EFFECTS OF PREOPERATIVE SOFT CONTACT LENS WEAR ON HIGHER-ORDER ABERRATIONS AFTER LASER IN SITU KERATOMILEUSIS

Objective To evaluate the effects of preoperative soft contact lens (SCL) wear on higher-order aberrations(HOAs)correction after wavefront-guided and conventional laser in situ keratomileusis (LASIK). Methods A prospective randomized double-masked comparative study was conducted in 180 eyes of 90 patients scheduled for LASIK, including 92 eyes of 46 patients with previous SCL wear. The patients were divided into four groups: no SCL-conventional group, SCL-conventional group, no SCL-wavefront group and SCL-wavefront group. Preoperative and postoperative examinations included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), contrast sensitivity and HOAs. Results The UCVA and BSCVA were 20/20 in all patients at 6 months postoperatively. And 36.3%, 22.7%, 18.1% and 35.4% gained one line or more of BSCVA in no SCL-wavefront group, SCL-wavefront group, no SCL-conventional group and SCL-conventional group, respectively. Both the safety index and efficacy index surpassed one in 4 groups and were highest in no SCL-wavefront group. The increase in root-mean-square (RMS) values of HOAs was significantly lower in no SCL-wavefront group and higher in SCL-wavefront group. At 6 months postoperatively, the increase in RMS of HOAs (RMSh) were 0.67, 1.58, 1.17 and 1.28 in no SCL-wavefront group, SCL-wavefront group, no SCL-conventional group and SCL-conventional group, respectively. Conclusion Preoperative contact lens wear has significant influence on the efficacy of HOAs correction in wavefront-guided LASIK. Patients with contact lens wear preoperatively should be cautious when scheduled for wavefront-guided LASIK.

Comparison of optical quality after implantable collamer lens implantation and wavefront-guided laser in situ keratomileusis

AIM： To compare the optical quality after implantation of implantable collamer lens（ICL） and wavefront-guided laser in situ keratomileusis（WG-LASIK）.METHODS： The study included 40 eyes of 22 patients with myopia who accepted ICL implantation and 40 eyes of 20 patients with myopia who received WG-LASIK. Before surgery and three months after surgery, the objective scattering index（OSI）, the values of modulation transfer function（MTF） cutoff frequency, Strehl ratio, and the Optical Quality Analysis System（OQAS） values（OVs） were accessed. The higher order aberrations（HOAs） data including coma, trefoil, spherical, 2^（nd） astigmatism and tetrafoil were also obtained. For patients with pupil size 〈6 mm, HOAs data were analyzed for 4 mm-pupil diameter. For patients with pupil size ≥6 mm, HOAs data were calculated for 6 mm-pupil diameter. Visual acuity, refraction, pupil size and intraocular pressures were also recorded.RESULTS： In both ICL and WG-LASIK group, significant improvements in visual acuities were found postoperatively, with a significant reduction in spherical equivalent（P〈 0.001）. After the ICL implantation, the OSI decreasedslightly from 2.34±1.92 to 2.24±1.18 with no statistical significance（P=0.62）. While in WG-LASIK group, the OSI significantly increased from 0.68±0.43 preoperatively to 0.91±0.53 postoperatively（Wilcoxon signed ranks test, P=0.000）. None of the mean MTF cutoff frequency, Strehl ratio, OVs showed statistically significant changes in both ICL and WG-LASIK groups. In the ICL group, there were no statistical differences in the total HOAs for either 4 mmpupil or 6 mm-pupil. In the WG-LASIK group, the HOA parameters increased significantly at 4 mm-pupil. The total ocular HOAs, coma, spherical and 2^（nd） astigmatism were 0.12±0.06, 0.06±0.03, 0.00±0.03, 0.02±0.01, respectively. After the operation, these values were increased into 0.16±0.07, 0.08±0.05,-0.04±0.04, 0.03±0.01 respectively（Wilcoxon signed ranks test, all P〈0.05）. At 6 mm-pupil, the induction of total HOAs was not statistically significant in the WG-LASIK group. CONCLUSION： ICL implantation has a less disturbance to optical quality than WG-LASIK. The OQAS is a valuable complementary measurement to the wavefront aberrometers in evaluating the optical quality.

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.

