。方法选择200例近视患者为研究对象,随机分为对照组和研究组,每组100例(200眼)。所有患者均进行准分子激光原位角膜磨镶术治疗,对照组给予围术期常规干预,研究组给予围术期综合干预。比较两组患者视觉质量[斯特列尔比(SR)、调制传递函数截止频率(MTF cutoff)及100%对比敏感度的视觉质量分析系统(OQAS)分值(OV100%)、20%对比敏感度的OQAS分值(OV20%)、9%对比敏感度的OQAS分值(OV9%)、客观散射指数(OSI)]、对干预方式的满意度、术后并发症发生率。结果研究组SR(0.27±0.09)、MTF cutoff(33.05±5.18)c/deg及OV100%(1.36±0.41)、OV20%(1.37±0.43)、OV9%(1.50±0.47)均大于对照组的(0.23±0.02)、(30.20±4.26)c/deg、(1.15±0.11)、(1.18±0.14)、(1.26±0.21),OSI(0.39±0.08)小于对照组的(0.46±0.12),差异有统计学意义(P<0.05)。研究组术后并发症发生率0.50%低于对照组的12.50%,差异有统计学意义(P<0.05)。研究组总满意率99.00%高于对照组的75.00%,差异有统计学意义(P<0.05)。结论给予近视患者准分子激光原位角膜磨镶术手术围术期综合干预能够减少术后并发症的发生,提高患者满意度,改善视觉质量。

SMILE和超薄瓣FS-LASIK矫正中度近视疗效比较

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。

飞秒激光小切口角膜基质透镜取出术治疗近视性屈光参差

目的:探讨飞秒激光小切口角膜基质透镜取出术(SMILE)治疗近视性屈光参差的临床效果。方法:回顾性分析2021-01/2022-12于本院行SMILE或FS-LASIK治疗的近视性屈光参差患者76例146眼的临床资料,根据手术方式分为SMILE组(39例77眼)和FS-LASIK组(37例69眼)。比较两组患者术后1 wk,1、3 mo裸眼视力(UCVA)、屈光度、屈光参差度、角膜像差及术后并发症发生情况。结果:两组患者术后UCVA均较术前改善,彗差、三叶草、球差、总高阶像差均较术前显著增加(P<0.05),且FS-LASIK组患者彗差、三叶草、球差、总高阶像差显著高于SMILE组(P<0.05)。随访至术后3mo,SMILE组术后并发症发生率显著低于FS-LASIK组(5.2%vs 15.9%,P<0.05)。结论:SMILE与FS-LASIK均可有效提高近视性屈光参差患者UCVA,改善视觉质量,但SMILE术后角膜高阶像差更低、并发症发生率更小,整体效果更好。

FS-LASIK矫正中高度近视术后1年屈光回退危险因素及其预测模型构建

目的:探讨飞秒激光辅助准分子激光原位角膜磨镶术(FS-LASIK)矫正中高度近视术后1 a屈光回退的危险因素并构建预测模型。方法:回顾性分析2017-06/2018-11于西安高新医院行FS-LASIK手术矫正中高度近视患者400例800眼临床资料,将患者按照3∶1的比例随机分为建模组(n=300例)和验证组(n=100例),依照患者术后1 a屈光回退发生情况将建模组分为回退组与未回退组两个亚组,观察其角膜曲率和角膜厚度变化情况,采用Logistic回归分析筛选FS-LASIK矫正中高度近视患者术后1 a屈光回退的危险因素,基于回归系数构建预测模型,采用受试者工作特征曲线(ROC)评估模型区分度。结果:建模组44眼、验证组15眼于术后1 a发生屈光回退。建模组中未回退组术后6、12 mo时角膜前表面曲率低于回退组(均P<0.05);术后1、3、6、12 mo时回退组角膜增生程度大于未回退组(均P<0.05);FS-LASIK矫正中高度近视患者术后1 a屈光回退发生概率值回归方程为:P=1/[1+e^(-(-5.989+0.127×年龄+2.019×术前屈光度-0.022×术前角膜中央厚度+0.043×切削深度-1.569×切削光学区直径))],Hosmer-Lemeshow检测回归方程拟合优度(P=0.818),利用建模组数据进行内部验证,ROC曲线下面积为0.890(95%CI 0.843-0.937),灵敏度为81.82%,特异度为84.71%;利用验证组数据进行外部验证,ROC曲线下面积为0.838(95%CI 0.717-0.959),灵敏度为80.00%,特异度为87.57%。结论:构建的风险模型判别效度良好,可用于识别中高度近视患者行FS-LASIK术后1 a屈光回退高危人群。

