中高度近视行SMILE或FS-LASIK术后双眼视功能比较  

Comparison of Binocular Visual Function after SMILE and FS-LASIK in Moderate and High Myopia

作　　者：唐敏 许亚菲 侯杰 徐宝增 雷玉琳 Min Tang;Yafei Xu;Jie Hou;Baozeng Xu;Yulin Lei(Heze Medical College,Heze 274000,China;Jinan Mingshui Eye Hospital,Jinan 250200,China)

机构地区：[1]菏泽医学专科学校,菏泽274000 [2]济南明水眼科医院,济南250200

出　　处：《中华眼视光学与视觉科学杂志》2024年第6期423-430,共8页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的:比较不同角膜屈光手术方式对中高度近视患者双眼视功能的影响。方法:前瞻性非随机对照研究。连续性纳入2020年12月至2021年12月在济南明水眼科医院角膜屈光手术中心选择屈光手术的中高度近视患者50例(100眼),根据患者手术意愿分为飞秒激光小切口角膜基质透镜取出术(SMILE)组28例(56眼)和飞秒激光辅助准分子激光原位角膜磨镶术(FS-LASIK)组22例(44眼)。分别在术前和术后1周、1个月、3个月检查2组患者的双眼视功能参数,包括调节功能[正负相对调节(PRA/NRA)、调节反应(BCC)、调节幅度(AMP)、单双眼调节灵敏度(M/BAF)]和集合功能[近远距水平隐斜、调节性集合/调节(AC/A)、近远距水平融像范围、集合近点(NPC)]。采用单因素和两因素重复测量方差分析对组内和组间数据进行分析。结果:FS-LASIK组的等效球镜度(SE)在术后3个月低于术后1周、1个月(均P<0.05);PRA在术后3个月高于术前(P=0.038);BCC在术后3个月低于术前(P=0.004);右眼AMP在术后1、3个月均低于术前(P<0.05),左眼在术后3个月低于术前(P=0.010);双眼BAF在术后3个月高于术前、术后1周(P<0.05);近距负融像破裂点(NNFA)在术后1、3个月均低于术前(P<0.05)。SMILE组的SE在术后均较术前降低(均P<0.001);PRA在术后3个月均高于术前及术后1周、1个月(均P<0.05);BBC在术后1、3个月低于术前(P<0.05);右眼MAF和BAF在术后1个月均高于术前(均P<0.05);远距负融像性(FNFV)聚散范围恢复点在术后1、3个月均低于术前(P<0.05)。2组组间比较:SE随时间变化差异有统计学意义(F_(时间)=1537.38,P<0.001;F_(组别)=0.13,P=0.727;F_(交互)=2.52,P=0.121),FS-LASIK组SE在术后1周和1个月高于SMILE组(t=3.16,P=0.003;t=2.62,P=0.012)。右眼、左眼MAF随时间变化差异有统计学意义(右眼:F_(时间)=2.09,P=0.113;F_(组别)=6.43,P=0.022;F_(交互)=2.03,P=0.123;左眼:F_(时间)=1.04,P=0.384;F_(组别)=7.18,P=0.016;F_(交互)=2.21,P=0.099)Objective:To compare the effects of different corneal refractive surgery on binocular visual function in patients with moderate to high myopia.Methods:This was a prospective non-randomized controlled study.Totally 50 patients(100 eyes)with moderate to high myopia who received refractive surgery at the Corneal Refractive Surgery Center of Jinan Mingshui Eye Hospital from December 2020 to December 2021 were consecutively enrolled in this study,and participants were divided into small incision lenticule extraction(SMILE)group of 28 cases(56 eyes)and femtosecond assisted-laser in situ keratomileusis(FS-LASIK)group of 22 cases(44 eyes)according to the patients'willingness.The binocular visual function parameters of the 2 groups were examined preoperatively and postoperatively at 1 week,1 month,and 3 months,respectively,including accommodative function:Positive/negative relative accommodation(PRA/NRA),accommodative response(BCC),accommodative amplitude(AMP),monocular/binocular accommodative facility(M/BAF),and convergence function:Near/distance horizontal phoria,accommodative convergence/accommodation(AC/A),near/far horizontal fusion vergence and near point of convergence(NPC).Data from within and across groups were analyzed using one-way and two-way repeated measures ANOVA.Results:In FS-LASIK group,SE at 3 months postoperatively was lower than 1 week and 1 month postoperatively(P<0.05).PRA at 3 months postoperatively was higher than preoperative(P=0.038).BCC at 3 months postoperatively was lower than preoperative(P=0.004);The right AMP at 1 month and 3 months postoperatively was lower than preoperative(P<0.05);And left AMP at 3 months postoperatively was lower than preoperative(P=0.010).Binocular BAF at 3 months postoperatively was higher than preoperative and 1 week postoperatively(P<0.05);and NNFV(break)at 1 month and 3 months postoperatively was lower than preoperative(P<0.05).In SMILE group:SE was lower than preoperatively at all postoperative times(P<0.001).PRA at 3 months postoperatively was higher than preopera

关 键 词：角膜屈光手术 双眼视功能 调节功能 集合功能 

分 类 号：R779.6[医药卫生—眼科]