Comparation of effectiveness of silicone hydrogel contact lens and hydrogel contact lens in patients after LASEK

AIMTo conduct a comparative study of effectiveness of silicone hydrogel contact lens and hydrogel contact lens, which are used in patients after laser-assisted subepithelial keratomileusis (LASEK).METHODSSixty-three patients (121 eyes) with a spherical equivalent ≤-5.0 D were chosen after undergoing LASEK in 2012 at Guangdong General Hospital. They were randomly divided into 2 groups. The silicone hydrogel group included 32 cases (61 eyes) that wore silicone hydrogel contact lenses for 4-6d after the operation, while the hydrogel group included 31 cases (60 eyes) who wore hydrogel contact lenses for 4-6d after the operation. Patients' self-reported postoperative symptoms (including pain, photophobia, tears, and foreign body sensation) were evaluated. The healing time of the corneal epithelium, the visual acuity of patients without contact lens after epithelial healing, and the incidence of delayed corneal epithelial shedding were also assessed. The follow-up time was 1mo.RESULTSPostoperative symptoms were milder in the silicone hydrogel group than in the hydrogel group. There were significant differences in pain, foreign body sensation, and photophobia between the 2 groups (P<0.05), although there was no significant difference in postoperative tearing (P>0.05). The healing time of the corneal epithelium in the silicone hydrogel lens group was markedly shorter than that in the hydrogel group (4.07±0.25 vs 4.33±0.82d, t=2.43, P=0.02). Visual acuity without contact lenses after healing of the corneal epithelium was better in the silicone hydrogel group compared with the hydrogel group (χ2=7.76, P=0.02). There was no significant difference in the occurrence of delayed corneal epithelial shedding between the 2 groups (P>0.05).CONCLUSIONPatients with LASEK using silicon hydrogel contact lenses had less discomfort and shorter corneal epithelial healing time compared with those using hydrogel contact lenses, suggesting that silicon hydrogel contact lenses may be considered to be a better choice of bandage contact lens after LASEK.

Comparison of high order aberration after conventional and customized ablation in myopic LASIK in different eyes of the same patient

Purpose: To verify whether there exists any difference in higher order aberrations after undergoing myopic LASIK (laser in situ keratomileusis) with conventional ablation and customized ablation in different eyes of the same patient. Methods: This was a prospective randomized study of 54 myopic eyes (27 patients) that underwent LASIK using the Nidek EC-5000 ex-cimer laser system (Nidek, Gamagori, Japan). Topography-guided customized aspheric treatment zone (CATz) was used in the first eye of the patient (study group) and the other eye of the same patient was operated on with conventional ablation (control group). Higher order aberrations [root-mean-square (RMS) in the 5-mm zone] of both groups were observed with the Nidek OPD-Scan aberrometer before and 3 months after LASIK. Preoperative mean refractive error was similar between two eyes of the same patient (t=?0.577, P>0.05). Results: Preoperatively, higher order aberrations (RMS in the 5-mm zone) in the CATz ablation and conventional groups were (0.3600±0.0341) μm and (0.2680±0.1421) μm, respectively. This difference was not statistically significant (t=1.292, P>0.05). Three months after LASIK, higher order aberrations (RMS in 5-mm zone) in the CATz ablation and conventional groups were (0.3627±0.1510) μm and (0.3991±0.1582) μm, respectively. No statistically significant difference was noted between pre- and postoperative higher order aberrations in the CATz group (t=?0.047, P>0.05). However, a statistically significant increase in higher order aberrations was observed after conventional ablation (t=?5.261, P<0.05). A statistically sig-nificant difference was noted in the increase of higher order aberrations after LASIK between groups (t=?2.050, P=0.045). Con-clusion: LASIK with conventional ablation and topography-guided CATz ablation resulted in the same BSCVA (best specta-cle-corrected visual acuity) 3 month after LASIK. Higher order aberrations were increased, but the increase of higher order ab-errations after customized ablation treatment was less than that after conventional ablation.