FEMTOLDVFS-LASIK角膜瓣发生并发症的原因及处理办法

目的分析FEMTO LDV飞秒激光辅助制作角膜瓣的准分子激光原位角膜磨镶术(FS-LASIK)角膜瓣相关并发症的发生原因,并探讨其处理方法。方法回顾性病例研究。选取2012年7月至2022年6月于医院接受FS-LASIK的10600例(20480眼)近视散光患者,术中均使用FEMTO LDV飞秒激光辅助制作角膜瓣,观察角膜瓣的制作情况。结果本研究共出现角膜瓣相关并发症5566眼(27.18%),其中术中并发症5516眼,占99.1%,术后并发症50眼,占0.9%。术中并发症:直径超小瓣2眼(0.10‰),游离瓣9眼(0.44‰),不全瓣、碎瓣、纽扣瓣15眼(0.73‰),角膜瓣掀开困难94眼(4.59‰),角膜基质床线状条纹96眼(4.69‰),角膜基质床颗粒状107眼(5.22‰),角膜基质微小气泡15眼(0.73‰),前房气泡13眼(0.63‰),角膜上皮脱落12眼(0.59‰),术中负压丢失2眼(0.10‰),角膜瓣蒂位置反向3眼(0.15‰),眼底出血1眼(0.05‰),角膜瓣边缘出血2078眼(10.15%),球结膜下出血1043眼(5.09%),角膜瓣偏中心2039眼(9.96%)。术后并发症:角膜瓣皱褶50眼(2.44‰)。结论FEMTO LDV飞秒激光辅助制作角膜瓣虽有并发症发生,但均不影响手术效果,全面了解设备的性能,合理设计切削参数,提高医生的操作技巧才能制作完美的角膜瓣。

飞秒激光小切口角膜基质透镜取出术和飞秒激光辅助准分子激光原位角膜磨镶术矫治近视的临床效果

目的:分析飞秒激光小切口角膜基质透镜取出术(SMILE)和飞秒激光辅助准分子激光原位角膜磨镶术(FS-LASIK)矫治近视的临床效果。方法:选取2022年6月山东滨州沪滨爱尔眼科医院屈光手术科收治的60例(119眼)近视患者作为研究对象,随机分为研究组(30例,59眼)与对照组(30例,60眼)。研究组接受SMILE手术,对照组接受FS-LASIK手术。比较两组手术效果。结果:术后1、3个月,两组裸眼视力高于术前,球镜屈光度、柱镜屈光度、等效球镜度低于术前(P<0.05);两组间比较,无统计学差异(P>0.05)。术后3个月,研究组3 mm瞳孔直径下垂直彗差、球差大于对照组(P<0.05);两组水平彗差无明显变化(P>0.05)。术后3个月,两组总高阶像差无明显变化(P>0.05);两组斯特列尔比、调制传递函数值升高,且研究组大于对照组(P<0.05)。结论:SMILE和FS-LASIK矫治近视的临床效果均较好,能够改善患者视力与屈光度,其中SMILE可能会影响患者角膜高阶像差,但能改善患者全眼高阶像差,提高视觉质量。

SMILE与FS-LASIK治疗高度近视散光患者5年疗效对比

目的比较飞秒激光小切口角膜基质透镜取出术(SMILE)与飞秒激光辅助准分子激光原位角膜磨镶术(FS-LASIK)治疗高度近视散光患者5年的临床疗效。方法前瞻性非随机对照研究。根据所接受的手术方式不同患者被分为SMILE组和FS-LASIK组,术后随访5年,对比分析两组患者裸眼远视力(UDVA)、最佳矫正远视力(BCDVA)、等效球镜度(SE)、散光、总高阶像差(HOAs)、球差、彗差、泪液分泌功能、泪膜破裂时间(TBUT)和眼表疾病指数量表(OSDI)评分。采用重复测量资料的方差分析进行统计学分析,采用LSD-t检验进行两两比较,采用独立样本t检验进行组间分析。结果2组患者相比,术后UDVA、SE、HOAs、球差、彗差、泪液分泌试验、TBUT、OSDI评分差异均有统计学意义(均为P<0.05),但BCDVA、散光的差异均无统计学意义(均为P>0.05)。SMILE组患者术后1个月的SE低于FS-LASIK组,而术后1~5年的SE均高于FS-LASIK组(均为P<0.05)。SMILE组患者术后3~6个月、3~5年的HOAs均较FS-LASIK组更低(均为P<0.05)。SMILE组患者术后3~5年的球差绝对值均明显低于FS-LASIK组(均为P<0.05);SMILE组患者术后1个月、1~5年的彗差均高于FS-LASIK组(均为P<0.05)。SMILE组患者术后1~6个月的TBUT均明显长于FS-LASIK组(均为P<0.05)。结论SMILE和FS-LASIK均安全有效,但SMILE在长期稳定性方面具有优势。SMILE引入较少的HOAs和球差,但引入较多的彗差。SMILE患者术后干眼症状持续时间更短,恢复更快。

Effect of open ultraviolet germicidal irradiation lamps on functionality of excimer lasers used in cornea surgery

We report on the impact of direct ultraviolet germicidal irradiation（UVGI）on reflective optics,used in the excimer laser system Allegretto Eye-Q.The aim of our work was to confirm our hypothesis based on long-rate observations of obtained anomalies in post-operative results that are attributed to degradation of reflective optics upon ultraviolet radiation.The presence of direct UVGI coupled with humidity in the operating environment caused merging anomalies and unwanted post-operative correction values.Ultraviolet-A radiation caused a similar effect on the reflective cover of the mirrors.