不同的目标屈光度设计SMILE术后早期临床效果  

An early clinical study on femtosecond small incision lenticule extraction for myopia and myopic astigmatism with different target refraction designs

作　　者：梁刚[1,2] 查旭[1,3] 张丰菊[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科学与视觉科学重点实验室,100730 [2]云南省第二人民医院眼屈光中心,昆明650021 [3]昆明医科大学第二附属医院眼科,6501013

出　　处：《中华眼视光学与视觉科学杂志》2014年第7期399-402,共4页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：基金项目：国家“十二五”科技支撑计划子课题（2011BAI1208）;北京市卫生系统高层次卫生技术人才基金（2013-2-023）

摘　　要：目的在SMILE手术中设计不同目标屈光度手术方案，观察术后的疗效和可预测性，以期为临床合理设计手术方案提供依据。方法回顾性病例研究。接受SMILE手术的近视病例共104例（207眼）．人选患者的等效球镜度小于-8．25D，散光度小于-3．25D。根据手术后的目标屈光度分为3组：0D组目标屈光度为0．00D（82眼），术前等效球镜度为（-6．26±1．47）D；＋0．25D组目标屈光度为＋0．25D（81眼），术前等效球镜度为（-5．62±1．43）D；＋0．50D组目标屈光度为＋0．50D（44眼），术前等效球镜度为（-4．31±2．75）D。术后1d、7d、1个月和3个月分别检查UCVA、BCVA、屈光状态及残余散光。应用方差分析检验术后不同时间点各组内屈光状态的稳定性和各组间视力的差异。结果①在术后1d、7d、1个月和3个月3组间视力比较差异均无统计学意义（F=2．67、0．82、0．62、0．25，P〉0．05）。②0D组、＋0．25D组和＋0．50D组组内在不同时间点间的等效球镜度差异无统计学意义（F=1．88、1．03、2．18，P〉0．05）。结论SMILE术后随时间推移屈光状态的变化较小，屈光状态和视力的稳定性好，在手术设计时个性化地行0．50D内过矫的设计调整是安全可行的。Objective To evaluate the predictability and efficacy of femtosecond small incision lenticule extraction （SMILE） with different refractive targets in order to provide data for the clinic. Methods This was retrospective clinical study that included 207 eyes from 104 patients who were treated for myopia or myopic astigmatism with SMILE surgery. The spherical equivalent （SE） of subjective manifest refraction less than -8.25 diopters （D） and astigmatism less than -3.25 D. SMILE surgery was performed on all eyes and patients were followed for 3 months. Patients were divided into three groups based on target refractions： group I （target refraction was 0.00 D）, group Ⅱ （target ＋0.25 D） and group m （target ＋0.50 D）. Preoperative mean SE refraction for group I was -6.26±1.47 D, group Ⅱ was -5.62±1.43 D and group Ⅲ was -4.31±2.75 D. All surgeries were performed by the same doctor and uncorrected visual acuity （UCVA）, refraction and residual astigmatism were measured 1 day, 7 days, 1 month and 3 months postoperatively. An analysis of variance was used to analyze the changes in visual acuity and refraction at the different time points. Results （1）Differenees in postoperative uncorrected visual acuity （UCVA） at the different time points were insignificant for the 3 groups （F=2.67, 0.82, 0.62, 0.25, /9〉0.05）. （2）The differences in target refraction at 1 day, 7 days, 1 month and 3 months postoperatively were also insignificant for the three groups （F=1.88, 1.03, 2.18, P〉0.05）. Conclusion Clinical outcomes of SE and UCVA were stable for different target refractions with the SMILE procedure for myopia and myopicastigmatism. This study suggests that the nomogram needs to be adjusted for different ages to account for potential refractive changes. Nomogram adjustment is safe and feasible for controlling overcorrections within 0.50 D.

关 键 词：飞秒激光 飞秒激光小切口基质透镜取出术 目标屈光度 近视 近视散光 

分 类 号：R779.63[医药卫生—眼科]