Comparative study of visual acuity and aberrations after intralase femtosecond LASIK:small corneal flap versus big corneal flap

AIM:To study the effects of different flap sizes on visual acuity,refractive outcomes,and aberrations after femtosecond laser for laser in situ keratomileusis(LASIK).METHODS:In each of the forty patients enrolled,1 eye was randomly assigned to receive treatment with a 8.1mm diameter corneal flap,defined as the small flap,while the other eye was treated with a 8.6mm diameter corneal flap,defined as the big flap.Refractive errors,visual acuity,and higher-order aberrations were compared between the two groups at week 1,month 1 and 3 postoperatively. RESULTS:The postoperative refractive errors and visual acuity all conformed to the intended goal.Postoperative higher-order aberrations were increased,especially in spherical aberration(Z12) and vertical coma(Z7).There were no statistically significant differences between the two groups in terms of postoperative refractive errors,visual acuity,root mean square of total HOAs(HO-RMS),trefoil 30°(Z6),vertical coma(Z7),horizontal coma(Z8),trefoil 0°(Z9),and spherical aberration(Z12) at any point during the postoperative follow-up.CONCLUSION:Both the small and big flaps are safe and effective procedures to correct myopia,provided the exposure stroma meets the excimer laser ablations.The personalized size corneal flap is feasible,as we can design the size of corneal flap based on the principle that the corneal flap diameter should be equal to or greater than the sum of the maximum ablation diameter and apparatus error.

Comparison of correcting myopia and astigmatism with SMILE or FS-LASIK and postoperative higher-order aberrations

AIM:To compare the effect of myopia and astigmatism correction and postoperative change in higher-order aberration as results of receiving small-incision lenticule extraction(SMILE)and femtosecond laser-assisted in situ keratomileusis(FS-LASIK).METHODS:A prospective and non-randomized controlled study was conducted.The subjects are divided into two groups according to different operations received:229 eyes of 116 patients in the SMILE group and 168 eyes of 86 patients in the FS-LASIK group.All subjects were followed up for 3 mo by monitoring their uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA),spherical equivalent,higher-order aberrations,and the preoperative and postoperative complications.RESULTS:At 1 wk,1,and 3 mo post-surgery,224 eyes(97.8%),227 eyes(99.1%)and 229 eyes(100%)had UCVA≥20/20 in the SMILE group,while 165 eyes(98.2%),167 eyes(99.4%)and 167 eyes(99.4%)had UCVA≥20/20 in the FS-LASIK group,respectively(χ^(2)=0.146,2.135,and 1.124;all P>0.05).BCVA reduction was not observed in both groups at 1 and 3 mo of post-surgery(χ^(2)=0.734 and 1.898,P>0.05).There was no statistically significant difference in the spherical equivalent between the two groups at 1 and 3 mo post-surgery,though the percentage of the spherical equivalent within±0.50 D at 3 mo postsurgery was 98%in the SMILE group,which was higherthan that of the FS-LASIK group(92%,χ^(2)=1.872,P>0.05).The root mean square(RMS)values of total high-order aberration,coma,and spherical aberration of the two groups increased significantly in the early postoperative period and decreased after 3 mo,but the values were still higher than the preoperative levels(P<0.05);there was no significant difference between the two groups in the RMS values of total higher-order aberrations and specific higherorder aberrations(P>0.05).The incidence of complications in the SMILE group was lower than that in the FS-LASIK group(χ^(2)=14.52,P<0.05).CONCLUSION:SMILE and FS-LASIK can effectively treat myopia,significantly improve visual acuity,and increase the total high-order aberration,spherical aberration,and coma.The incidence of complications after SMILE is relatively low.

Comparison of the femtosecond Laser and mechanical microkeratome for flap cutting in LASIK

· AIM: To compare refractive results, higher-order aberrations(HOAs), contrast sensitivity and dry eye after laser in situ keratomileusis(LASIK) performed with a femtosecond laser versus a mechanical microkeratome for myopia and astigmatism.·METHODS: In this prospective, non-randomized study,120 eyes with myopia received a LASIK surgery with the Visu Max femtosecond laser for flap cutting, and 120 eyes received a conventional LASIK surgery with a mechanical microkeratome. Flap thickness, visual acuity, manifest refraction, contrast sensitivity function(CSF) curves,HOAs and dry-eye were measured at 1wk; 1, 3, 6mo after surgery.·RESULTS: At 6mo postoperatively, the mean central flap thickness in femtosecond laser procedure was113.05 ±5.89 μm(attempted thickness 110 μm), and148.36 ±21.24 μm(attempted thickness 140 μm) in mechanical microkeratome procedure. An uncorrected distance visual acuity(UDVA) of 4.9 or better was obtained in more than 98% of eyes treated by both methods, a gain in log MAR lines of corrected distance visual acuity(CDVA) occurred in more than 70% of eyes treated by both methods, and no eye lost ≥1 lines of CDVA in both groups. The difference of the mean UDVA and CDVA between two groups at any time post-surgery were not statistically significant(P 】0.05). The postoperative changes of spherical equivalent occurred markedly during the first month in both groups. The total root mean square values of HOAs and spherical aberrations in the femtosecond treated eyes were markedly less than those in the microkeratome treated eyes during 6mo visit after surgery(P 【0.01). The CSF values of the femtosecond treated eyes were also higherthan those of the microkeratome treated eyes at all space frequency(P 【0.01). The mean ocular surface disease index scores in both groups were increased at 1wk, and recovered to preoperative level at 1mo after surgery. The mean tear breakup time(TBUT) of the femtosecond treated eyes were markedly longer than those of the microkeratome treated eyes at postoperative 1, 3mo(P 【0.01).·CONCLUSION: Both the femtosecond laser and the mechanical microkeratome for LASIK flap cutting are safe and effective to correct myopia, with no statistically significant difference in the UDVA, CDVA during 6mo follow-up. Refractive results remained stable after 1mo post-operation for both groups. The femtosecond laser may have advantages over the microkeratome in the flap thickness predictability, fewer induced HOAs, better CSF,and longer TBUT.

Comparison of choroidal thickness in high myopic eyes after FS-LASIK versus implantable collamer lens implantation with swept-source optical coherence tomography

AIM:To investigate the changes in choroidal thickness(CT)in high myopic eyes after femtosecond laser-assisted in situ keratomileusis(FS-LASIK)surgery or central hole implantable collamer lens(ICL V4c)implantation using swept-source optical coherence tomography(SS-OCT).METHODS:We examined the right eyes of 116 patients with high myopia who were candidates for FS-LASIK surgery and ICL implantation.Sixty eyes underwent ICL V4c implantation and 56 eyes were subjected to FS-LASIK surgery.The CT was measured with SS-OCT.All data were recorded preoperatively and 2 h,1 wk,1 and 3 mo postoperatively.Other demographic information was collected,including age,sex,uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),spherical equivalent(SE),intraocular pressure(IOP)and axial length(AL).RESULTS:The UCVA improved in both groups and showed no significant differences between groups.There also were no significant differences between the two groups in postoperative BCVA and SE(P=0.581 and 0.203,respectively).The foveal CTs,inner nasal and outer nasal CTs were significantly thicker at 2 h postoperatively in both groups(P<0.05)but returned to baseline levels in 1 wk;after 1 mo,no significant differences were found relative to the preoperative values.At 3 mo in each group,nine regions showed variations in the CT as compared with preoperative thickening,but only the foveal and nasal area CTs preoperative differences were statistically significant(P<0.05).In addition,there was no significant difference in 9 regions of CT between the two groups at all follow-up times(P>0.05).CONCLUSION:The CTs after ICL implantation and FSLASIK surgery are significantly thicker than those before operation,especially in the foveal and nasal areas,but there is no significant difference between the two methods.

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。

Implantable collamer lens for residual refractive error after corneal refractive surgery

AIM：To assess the safety,efficacy,predictability and stability of implantable collamer lens（ICL） for residual refractive error after corneal refractive surgery.METHODS： This study evaluated 19 eyes of 12 patients who underwent ICL implantation after corneal refractive surgeries.They were followed up for 1y to 5y of uncorrected distance visual acuity（UDVA）,corrected distance visual acuity（CDVA）,manifest refractive error,flat and steep K value,axial length,intraocular pressure,corneal endothelial cell density,adverse events after ICL surgery.RESULTS： The mean follow-up period was 39.05 ±19.22 mo（range,1-5y）.Spherical equivalent refractive error changed from-7.45±3.02 D preoperatively to-0.85±1.10 D 1wk to 1mo after ICL implantation,with the safety and efficacy indices being 1.12 and 1.15,respectively.A total of 52.63% of eyes were within ±0.5 D of the predicted spherical equivalents,73.68% were within ±1.0 D.A trend of mild regression towards myopia with axial elongation after 5y was observed.One eye with mild anterior capsule opacity and retinal detachment 1y after surgery were observed.CONCLUSION： ICL implantation is safe and effective for the correction of residual refractive error after corneal refractive surgeries,especially in moderate to high residual myopia.

Visual differences in topography-guided versus wavefront-optimized LASIK in the treatment of myopia: a Meta-analysis

AIM: To investigate the potential differences between topography-guided(TG) and wavefront-optimized(WFO) laser in situ keratomileusis(LASIK) for the treatment of myopia.METHODS: A systematic literature search was performed to determine relevant trials comparing LASIK with TG and WFO from the time of library construction to August 2020, and The PubMed, Cochrane, Web of Science, EMBASE and Chinese databases(i.e. CNKI, CBM, WAN FANG and VIP) were accessed. The data on visual acuity, refractive status and wavefront aberration were retrieved and evaluated from three to six months after surgery. STATA(version 14.0) software was used for statistical analysis. A cumulative Meta-analysis was simultaneously performed.RESULTS: Eleven studies with a total of 1425 eyes were incorporated. No statistically significant differences were evident between TG and WFO ablation in the proportion of eyes achieving an uncorrected distance visual acuity(UCVA) of 20/20 or better(P=0.377), gaining one line or more(P=0.05), postoperative cylinder(P=0.40), vertical coma(P=0.593) and horizontal coma(P=0.957). After TG ablation, the proportion of the patients’ eyes of which postoperative refraction is within ±0.5 diopter of the target refraction was significantly higher than that undergoes WFO(P=0.003). As opposed to the WFO group, manifest refraction spherical equivalent(MRSE;P=0.000) was lower, and UCVA(P=0.005) was better in the TG group. The higher-order aberrations(HOAs;P=0.000), spherical aberration(P=0.000) and coma(P=0.000) were significantly lower in TG group. The cumulative Meta-analysis illustrated that the proportion of eyes achieving UCVA of 20/20 or better, postoperative refraction within ±0.5 diopter, and MRSE has steady between the two groups.CONCLUSION: Both TG-LASIK and WFO-LASIK are safe, effective, and predictable for correcting myopia. TG-LASIK may produce fewer aberration and is more precise than WFO-LASIK.

波前像差引导FS-LASIK矫正中高度近视患者术后1年眼前节变化

目的探讨波前像差引导FS-LASIK矫正中高度近视患者术后1年对眼前节结构的影响。方法收集2020年7月至2021年3月在徐州市第一人民医院就诊符合手术适应证且接受波前像差引导FS-LASIK患者共40例78眼的临床资料,分为中度近视组和高度近视组;分别于术前、术后1个月、术后1年行Pentacam AXL眼前节分析仪测量眼前节,包括角膜后表面Q值,全角膜像差,后表面高阶像差、球差、彗差,角膜后表面曲率、顶点高度及最薄点高度,前房深度(ACD)、前房容积(ACV)和前房角(ACA),并对比分析。结果中度近视组患眼角膜后表面曲率和角膜后表面Q值术前与术后1个月、术后1年相比差异均有统计学意义(均为P<0.05),高度近视组患眼角膜后表面最薄点高度和角膜后表面Q值术前与术后1年相比差异均有统计学意义(均为P<0.05)。中度近视组患眼角膜后表面垂直彗差术前与术后1个月、术后1年相比差异均有统计学意义(均为P<0.05),高度近视组患眼全角膜像差、角膜后表面球差和垂直彗差术前与术后1个月、术后1年相比差异均有统计学意义(均为P<0.05)。中度近视组及高度近视组患眼ACD、ACV术前与术后1个月、术后1年相比差异均有统计学意义(均为P<0.05),ACA术前术后相比差异均无统计学意义(均为P>0.05)。术后1年和术前球差变化值与术前等效球镜度(SE)相关性分析发现,高度近视组患眼球差变化值与术前SE呈中度相关(r=-0.349,P=0.025),而中度近视组患眼球差变化值与术前SE无明显相关性(r=-0.052,P=0.758)。结论波前像差引导FS-LASIK虽然对患者高阶像差有一定改善,但对角膜后表面和前房结构仍然有一定影响,主要集中在中央区,对周边影响相对较小,术后1年眼前节结构相对稳定。

FS-LASIK与SMILE术后角膜高阶像差变化比较

目的分析并比较飞秒激光辅助准分子激光角膜原位磨镶术(FS-LASIK)和飞秒激光小切口角膜基质透镜取出术(SMILE)术后角膜高阶像差(HOA)变化。方法采用非随机对照研究方法,纳入2018年4月至2020年1月于山东省眼科医院接受FS-LASIK或SMILE矫正的近视患者60例60眼,均收集右眼数据纳入分析。FS-LASIK组30例30眼,术前等效球镜度为(-5.36±1.11)D;SMILE组30例30眼,术前等效球镜度为(-4.93±1.03)D。分别于术前和术后1、3、6、12个月采用Pentacam三维眼前节分析系统测定直径6 mm范围的角膜前表面、后表面和全角膜HOA,获取患者角膜总HOA、球差、彗差和三叶草像差,以均方根值(μm)表示,比较2个组不同时间点各指标差异。结果术前及术后1、3、6、12个月FS-LASIK组角膜前表面HOA分别为(0.428±0.126)、(0.775±0.169)、(0.811±0.194)、(0.759±0.214)、(0.704±0.199)μm,SMILE组分别为(0.409±0.094)、(0.656±0.148)、(0.681±0.161)、(0.668±0.175)、(0.648±0.160)μm,总体比较差异均有统计学意义(F_(分组)=5.652,P=0.024;F_(时间)=107.169,P<0.01)。与SMILE组相比,FS-LASIK组术后各时间点角膜前表面总HOA、球差明显增大,差异均有统计学意义(均P<0.05);2个组术眼术后各时间点角膜前表面总HOA、球差明显大于术前,术后6个月和12个月角膜前表面总HOA小于术后3个月,术后12个月角膜前表面球差明显小于术后1个月和3个月,差异均有统计学意义(均P<0.05)。手术前后不同时间点角膜前表面彗差、三叶草像差总体比较差异均有统计学意义(彗差:F_(时间)=47.848,P<0.01;三叶草像差:F_(时间)=2.497,P=0.046),其中与术前比较,2个组术眼术后各时间点角膜前表面彗差明显增大,差异均有统计学意义(均P<0.05)。2个组间手术前后不同时间点全角膜总HOA、球差总体比较差异均有统计学意义(总HOA:F_(分组)=8.093,P=0.008;F_(时间)=125.019,P<0.01.球差:F_(分组)=4.771,P=0.037;F_(时间)=34.033,P<0.01),其中与SMILE组相比,FS-LASIK组术后各时间点全角膜总HOA、球差明显增大,差异均有统计学意义(均P<0.05);2个组术眼术后各时间点全角膜总HOA、球差明显大于术前,术后12个月全角膜球差明显小于术后1个月和3个月,差异均有统计学意义(均P<0.05)。手术前后不同时间点全角膜彗差总体比较差异有统计学意义(F_(时间)=30.829,P<0.01),其中与术前比较,2个组术眼术后各时间点全角膜彗差明显增大,差异均有统计学意义(均P<0.05)。结论FS-LASIK和SMILE术后均导致角膜前表面和全角膜总HOA、球差和彗差增加;相较FS-LASIK,SMILE术后引入了更少的角膜前表面、全角膜总HOA和球差。

应用眼球自旋控制功能的FS-LASIK与SMILE术后角膜高阶像差的比较

目的比较应用眼球自旋控制功能的飞秒激光辅助准分子激光原位角膜磨镶术(femtosecond laser-assisted laser in situ keratomileusisis,FS-LASIK)与飞秒激光小切口角膜基质透镜取出术(small incision lenticule extraction,SMILE)术后角膜前表面高阶像差的变化。方法采用前瞻性非随机对照研究方法,选取2021年4~12月于徐州医科大学附属徐州市立医院行角膜屈光手术的近视患者70例(70眼),所有患者均只纳入右眼,根据患者选择的术式分为FS-LASIK组与SMILE组,每组各35例。分别于术前及术后1、3个月应用Pentacam AXL系统测量角膜前表面6mm区域的高阶像差。结果术后1天裸眼视力(uncorrected visual acuity,UCVA)≥5.0的占比FS-LASIK组为94.30%(33眼),SMILE组为60.00%(21眼),差异有统计学意义(χ^(2)=11.67,P<0.01);两组术后1、3个月UCVA≥5.0的占比比较,差异无统计学意义(P>0.05)。FS-LASIK组术后1天及术后1、3个月等效球镜度数均高于SMILE组,差异均有统计学意义(P均<0.05)。两组术后1、3个月,除SMILE组水平彗差与术前无明显变化,余均较同组术前明显提高,差异有统计学意义(P均<0.05);术后1、3个月,两组垂直彗差及球差组间比较,差异均有统计学意义(P值<0.01)。结论FS-LASIK和SMILE术后垂直彗差、球差及总高阶像差均较术前增加,但应用眼球自旋控制功能的FS-LASIK垂直彗差的绝对值低于SMILE,而球差高于SMILE。

FS-LASIK与SMILE手术前后视网膜周边屈光状态及像差的变化

目的:观察比较飞秒激光制瓣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)矫正近视术后视网膜周边屈光和像差的改变。方法:选取2022-10/2023-04来院行FS-LASIK的近视患者71例71眼作为FS-LASIK组,行SMILE的近视患者80例80眼作为SMILE组。所有患者于术前,术后3mo均行角膜像差检查和多光谱地形图检查,检查黄斑周围0°~10°、10°~20°、20°~30°、30°~40°、40°~53°环形视网膜相对离焦值(RDV),并记录为RDV-(0°~10°)、RDV-(10°~20°)、RDV-(20°~30°)、RDV-(30°~40°)、RDV-(40°~53°)。对两组患者检查结果进行比较。结果:术后3mo,两组患者RDV-(0°~10°)、RDV-(10°~20°)、RDV-(20°~30°)、RDV-(30°~40°)、RDV-(40°~53°)比较均无差异(均P>0.05)。两组术后3mo的RDV-(20°~30°)、RDV-(30°~40°)、RDV-(40°~53°)均显著低于术前(均P<0.05)。SMILE组患者术后3mo时的彗差(水平)及球差(SA)分别为0.106(0.056,0.171)、0.115(0.081,0.182)μm,均显著低于FS-LASIK组[0.206(0.104,0.355)、0.197(0.128,0.254)μm](Z=-4.170、-5.016,均P<0.05)。术后SA与术后RDV-(10°~53°)呈负相关(rs=-0.205、-0.181、-0.226、-0.244,均P<0.05)。结论:FS-LASIK与SMILE均能减少黄斑周围20°~53°离心率范围的视网膜远视离焦,且SMILE术后彗差(水平)和SA的改变比FS-LASIK小。术后SA与术后的周边视网膜离焦存在一定的相关性。

准分子激光原位角膜磨镶术后白内障患者术后远视漂移一例

该文报道了一例40岁女性患者,因“双眼渐进性视物模糊3个月”就诊。患者既往于2005年因高度近视行双眼准分子激光原位角膜磨镶术(LASIK)。最佳矫正视力OD:0.2(–11.00 DS/–1.25 DC×170°),OS:0.7(–4.00 DS/–0.75 DC×25°)。双眼角膜透明,前房中深,晶状体混浊,豹纹状眼底伴后巩膜葡萄肿。诊断为双眼并发性白内障,并行右眼白内障超声乳化联合人工晶状体(IOL)植入术,术中植入+14.0 D IOL一枚,目标屈光度为–0.5 D。术后1周裸眼视力0.3,验光结果示右眼屈光度+2.75 DS,最佳矫正视力0.7。术后2周行右眼IOL置换术,由+14.0 D置换为+17.0 D。右眼术后1周裸眼视力0.8,验光结果示右眼屈光度–0.75 DC×15°。

ICL植入术与FS-LASIK矫治中高度近视的临床疗效比较

目的:探讨中高度近视患者采用人工晶状体(ICL)植入术与飞秒激光LASIK(FS⁃LASIK)的矫治效果。方法:选取2020年6月至2022年5月本院收治的中高度近视患者83例(166眼),根据治疗方案不同分为ICL植入术组(n=42,84眼)与FS⁃LASIK组(n=41,82眼),分别采用ICL植入术、FS⁃LASIK进行治疗。术后随访3个月,比较两组手术前后裸眼视力、最佳矫正视力、等效球镜和波前像差,包括高阶像差、垂直彗差、水平彗差及球差,记录两组术后并发症发生情况。结果:术前及术后3个月两组患者裸眼视力、最佳矫正视力及等效球镜比较,差异均无统计学意义(均P>0.05)。与术前比较,术后3个月两组患者裸眼视力、最佳矫正视力均提高,等效球镜均降低(均P<0.05)。术前两组患者波前像差比较,差异均无统计学意义(均P>0.05)。术后3个月两组患者垂直彗差对比,差异无统计学意义(P>0.05),而两组患者高阶像差、水平彗差、球差均较术前提高,ICL植入术组以上指标均低于FS⁃LASIK组(均P<0.05)。两组并发症发生率差异无统计学意义(χ^(2)=0.239,P>0.05)。结论:两种术式治疗中高度近视均可显著提高患者视觉质量,获得满意的矫治效果。